Attachment and family functioning among a sample of Puerto Rican - PowerPoint PPT Presentation

Attachment and family functioning among a sample of Puerto Rican women living in communities with high levels of violence IFP World Congress of Psychotherapy Amsterdam, The Netherlands June 8, 2018 Dra. Aida Jiménez, University of Puerto Rico Dra. Aysha Concepción-Lizardi, Carlos Albizu University, Puerto Rico Dr. José Martínez, Carlos Albizu University, Puerto Rico

Aims of this presentation • Explore variables that • Identify the factors affect family functioning – that contribute to a – attachment styles healthy family functioning among – mental health women – sociodemographic variables • living in marginalized communities with • Explore role past – high level of violence in attachment on Puerto Rico. (drugs and weapons) – Current attachments – Family functioning

Literature Review (Why study Family Functioning?) • Family functioning has been one of the most frequently investigated correlates of psychological adjustment of children and their parents. • Positive family functioning has been linked with high levels of secure attachment (Harvey & Byrd, 2000; Sheftall et al., 2013).

Factors associated with poor family functioning • Risk factors • Poor family functioning has been related in – environmental children and adults to • unemployment, • perceived stress, – health and • low education, – mental health problems • stressful life, and • poverty (Webster-Stratton, C., & Hooven. C., 1998; Grecas, 1979; Straus & Gelles, 1986)

Other factors that affect family functioning: Literature review • Psychiatric symptomatology and • Social inequality attachment history and poverty have – Ej. Depressed, stressed, or adverse effects demoralized parents are less likely on health and to provide mental health. – cognitive stimulation, – emotional support, and – social learning necessary to foster a child's positive behavior (Wahler and Sansbury,1990; 1992).

Scale • Experiences in Close Measures Relationships-Revised (ECR-R) • Beck Depression – Internal and relationship Inventory -BDI attachment • Beck Anxiety Inventory- • 2 subscales BAI • Cartes: Modèles Individuels de Relation • Family Functioning (CAMIR-R). Scale FF-SIL (Louro Bernal, et al.) – Measures history of attachment • 7 subscales

Methodology • A cross sectional study, • Survey assessed non experimental design – Family functioning • Data collection – Attachment – Residents living in – Sociodemographic underserved communities variables from 4 sectors in Puerto – Exposure to violence Rico • Community • Sample N=122 of Puerto • Intra familial Rican women ages 21+ – Risk and protective factors

Table 1: Demographic results (n=122) Variables Mean CI 95% Mean (SD) Lower Upper Age 17.8 (13.03) 15.58 20.02 CI 95% f (%) Lower Upper Civil Status Single 72 (60.0) 50.8 68.8 43 (35.8) 27.1 44.6 Married/Cohab 5 (4.2) 0.8 8.1 Sep/Div/Widow Educational Level 21 (17.6) 11.1 24.5 LT HS 65 (54.6) 45.8 63.6 HS Graduate 33 (27.7) 19.5 35.8 College Income – Less than 5K 104 (85.2) 78.7 91.5 Occupational Status Unemployed 78 (63.9) 55.2 72.0

Table 2: Risk factors results (n=122) Variables CI 95% f (%) Lower Upper Impairment (child) 68 (52.3) 43.8 61.5 Alcohol abuse Never/Rarely 87 (71.3) 62.8 79.0 Substance abuse Never/Rarely 98 (81.7) 74.4 88.7 Physical/Emotional abuse Never/Rarely 77 (68.8) 60.4 77.2 Exposure to violence Community 73 (59.8) 51.2 68.6 Family 35 (29.2) 21.0 37.9 Mean CI 95% Psych Symptomatology Mean (SD) Lower Upper Depression 13.96 (12.46) 11.74 16.28 Anxiety 13.60 (13.65) 11.28 16.13

Table 3: Protective factors results (n=122) Variables Mean CI 95% Mean (SD) Lower Upper Resiliency 5.28 (1.51) 5.00 5.54 Social emotional support 5.24 (1.80) 4.88 5.55 Concrete support 4.75 (1.94) 4.39 5.08 Child development and 6.13 (0.86) 5.98 6.29 knowledge of parenting Nurturing and 6.62 (0.59) 6.52 6.73 attachment Measured by the Spanish Protective Factors Survey (to prevent child abuse & maltreatment), FRIENDS National Center for Community-Based Child Abuse Prevention, https://friendsnrc.org/what-we-do

Table 4: Attachment Measures and their Correlations: CaMir subscales and ECR-R subscales. CaMir ECR-R Adult Attachment Measures (Internal working models) Adult Attachment Measures (Present) Scale Scale Scale Scale Scale Scale Scale A B C D E F G Sec. F Preo. P Interf. P Autho. P Perm. P Rese. Inf Trau. Anxiety -.16 .04 -.10 -.21* .07 .16 .09 Related Avoidance -.18 -.10 -.01 -.27** .06 .06 .03 Related Total Scale -.21* -.03 -.07 -.30** .08 .14 .07

Table 5: Standardized Regression Coefficients Predicting Perception of Family Functioning Variables B SE B β 0.20 .10 .14* Participant´s age -0.73 1.90 -.03 Violence index -0.06 .08 -.07 Beck Anxiety Inventory (BAI) Beck Depression Inventory (BDI) -0.01 .09 -.01 Socio-emotional support scale (SPFS) -0.16 .55 -.03 Concrete support scale (SPFS) 0.62 .55 .11 Nurturing and attachment scale (SPFS) 2.91 1.39 .15* Child development and knowledge of 2.05 1.03 .16* parenting scale (SPFS) 3.56 .59 6.06*** Resiliency scale (SPFS) 0.14 .14 1.02 CaMir Scale A .55 Adjusted R 2 15.02 F Note. * p < .05; *** p <.001.

Discussion & Take away message • Risk factors – Less associated with family functioning than protective factors. • For example: – Internal attachment models as measured by the CAMIR did not predict family functioning. – Neither psychiatric symptomatology (dep & anxiety). • Protective factors – More predictive of family functioning. – Need to focus on strengths vs. deficits

“Familism” and family support in PR: Literature Review • About the concept – Despite the severe social adversity and poverty in PR this has not produced higher rates of mental disorders (Canino, 1987). This phenomenon has been explained with the protective factor of family support and “familism”. Therefore, it is important to understand the role of family functioning and the different factors that contribute to a good family functioning. • Latinos places a high value on “familism” and family support. This has been related with protective factors against the development of psychiatric disorders (Jimenez, 2014). • It seems like in order to increase family functioning, we have to increase those protective factors associated with family cohesiveness and nurturing.

Thank you Dra. Aida Jiménez aida.jimenez@upr.edu Dra. Aysha Concepción-Lizardi aconcepcion@sju.albizu.edu Dr. José Martínez jmartinez@albizu.edu

References Canino, G. J., Bird, H. R., Shrout, P. E., Rubio-Stipec, M., Bravo, M., • Martinez, R. & Guevara, L. M. (1987). The Prevalence of Specific Psychiatric Disorders in Puerto Rico. Archives of General Psychiatry , 44 (8), 727–735. http://doi.org/10.1001/archpsyc.1987.01800200053008 Gelles, R. J. (1992). Poverty and Violence Toward Children. American • Behavioral Scientist , 35 (3), 258–274. http://doi.org/10.1177/0002764292035003005 Harvey, M., & Byrd, M. (2000). Relationships between adolescents’ • attachment styles and family functioning. Adolescence , 35 (138), 345–356. Jiménez, A . Alegría, M., Camino R., Lazaro J. (2014). Cultural Sensitivity: • What Should We Understand About Latinos? In: Parekh, R. (Ed.), The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health (pp.61-87). New York: Springer. ISBN 978-1- 4614-8918-4 (Online), ISBN 978-1-4614-8917-7 (Print)

References Sansbury, L. L., & Wahler, R. G. (1992). Pathways to Maladaptive Parenting • with Mothers and Their Conduct Disordered Children. Behavior Modification , 16 (4), 574–592. http://doi.org/10.1177/01454455920164008 Sheftall, A. H., Mathias, C. W., Furr, R. M., & Dougherty, D. M. (2013). • Adolescent attachment security, family functioning, and suicide attempts. Attachment and Human Development , 15 (4), 368–383. http://doi.org/10.1080/14616734.2013.782649 Straus, M. A., & Gelles, R. J. (1986). Societal Change and Change in Family • Violence from 1975 to 1985 as Revealed by Two National Surveys. Journal of Marriage and the Family , 48 (3), 465. http://doi.org/10.2307/352033 Straus, M. A., & Gelles, R. J. (1990). Physical Violence in American Families: • Risk Factors and Adaptations to Violence. In 8, 145 Families. New Brunswick, NJ: Transaction Publishers, 1990. xxii+622 pp. http://doi.org/10.3109/09687681003647057