The COVID-19 pandemic has altered lifestyles globally. Confinement, the fear of becoming ill and/or losing loved ones, the impending economic recession, and uncertainty make up an unprecedented global situation. In this scenario, child and adolescent mental health has been significantly affected (Chadi et al., 2022; de Figueiredo et al., 2021; Hossain et al., 2020; Moreno et al., 2020; O’Sullivan et al., 2021; Panchal et al., 2021; Parrish, 2020). Surveys from around the world have shown increased anxiety, stress, and depression (Cao et al., 2020; Dąbkowska et al., 2021; González-Sanguino et al., 2020; Li et al., 2020; Pera, 2020).
Among the population, some groups may be more vulnerable than others to the psychosocial repercussions of pandemics. For instance, in adverse contexts, children and adolescents are particularly vulnerable to mental health (MH) problems (Holmes et al., 2020; Wang et al., 2020). The school closures, lack of contact with peers and physical and recreational activities are some of the unfavorable circumstances that have prevented children and adolescents from deploying their usual emotional regulation strategies. Isolation, one of the consequences of the pandemic, leaves families without access to external support, both from institutions and extended family. This situation has led to an overburden, both in children and their caregivers, which has already revealed negative effects in various areas, such as increased emotional and behavioral problems, anxiety and depression (Buzzi et al., 2020; Fegert et al., 2020).
Overall, the consequences of the pandemic, in both the short and long term -post-pandemic-, will be associated with high-risk factors for the mental health of children and adolescents, especially for those who come from low-income households (Fegert et al., 2020; Van Lancker & Parolin, 2020).
In this context, reflective functioning becomes a useful model for understanding the processes associated with mental health problems in children and adolescents derived from stressful situations - such as the current one.
The term reflective functioning (RF) (here used synonymously with the term mentalizing) is the capacity to understand our own and others’ behaviors as an expression of mental states (such as beliefs, desires, and emotions) (Fonagy & Target, 1997). In the context of parenting, mentalizing has been investigated using the construct of parental reflective functioning which has been defined as the ability of the caregiver to think reflectively about the child’s internal experiences, especially when the child is under stress (Slade et al., 2005). This ability contributes to stress regulation and emotional well-being in children and adolescents (Fonagy, 2018; Slade et al., 2005).
The parental reflective functioning model allows stress regulation in children and adolescents to be systematically explored, enabling evidence-based interventions.
Reflective functioning in the caregiver-child dyad
In the past decades, parental reflective functioning (RF) or parental mentalizing has played an important role in understanding parental behaviors and their influence on the child’s psychological development (Leon et al., 2021).
Parents with higher levels of RF are more likely to recognize and respond coherently to their children’s necessities (Riva Crugnola et al., 2018). Thus, the accuracy of parental RF affects the quality of stress regulation within the caregiver-child dyad (Mayes, 2000). In this way, parental RF has been shown to act as a protective factor for children’s mental health in adverse contexts (Ensink et al., 2015, 2016, 2017).
Parental RF is associated with the quality of caregiving (Schechter et al., 2008), parental sensitivity (Suchman et al., 2010), and attachment security (Slade et al., 2005). There is evidence of the role of parental RF on children’s psychological development across infancy, childhood, and adolescence (Benbassat & Priel, 2012; Ensink et al., 2015).
Parents with moderate to high levels of RF show better tolerance to their child’s distress (Rutherford et al., 2015), which prevents negative caregiving behaviors (such as maltreatment) during stressful situations (Borelli et al., 2017). By contrast, low levels of RF have been associated with later socioemotional and cognitive problems in children (Luyten & Fonagy, 2015), such as anxiety disorders (Esbjørn et al., 2013), difficulties in emotion regulation (Rutherford et al., 2015), and higher levels of externalizing behaviors (Ensink et al., 2016).
Children whose parents show moderate to high RF levels show better emotion regulation skills (Heron-Delaney et al., 2016). Likewise, parental RF impacts children’s health outcomes, such as type 1 diabetes (Costa-Cordella et al., 2021) and somatic symptoms disorder (Bizzi et al., 2019).
There is also evidence of the role of parental RF on the development of the child’s own mentalizing abilities (Gordo et al., 2020; Rosso et al., 2015; Rosso & Airaldi, 2016). This is particularly important because a child’s levels of mentalizing are closely linked to their capacity to regulate their own emotions. According to theory, mentalizing would support the processing of affective experiences (Gergely et al., 2002). In fact, a recent study by Borelli and colleagues (Borelli et al., 2018) found an association between higher mentalizing and lower cardiovascular reactivity during a stress task and recovery after the task in school-aged children, suggesting that mentalizing plays a role in physiological emotion regulation (Borelli et al., 2017).
Therefore, it is clear that parental RF is a key protective factor in children’s mental health. Hence, efforts have been made to develop and test interventions tailored to enhance parental RF. Two meta-analyses focused on psychosocial interventions to increase parental RF showed that, although there are several limitations in the current literature, there is evidence to establish that parental RF can be improved (Letourneau et al., 2015; Lo & Wong, 2022). However, most of these interventions have been developed and tested in either Europe or North America. There are only two published interventions from Africa (Cooper et al., 2009; Lo & Wong, 2022) and only one from South America (Santelices et al., 2011), which was designed for mothers and babies.
Surprisingly, no previous study has experimentally investigated the role of parental RF in older children’s psychological outcomes in South America. It is important to explore if this population would benefit from future interventions based on parental RF to fill this research gap.
Therefore, the present study aimed to investigate the relationship between parental RF, child RF and parental and child perceived stress levels in a sample of caregiver-child dyads from low-income backgrounds in Chile during the COVID-19 pandemic.
Based on the evidence reviewed above, we expected to find an association between parental and child RF and also between both parental RF and child RF and their levels of perceived stress. Specifically, we expected to find that higher levels of RF (both parent and child) would be associated with lower levels of both parental and child stress.