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En este estudio transversal se investiga la asociación entre los principales síntomas del Trastorno bipolar (TB) y las dificultades asociadas a las estrategias de regulación emocional (ERE) adaptativas y desadaptativas. Además, este estudio examina los efectos mediadores de las ERE con el mindfulness rasgo y el TB. Método. Veinticuatro adultos con TB completaron la Escala de Conciencia de Atención Plena (MAAS), el Inventario de Depresión de Beck (BDI-II), la Escala de Autoevaluación de Manía de Altman (ARSM), el Inventario de Ansiedad Rasgo (STAI-R), y el Cuestionario de Regulación Emocional Cognitiva (CERQ). Resultados. El análisis de regresión múltiple mostró cómo la depresión se relacionaba significativa y positivamente con la autoculpabilización, mientras que la ansiedad rasgo estaba positivamente asociada con la autoculpabilización y el catastrofismo. En segundo lugar, el análisis de mediación mostró un efecto de mediación significativo para la autoculpabilidad en la relación entre mindfulness y depresión (a*b = -.15; ICB 95% [-.36, -.03]) y entre mindfulness y ansiedad rasgo (a*b = -.09; ICB 95% [-.27, -.01]). Conclusiones. Nuestros resultados informan del papel de la auto-culpabilidad y el catastrofismo en el TB y de cómo éstas podrían mediar significativamente entre el mindfulness rasgo y el TB. Estos resultados sugieren que una práctica de meditación enfocada en el catastrofismo y la autoculpabilidad puede ser especialmente útil para reducir los síntomas en los pacientes bipolares.(AU)

This cross-sectional study investigates the association between the main symptoms of Bipolar disorder (BD) and emotional regulation dif-ficulties in adaptive and maladaptive emotional regulation strategies (ERS). In addition, this study examines the possible mediating effects of ERS with dispositional mindfulnessand bipolar symptoms. Method.Twenty-four adults diagnosed with BD completed the Mindful Attention Awareness Scale (MAAS), the Beck Depression Inventory (BDI-II), the Altman Mania Self-Assessment Scale (ARSM), the Trait Anxiety Inventory (STAI-R), and the Cognitive Emotional Regulation Questionnaire (CERQ). Results. First, mul-tiple regression analysis showed how depression was significantly positively related to self-blame, whereas trait anxietywas positively associated with self-blame and catastrophizing. Second, the results of the mediation analy-sis have shown a significant mediation effect for the self-blamein the rela-tionship between mindfulnessand depression (a*b = -.15; BCI 95% [-.36, -.03]) and between mindfulnessand trait anxiety (a*b = -.09; BCI 95% [-.27, -.01]). Conclusions. Our results report the role of self-blame and catastrophiz-ing in BD and how these might significantly mediate between dispositional mindfulness and symptoms of depression and anxiety. These results suggest that a meditation practice focused on reducing catastrophizing and self-blame may be especially helpful for symptoms of depression and anxiety in bipolar patients.(AU)

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Cyber victimization is strongly and positively associated with depressive symptoms in adolescence. Identifying mechanisms of this association is imperative to benefit adolescents' mental health. Applying the General Aggression Model in a theoretically novel way, this study examined a complex mediational pathway between cyber victimization and depressive symptoms. Two hundred seventy-seven adolescent participants (M age = 15.84; 65.7% females) reported their own cyber victimization experiences, depressive symptoms, and cognitive, emotional, and behavioral attributions in response to a hypothetical cyber victimization scenario. Path analysis within structural equation modeling was used to test a model where cyber victimization predicted depressive symptoms through characterological self-blame cognitions, sadness emotions, and passive avoidance behaviors. Characterological self-blame was found to partially mediate the positive and significant association between cyber victimization and depressive symptoms. Sadness emotions and passive avoidance behaviors did not emerge as significant mediators. The findings implicate the importance of cognitions in explaining the association between cyber victimization and depression and suggest incorporating cognitive re-framing education into anti-cyberbullying prevention programs.

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Prolonged Grief Disorder (PGD) is characterized by extensive yearning, which includes a strong desire, for the deceased that occurs for at least 12 months. The aim of this study was to identify risk factors that contribute to PGD including the type of loss, relationship to the deceased, and coping. The sample included 190 bereaved adults (71 unexpected or violent loss and 119 natural loss) that experienced the loss of a loved one at least 12 months prior to completing the survey used in this study. There were non-significant results for type of loss, the presence of PGD, and coping. Findings showed that dysfunctional coping including self-blame explained the presence of PGD. Closeness to the deceased prior to the loss contributed to the presence of PGD. The findings highlight the risk factors for adults that experience a presence of PGD.

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Introduction: Alcohol-involved sexual assault (AISA) survivors who were drinking at the time of the assault may be at risk of internalizing victim-blaming myths and stigma. Cognitive-behavioral models posit the link between AISA and negative emotional outcomes may be explained through maladaptive appraisals and coping - i.e., characterological and behavioral self-blame, shame, low self-compassion (i.e., high self-coldness, low self-caring), and fear of self-compassion. Methods: Using a cross-sectional design and community sample of younger adults (N = 409 Canadians, M = 28.2 years old, 51.3% women), we examined these mechanisms' unique effects in mediating the associations between AISA and posttraumatic stress, general anxiety, and depressive symptoms, respectively. Results: In terms of gender differences, AISA was more common, self-coldness higher, and general anxiety symptoms more frequent in women, and fear of self-compassion was higher in men. Using structural equation modeling that controlled for gender and the overlap between outcomes, shame emerged as the strongest mediator linking AISA with all emotional outcomes. Fear of self-compassion also partially mediated the AISA-posttraumatic stress symptom association, self-coldness partially mediated the AISA-general anxiety symptom association, and characterological self-blame fully mediated the AISA-depressive symptom association. Conclusion: Avoidance-based processes, ruminative-/worry-based cognitions, and negative self-evaluative cognitions may be distinctly relevant for AISA-related posttraumatic stress, general anxiety, and depressive symptoms, respectively, after accounting for the overarching mediation through shame. These internalized stigma-related mechanisms may be useful to prioritize in treatment to potentially reduce AISA-related negative emotional outcomes, particularly for AISA survivors with posttraumatic stress, general anxiety, and/or depressive symptoms.

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Suicide remains a major public health problem, with nearly 1 million deaths per year. The number tends to increase over time and factors leading to suicide suicidal behaviors are complex. However, there is a paucity of evidence on suicidal behaviors and the associated factors among people living with HIV (PLWH) in Indonesia. Therefore, this study aimed to estimate the prevalence and associated factors of suicidal behavior between indigenous and non-indigenous living with HIV who were on Dolutegravir and Efavirenz therapies. The cross-sectional data were collected using questionnaires. Participants completed the Suicidal Behaviors Questionnaire-Revised (SBQ-R), Depression Anxiety Stress Scale-42 (DASS-42), HIV Stigma-Sowell Scale, and demographic information questions. The outcome was low and high self-reported suicidal behaviors, while logistic regression analyses were used to estimate adjusted odds ratios (aOR) for associated factors of high suicidal behaviors. A total of 200 PLWH were enrolled and 8.5% of the participants had high levels of suicidal behaviors. The majority of participants were Efavirenz users (84.0%), and Papuans as Indigenous (75.5%). More than half had a high school education (60.5%), were female (58%), married (54%), and unpaid (59%). The multiple logistic regression model showed that indigenous (aOR = 0.122; 95% CI = 0.029-0.514), and people who had children (aOR = 0.221; 95% CI = 0.051-0.957) were more likely to have low suicidal behaviors. Participants who were aged 18-27 years (aOR = 5.894; 95% CI = 1.336-30.579), had high self-blame (aOR = 1.342; 95% CI) = 1.004-1.792), and detectable HIV viral load (aOR = 6.177; 95%CI = 1.118-34.119) had high suicidal behavior. This study identified the risk of suicidality among PLWHs is high and routine suicide assessment is prioritized. The findings are also useful for intervention design and the development of clinical practice guidelines to manage the well-being of PLWH such as using digital intervention to cope with hindrances.

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Problematic Internet Use (PIU) is a growing problem among children. Insecure attachment has been associated with PIU and emotion dysregulation. Furthermore, there is evidence suggesting that maladaptive Cognitive Emotion Regulation Strategies (CERS), such as Self-blame, Rumination, Catastrophizing and Other-blame, lead to PIU, nevertheless, the mediating role of CERS between attachment and PIU has not been explored. A sample of 641 children (M = 10.15; SD = .89) participated in the study. The findings showed that there were significant differences between problematic and non-problematic users in terms of secure attachment and emotion dysregulation. Results show a negative association between attachment security and PIU and a negative association between attachment and maladaptive CERS, whilst maladaptive CERS were positively related with PIU. Finally, maladaptive CERS, particularly Rumination, were found to mediate the relationship between attachment security and PIU. However, Catastrophizing and Other Blame partially mediated the relationship between maternal attachment, but not the relationship between Father attachment and PIU. Limitations and implications are discussed, motivating the promotion of prevention and intervention programs.

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BACKGROUND: Caring for a young person with anorexia nervosa (AN) has been associated with psychological distress and found to be a traumatic experience. This can have an impact on patient and family outcomes. OBJECTIVE: This study aimed to investigate whether self-blame cognitions contribute to post-traumatic stress disorder (PTSD) symptoms in parents of young people with AN. METHODS: A cross-sectional design was used. One hundred and twenty-three parents of young people with AN completed a range of questionnaires assessing self-blame cognitions and PTSD symptoms. RESULTS: Overall, levels of self-blame cognitions were significantly higher in those experiencing higher levels of PTSD symptoms compared to low levels. Additionally, levels of self-blame cognitions significantly predicted PTSD symptoms over and above demographic factors and illness severity, accounting for 22% of unique variance in PTSD symptoms. CONCLUSIONS: The findings suggest that negative appraisals regarding self-blame for their child's eating disorder contributed to the potential maintenance of PTSD symptoms. Parents presenting with thoughts of self-blame would benefit from further support to reduce these feelings and, subsequently, reduce carer distress.

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PURPOSE: Accepting and adapting to the child's diagnosis of Autism Spectrum Disorder (ASD) can be challenging for parents. We aimed to assess domains of parental adjustment namely despair, self-blame, and acceptance among parents whose children were diagnosed with ASD. METHODS: A cross-sectional study was conducted among 111 parents of children with autism who attended Child and Adolescent Psychiatry Unit (CAPU), in a university teaching hospital in Kuala Lumpur, Malaysia. Sociodemographic profiles of both parents and children were gathered. Parental adjustment focusing on parental self-blame, despair and acceptance were assessed using self-reported questionnaires namely Adjustment to the Diagnosis of Autism (ADA). RESULTS: Higher level of despair was associated with parents who have medical illness (ß = 0.214, p = 0.016) and children who received antipsychotic medications (ß = 0.329, p < 0.001). Parents with tertiary education (ß = -0.207, p = 0.023) and those with autistic child attended school (ß = -0.200, p = 0.037) have lower level of despair. Parents with medical illness (ß = 0.245, p = 0.008), child receiving antipsychotic medications (ß = 0.251, p = 0.005), Chinese ethnicity (ß = 0.185, p = 0.04), and child's gender (ß = 0.283, p = 0.003) were significantly associated with higher level of self-blame. Lower acceptance was found among Chinese parents (ß = -0.264, p = 0.005) while married parents had higher acceptance levels (ß = 0.215, p = 0.022). CONCLUSION: Parental adjustment involving domains of despair, self-blame, and acceptance were significantly associated with ethnicity of parents, educational level, parents' marital status and medical illness, as well as the ASD children's schooling status and type of medications used.

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Do victims really help their abusive supervisors? Does abusive supervision have any positive consequence? The study aims to address this concern through extending the work by Tröster and Van Quaquebeke (2021). Using subordinates' self-reports, Tröster and Van Quaquebeke (2021) found that abusive supervision in high-quality leader-member exchange (LMX) relationship motivates subordinates to blame themselves, subsequently making them feel guilty and make up for it by being more helpful. By integrating both subordinates' and supervisors' perspectives, and using multi-wave, multi-source, and multi-level data collected in China, we obtain three major findings. First, as a replication of their findings, LMX moderates the direct effect of abusive supervision on workplace self-blame, and the indirect effect of abusive supervision on workplace guilt via workplace self-blame. The positive direct and indirect effects are stronger when LMX quality is higher. Second, different from their findings, LMX moderates the indirect effect of abusive supervision on supervisor-directed helping (evaluated by supervisors) via workplace self-blame and workplace guilt such that the negative indirect effect is stronger when LMX quality is higher. Third, as an extension, supervisor-evaluated LMX (SLMX) moderates the effect of workplace guilt on supervisor-directed helping such that the negative effect is stronger when SLMX is lower-quality. Put together, LMX and SLMX moderate the indirect effect of abusive supervision on supervisor-directed helping via workplace self-blame and workplace guilt. The negative indirect effect is stronger when LMX quality is higher, but SLMX quality is lower. Our study challenges previous speculations on the positive or beneficial consequences of abusive supervision, and thus contributes to the literature on abusive supervision.

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The effects of school and classroom racial/ethnic diversity on peer victimization, self-blame, and perceived school safety were examined in a racially/ethnically diverse sample of students followed over the three years of middle school. Sixth grade students (N = 5,991, 52% female; M = 11.63 years) were recruited from 26 urban middle schools that systematically varied in racial/ethnic diversity. Based on student self-report, the sample was 31.6% Latino/Mexican, 19.6% White, 17.4%, Multiethnic/Biracial, 13% East/Southeast Asian, 10.9% Black, and 6.9% Other very small racial/ethnic groups. Each school had a structural diversity score based on the number and size of racial/ethnic groups enrolled. Using a novel method based on course schedules and class rosters, each student's individual exposure to diversity in their classes was assessed to capture dynamic diversity. Latent growth modeling showed that structural school diversity and dynamic classroom diversity were both related to less victimization at the start of middle school and a decrease over time. Dynamic classroom diversity buffered the associations between victimization and self-blame and between victimization and perceiving school as unsafe. Dynamic classroom diversity was more protective than structural school diversity. Implications for practice, intervention and policies to promote school racial/ethnic diversity were discussed.

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BACKGROUND: The association between child maltreatment and polyvictimization has received growing attention since being identified by Finkelhor and colleagues in 2005. OBJECTIVE: The current study was designed to explore the experiences and perceptions of children who reported polyvictimization during forensic interviews. METHODS: This mixed-methods study sample comprised 117 children aged 5-14, referred for the first time to forensic interviews following suspected physical abuse by a parent. More than one-third of the children reported polyvictimization. A thematic analysis was carried out to spotlight these children's experiences. RESULTS: The analysis identified three main themes: the way children comprehend the polyvictimization, the consequences of the polyvictimization regarding the children's negative self-attribution, and the way the polyvictimization was constructed through the dynamic with the forensic interviewers. CONCLUSIONS: The findings pointed to the importance of the forensic interview platform in assessing children's maltreatment burden. The current study also provided a glance into the possible involvement of the mechanics of self-blame among maltreated children. These findings have the potential to enhance our understanding of the excessive psychological toll taken on polyvictimized children.

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Background:Self-blame for past sexual behaviors or for the personal character may be associated with the development of cervical cancer. Purpose: Aims were to understand the burden of self-blame attribution (SBA) among women with cervical cancer by (1) examining relationships between SBA, psychological distress (PD), and spiritual well-being (SWB); (2) determining differences between behavioral (BSB) and characterological self-blame (CSB) attribution; and (3) describing associations between SBA and unwanted past sexual experiences. Methods: Women attending a cancer center in the southeastern United Stats (N = 106) completed an online survey including a demographic questionnaire and three instruments: (1) SBA for Cancer Scale; (2) Psychological Distress Subscale of the Psychological Adjustment to Cancer Scale-Self Report; and (3) Functional Assessment of Cancer Therapy-Spiritual Well-being. Results: Women with cervical cancer, 26-64 years of age, identified moderate levels of SBA, PD, and SWB. Relationships were found between PD, BSB and CSB, and unwanted sexual experiences. Significant inverse correlations between religious faith, BSB, unwanted sexual experiences, and SWB were noted. Unwanted sexual experiences were a significant predictor of SBA. Conclusion: SBA places women at risk for increased burden. Recognizing SBA in vulnerable cancer survivors is important to providing holistic nursing care.

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BACKGROUND: Feeling out of control during a traumatic event may evoke behavioral self-blame (BSB) to avoid feeling helpless following trauma by restoring one's sense of control. BSB is a common, persistent, and treatment-resistant post-traumatic stress symptom. The present study investigates the etiology and risk factors of BSB following a traumatic event and the reasons for its persistence over time. METHOD: Subjects were a group of 546 Israeli ex-combat soldiers (M age = 24.93 ± 5.657) registered in an Israel Defense Forces (IDF) combat reaction clinic. All completed the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), the Brief Symptom Inventory (BSI), and the PTSD Checklist for the DSM-5 (PCL-5). Item 10 of the PCL-5 served to measure BSB. The PDEQ and BSI measured distress and feeling out of control during the event. We used descriptive analyses of the data, t-test, and linear regression analysis to reveal the relationship between the research variables. RESULTS: Feeling out of control during a traumatic event often increases BSB and post-traumatic stress symptoms. A significant correlation emerged between continuing distress characterizing individuals who experience a persistent lack of control and BSB. Female combat soldiers were at a higher risk of BSB than their male counterparts. CONCLUSION: Loss of control experienced during a traumatic event may result in persistent long-term feelings of lack of control over one's behavior.

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Introduction: People of Color (PoC) in the United States encounter everyday racial microaggressions, and these commonplace experiences can wear and exhaust PoC's resources. Racial microaggressions have shown detrimental effects on physical and psychological well-being. Consequently, researchers have examined and tested different ways in which PoC cope and protect themselves from these everyday exchanges. Past findings have indicated that PoC might blame themselves for racism-related occurrences to cope with these commonplace discriminatory experiences. Ethnic identity and resilience have emerged in research as protective factors that can moderate and buffer the impact of racism on PoC's well-being. We used a combination of mediation, moderation, and conditional analyses to unpack the relationships between racial microaggression (predictor), psychological distress (outcome), self-blame (mediator), resilience (moderator), and ethnic identity (moderator). Methods: This study used a cross-sectional design and sampled 696 PoC regarding their experiences and responses to racial microaggressions. We tested the association between psychological distress and racial microaggressions and further examined whether self-blame mediated the relationship. We also tested ethnic identity and resilience as moderators and used a conditional analysis to determine whether these protective factors moderated the mediation model. Results: Findings from the mediation, moderation, and conditional analyses supported our four hypotheses: (H1) self-blame mediated the relation between racial microaggressions and psychological distress (mediation), (H2) ethnic identity moderated the association between racial microaggressions and self-blame but only at low and average levels (moderation), (H3) resilience moderated the relation between self-blame and psychological distress but only at low and average levels (moderation), and (H4) evidence of moderated mediation were found for all five variables (conditional). While statistically significant, most moderation effects were minimal to small. Conclusion: PoC may engage in self-blame when experiencing racial microaggressions, which explains why these everyday, commonplace occurrences might lead to psychological distress. There was evidence that ethnic identity and resilience can protect PoC from the negative effects of racial microaggressions. These buffering effects, however, only emerged for PoC endorsing high levels of ethnic identity and resilience, and it should be noted that for most participants, the link between racial microaggressions and psychological distress was still significant. Future studies might need to explore additional individual and interpersonal alongside institutional factors that can protect PoC from racism-related harms.

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BACKGROUND: Self-blame-related fMRI measures were shown to predict subsequent recurrence in remitted major depressive disorder (MDD). Their role in current MDD, however, is unknown. We hypothesised that these neural signatures reflect a highly recurrent but remitting course of MDD and therefore predict favourable outcomes over a four-month follow-up period in current MDD. METHODS: Forty-five participants with current MDD and non-responders to at least two serotonergic antidepressants, were encouraged to optimise their medication and followed up after receiving four months of primary care treatment-as-usual. Prior to their medication review, participants completed an fMRI paradigm in which they viewed self- and other-blame emotion-evoking statements. Thirty-nine participants met pre-defined fMRI data minimum quality thresholds. Psychophysiological interaction analysis was used to determine baseline connectivity of the right superior anterior temporal lobe (RSATL), with an a priori BA25 region-of-interest for self-blaming vs other-blaming emotions, using Quick Inventory of Depressive Symptomatology (16-item) percentage change as a covariate. RESULTS: We corroborated our pre-registered hypothesis that a favourable clinical outcome was associated with higher self-blame-selective RSATL-BA25 connectivity (Family-Wise Error-corrected p <.05 over the a priori BA25 region-of-interest; rs(34) = -0.47, p =.005). This generalised to the sample including participants with suboptimal fMRI quality (rs(39) = -0.32, p =.05). CONCLUSIONS: This study shows that neural signatures of overgeneralised self-blame are relevant for prognostic stratification of current treatment-resistant MDD. Future studies need to confirm whether this neural signature indeed represents a trait-like feature of a fully remitting subtype of MDD, or whether it is also modulated by depressive state and related to treatment effects.

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Bisexual women experience higher rates of rape and post-traumatic stress disorder (PTSD) prevalence compared to heterosexual and lesbian women. In addition, bisexual women experience unique antibisexual stigma and minority stress, which are associated with post-trauma outcomes. The aim of the current study was to test trauma-related shame as a mechanism in the relations of self-blame and bisexual minority stress (i.e., antibisexual stigma and internalized binegativity) with rape-related PTSD symptom. The sample consisted of 192 cisgender bisexual women (ages 18-35 years) who reported an experience of rape since the age of 18. Results from path analysis conducted in Mplus indicated that trauma-related shame mediated the link between self-blame and rape-related PTSD severity, as well as the links from antibisexual stigma and internalized binegativity to rape-related PTSD severity. There was also an indirect serial effect from antibisexual stigma to internalized binegativity to shame to PTSD severity. Thus, findings highlight the mechanistic role of trauma-related shame in rape-related PTSD symptoms. We identified two risk pathways: (a) general/universal risk from self-blame about rape and shame to PTSD severity and (b) group-specific risk from bisexual minority stress and shame to PTSD severity. Results indicate that reducing trauma-related shame may be an important target to improve post-rape outcomes. Finally, stigma associated with rape and sexual violence as well as antibisexual stigma must be eradicated to improve post-trauma outcomes among bisexual survivors.

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The consequences associated with child sexual abuse are well known. However, factors exacerbating child behavior problems following sexual abuse (SA) deserve further attention. Self-blame following the abuse has been identified as a predictor of negative outcomes in adult survivors, however there is limited evidence regarding the impact of self-blame on consequences in child victims of sexual abuse. This study assessed behavioral problems in a sample of sexually abused children and tested the mediating role of children's internal blame attributions in the association between the parent's self-blame and the internalizing and externalizing difficulties of the child. A sample of 1066 sexually abused children between 6 and 12 years of age and their non-offending caregiver completed self-report questionnaires. Parents completed questionnaires related to the child's behavior following the SA and their own feelings of self-blame regarding the SA. Children completed a questionnaire assessing their level of self-blame. Results showed that parents' self-blame was associated with a higher level of self-blame in the child which, in turn, was linked to more child internalizing and externalizing behavior problems. In addition, parents' self-blame was directly associated with a higher level of internalizing difficulties in children. These findings underscore the importance of considering the non-offending parent's self-blame in interventions aiming the recovery of child victims of SA.

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BACKGROUND: Action tendencies are implicit cognitive and motivational states before an action is taken, such as feeling like hiding when experiencing shame or guilt, independent of the actions people decide to take. Such "action tendencies" are key to understanding the maladaptive impact of self-blame in depression. For example, feeling like "hiding" in a text-based task was previously associated with recurrence risk in remitted depression. Despite their functional importance, action tendencies have not been systematically investigated in current depression, which was the aim of this pre-registered study. METHODS: We developed and validated the first virtual reality (VR) assessment of blame-related action tendencies and compared current depression (n = 98) with control participants (n = 40). The immersive VR-task, pre-programmed on devices sent to participants' homes, used hypothetical social interactions, in which either participants (self-agency) or their friend (other-agency) were described to have acted inappropriately. RESULTS: Compared with controls, people with depression showed a maladaptive profile: particularly in the other-agency condition, rather than feeling like verbally attacking their friend, they were prone to feeling like hiding, and punishing themselves. Interestingly, feeling like punishing oneself was associated with a history of self-harm but not suicide attempts. CONCLUSIONS: Current depression and self-harm history were linked with distinctive motivational signatures, paving the way for remote VR-based stratification and treatment.

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The associations between relational victimization, self-blame attributions, and internalizing problems in early childhood has not previously been examined. Using a sample of 116 preschool children, average age 44.05 months (SD = 4.23), multiple informants, multiple methods, and a longitudinal design, path analyses were conducted to explore the associations between relational victimization, self-blame attributions (Characterological Self-Blame[CSB] and Behavioral Self-Blame[BSB]), and maladjustment in early childhood. Concurrent significant associations were found between relational victimization and internalizing problems. The initial longitudinal models revealed some significant effects that were consistent with predictions. Importantly, follow-up tests decomposing internalizing problems, indicated that anxiety at Time 1 was positively and significantly associated with CSB at Time 2. Depression at Time 1 was negatively and significantly associated with CSB at Time 2. Implications of this work are discussed.

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BACKGROUND: Insecure adult attachment, shame, self-blame, and isolation following perinatal loss place bereaved women at risk of adverse psychological outcomes, which can impact child and family outcomes. To date, no research has considered how these variables continue to influence women's psychological health in pregnancy subsequent to loss. OBJECTIVE: This study explored associations between prenatal psychological adjustment (less grief and distress) and adult attachment, shame, and social connectedness, in women pregnant after loss. METHOD: Twenty-nine pregnant Australian women accessing a Pregnancy After Loss Clinic (PALC) completed measures of attachment styles, shame, self-blame, social connectedness, perinatal grief, and psychological distress. RESULTS: Four 2-step hierarchical multiple regression analyses revealed adult attachment (secure/avoidant/anxious; Step 1), shame, self-blame, and social connectedness (Step 2) explained 74% difficulty coping, 74% total grief, 65% despair, and 57% active grief. Avoidant attachment predicted more difficulty coping and higher levels of despair. Self-blame predicted more active grief, difficulty coping, and despair. Social connectedness predicted lower active grief, and significantly mediated relationships between perinatal grief and all three attachment patterns (secure/avoidant/anxious). CONCLUSIONS: Although avoidant attachment and self-blame can heighten grief in pregnancy after loss, focusing on social connectedness may be a helpful way for prenatal clinicians to support pregnant women during their subsequent pregnancy - and in grief.