Evaluation of the Danish version of the Prenatal Parental Reflective Functioning Questionnaire in early pregnancy as a screening tool

Mads Schwartz* (Corresponding Author), Ida Scheel Rasmussen, Philip Wilson, Gritt Overbeck, Volkert Siersma

*Corresponding author for this work

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Parental reflective functioning is the capacity to focus on feelings and experiences in oneself as a parent and in the child. Research has demonstrated that the better the parental reflective functioning the better outcomes for the child. This paper evaluated the Danish version of the prenatal parental
reflective functioning questionnaire (P-PRFQ). We used data from a cluster-randomized trial of pregnant women recruited from Danish general practice. The sample included 605 mothers. Factor structure and internal consistency were investigated. Linear regression analysis was used to examine the associations between the P-PRFQ score and the five most predictive variables.
The confirmatory factor analyses supported the three-factor model. The P-PRFQ had moderate internal consistency. The regression analysis showed a decrease in the P-PRFQ score with increasing age, increasing parity, current employment, better self-reported health, lower anxiety score and fewer negative life events with persistent impact. The directions of the associations between P-PRFQ score and the predictive variables were opposite of what was hypothesized raising questions about whether the P-PRFQ can be used as an early pregnancy screening tool assessing prenatal parental reflective functioning. Further validation studies are required to assess the extent to which the P-PRFQ truly measures reflective functioning.
Key finding 1: We found evidence supporting the previously reported three-factor structure of the P-PRFQ in a Danish general sample. The questionnaire showed moderate internal consistency
Key finding 2: Age, parity, occupation, anxiety, self-reported health status and recent life events may be important predictors for the prenatal parental mentalization capacity.
Key finding 3: Despite a good factor structure, the P-PRFQ’s moderate internal consistency, lack of association with constructs such as depression, trauma and attachment, its negative association with age and parity, and positive associations with anxiety, occupation, and health, indicate that the P-PRFQ may not reflect P-PRF in early pregnancy or be an adequate screening instrument.
Original languageEnglish
Pages (from-to)387-405
Number of pages19
JournalInfant Mental Health Journal
Issue number3
Early online date2 Mar 2023
Publication statusPublished - 18 May 2023

Bibliographical note

This study was supported by grants from the Capital Region of Copenhagen, Trygfonden, and Lundbeckfonden. We declare that these funders had no input to the study design, collection, analysis, interpretation of data or to the drafting of the manuscript.
Funding information
Capital Region of Copenhagen, Grant/Award Number: 19035774; Trygfonden, Grant/Award Number: 125227; Lundbeckfonden, Grant/Award Number: PW021220

Data Availability Statement

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.


  • parental mentalization
  • pregnancy
  • psychometric properties
  • prenatal parental reflective functioning
  • P-PRFQ


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