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Kok AAL, Twisk JWR, Blom F, Beekman ATF, Huisman M. Steeling or sensitizing? A longitudinal examination of how ongoing accumulation of negative life events affects depressive symptoms in older adults. J Gerontol B Psychol Sci Soc Sci 2021; 76:2041-2053. [PMID: 34171092 PMCID: PMC8599083 DOI: 10.1093/geronb/gbab114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine whether: 1) as people age, accumulation of negative events increases ('sensitizing') or decreases ('steeling') the detrimental effects of subsequent events on depressive symptoms, and 2) how particular psychosocial factors are associated with the strength of these steeling or sensitizing effects. METHOD We used data from six measurement waves from 2,069 adults aged 55-84 (M=68.0) at baseline in the Longitudinal Aging Study Amsterdam, the Netherlands. We included 18 different life events across the life course. Using hybrid multilevel models, we tested whether the effects of proximate life events (<3 years) on depressive symptoms (measured by the CES-D) were moderated by previous cumulative events (childhood until previous measurement wave). Additionally, we tested whether education, mastery, emotional support, neuroticism, having strong faith, and loneliness were associated with the strength of steeling/sensitizing effects. RESULTS Cumulative and proximate life events were independently associated with more depressive symptoms. Interaction effects indicated that the more cumulative life events, the weaker the effects of recent life events, suggesting a 'steeling' effect. Unexpectedly, three-way interaction effects showed that higher mastery and lower neuroticism were associated with weaker steeling effects. These effects were predominantly attributable to within-person changes rather than to fixed between-person differences. Results from analyses with event severity scores were similar. CONCLUSIONS As a population, older adults appear to become more resilient against new stressors as they accumulate experience in dealing with negative life events. Findings on mastery tentatively suggest that accepting limits to one's own control over life circumstances may foster a steeling effect.
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Affiliation(s)
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Fenneke Blom
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
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AlSadhan SA, Al-Jobair AM. Oral habits, dental trauma, and occlusal characteristics among 4- to 12-year-old institutionalized orphan children in Riyadh, Saudi Arabia. SPECIAL CARE IN DENTISTRY 2016; 37:10-18. [PMID: 27118440 DOI: 10.1111/scd.12187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess the oral habit practices, dental trauma, and occlusal characteristics of 4- to 12-year-old orphans living in governmental orphanages in Riyadh. This cross-sectional study was conducted in three government orphanages and three ordinary schools. All 90 orphans, residing in the orphanage, were included. Ninety schoolchildren were selected to serve as the controls. Demographic data, oral habit history, and dental trauma history were obtained through a questionnaire. All children were examined to confirm the presence of signs of oral habits, dental trauma, and associated occlusal characteristics. Pearson chi-square was used for statistical analysis. Orphans were found to have more digit sucking and oral self-mutilation habits; however, the control children were found to have more nail biting habit. Nearly 21% of the orphans had dental trauma compared to 10% of the control group. About 70% of the dental trauma affected permanent teeth among orphans, whereas, 85% affected primary teeth in the control children. Dental trauma increased as the orphans got older; however, it decreased significantly as the control children got older. Orphans were found to have more cross-bite, increased over-jet, and open-bite. Digit sucking habit was positively associated with class II molar relation, presence of posterior cross-bite, and open-bite. Orphans had increased prevalence of digit sucking habit, self-mutilation, dental trauma, and malocclusion.
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Affiliation(s)
- Salwa A AlSadhan
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Saudi Arabia
| | - Asma M Al-Jobair
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Saudi Arabia
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Conway CC, Rutter LA, Brown TA. Chronic environmental stress and the temporal course of depression and panic disorder: A trait-state-occasion modeling approach. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 125:53-63. [PMID: 26595465 DOI: 10.1037/abn0000122] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Both acute stressful life events and ongoing strains are thought to confer vulnerability to emotional disorders. Unremitting stressful conditions may be particularly pathogenic, but prior research has struggled to delimit chronic versus transient stressful experiences. We aimed to isolate stable stressors-theorized to be indicators of a latent stress proneness trait-and to examine their effects on the temporal course of depression and panic disorder. We recruited 677 patients diagnosed with an emotional disorder and administered interviews for psychopathology and life stress 3 times over 12-month intervals. Trait-state-occasion modeling revealed that 74% of the variance in life stress was stable over the follow-up period. These stable stressors were associated with a more refractory course of depression and, to a smaller degree, panic disorder over time. In addition, neither gender nor participation in cognitive-behavioral therapy affected the persistence of environmental stress over the study time frame. We discuss implications of these findings for explaining depression recurrence, improving psychological interventions for emotional disorders, and the measurement and evaluation of stress proneness.
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Biglan A, Flay BR, Embry DD, Sandler IN. The critical role of nurturing environments for promoting human well-being. AMERICAN PSYCHOLOGIST 2012; 67:257-71. [PMID: 22583340 PMCID: PMC3621015 DOI: 10.1037/a0026796] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The recent Institute of Medicine report on prevention (National Research Council & Institute of Medicine, 2009) noted the substantial interrelationship among mental, emotional, and behavioral disorders and pointed out that, to a great extent, these problems stem from a set of common conditions. However, despite the evidence, current research and practice continue to deal with the prevention of mental, emotional, and behavioral disorders as if they are unrelated and each stems from different conditions. This article proposes a framework that could accelerate progress in preventing these problems. Environments that foster successful development and prevent the development of psychological and behavioral problems are usefully characterized as nurturing environments. First, these environments minimize biologically and psychologically toxic events. Second, they teach, promote, and richly reinforce prosocial behavior, including self-regulatory behaviors and all of the skills needed to become productive adult members of society. Third, they monitor and limit opportunities for problem behavior. Fourth, they foster psychological flexibility-the ability to be mindful of one's thoughts and feelings and to act in the service of one's values even when one's thoughts and feelings discourage taking valued action. We review evidence to support this synthesis and describe the kind of public health movement that could increase the prevalence of nurturing environments and thereby contribute to the prevention of most mental, emotional, and behavioral disorders. This article is one of three in a special section (see also Muñoz Beardslee, & Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine.
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Affiliation(s)
- Anthony Biglan
- Promise Neighborhoods Research Consortium, Oregon Research Institute, Eugene, 97403-1983, USA.
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Horesh N, Iancu I. A comparison of life events in patients with unipolar disorder or bipolar disorder and controls. Compr Psychiatry 2010; 51:157-64. [PMID: 20152296 DOI: 10.1016/j.comppsych.2009.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 04/29/2009] [Accepted: 05/19/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The present study aimed to explore the association between stressful life events (LEs) and the development of affective psychopathology. METHOD Thirty patients with unipolar disorder and 30 patients with bipolar disorder were compared to 60 matched healthy controls in regard to the rate of stressful LEs. Assessment measures included the Beck Depression Inventory, the Adult Life Events Questionnaire, and the Childhood Life Events List. RESULTS The entire sample of affective patients had more LEs in general, more negative LEs, and more loss-related LEs in the year preceding their first depressive episode as compared with normal controls. Subjects with unipolar disorder had more positive LEs and more achievement LEs, whereas subjects with bipolar disorder had more uncontrollable LEs in the year preceding the first depressive episode. The relationship between LEs and manic episodes was prominent in the year preceding the first manic episode, with subjects with bipolar disorder reporting more LEs in general and more ambiguous events in that year. Almost no significant differences on LE frequency were observed in the year before the last depressive and manic episodes in the patient groups with unipolar and bipolar disorder. A significant relationship was found between childhood LEs and the development of affective disorders in adulthood, with patients with unipolar disorder exhibiting less positive and achievement LEs. CONCLUSIONS In both the unipolar and the bipolar groups, the major impact of LEs on the onset of affective disorders was found in the year before the first depressive or manic episodes. This suggests that the accumulation of stressful LEs at this crucial period contributes to the precipitation of a pathological response mechanism. Once established, this mechanism would be reactivated in the future by even less numerous and less severe stressors, compatible with the kindling hypothesis.
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Affiliation(s)
- Netta Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan 52900, Israel
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Furniss T, Beyer T, Müller JM. Impact of life events on child mental health before school entry at age six. Eur Child Adolesc Psychiatry 2009; 18:717-24. [PMID: 19399546 DOI: 10.1007/s00787-009-0013-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
Abstract
The study examined the association between life events and early child mental health prior to school entry. The impact of single life events and the cumulative effect of multiple life events on child mental health were examined. In a northern German city, the complete 1-year intake of preschool children at the primary school entry assessment was included. In 1,887 children, life events and psychiatric symptoms were recorded by means of standardized parent questionnaires. Included were all life events between child's birth and school entry. For more than 80 percent of all children, at least one life event was reported. The number of life events was independent of any demographic variable; the mean was 2.2. The number of life events had a highly significant effect on the prevalence of child mental health problems. Six family-change-factors, especially coherent in content, could be identified by factor analysis. The study provides important data on the epidemiology and clinical impact of life events and psychopathology in early childhood. For child mental health, the cumulative effect of multiple life events was found to be much more important than the effect of specific single life events.
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Affiliation(s)
- Tilman Furniss
- Department of Child and Adolescent Psychiatry, University Hospital Muenster, 48129 Muenster, Germany.
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Allen JL, Rapee RM, Sandberg S. Severe life events and chronic adversities as antecedents to anxiety in children: a matched control study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2008; 36:1047-56. [PMID: 18521739 DOI: 10.1007/s10802-008-9240-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 04/15/2008] [Indexed: 11/29/2022]
Abstract
The present study compared the number of severe life events and chronic adversities as reported retrospectively by mothers of children with an anxiety disorder (n = 39) prior to the onset of their most recent episode, with controls (n = 39) matched for age and sex. The parent version of the Psychosocial Assessment of Childhood Experiences (PACE) was used to assess chronic adversities (long-term experiences with negative impact on child) and severe life events (discrete life events with high long-term threat). A significantly greater number of severe life events and chronic adversities were assessed prior to onset for anxious children compared to controls. The finding for severe life events held regardless of whether impact ratings were assigned by mothers or a panel of independent raters, suggesting the findings reflect actual as opposed to perceived differences. Results suggest that both discrete and chronic stressors may constitute risk for future episodes of anxiety in children.
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Affiliation(s)
- Jennifer L Allen
- Clinical Child and Adolescent Psychology Department, University of Basel, Missionsstrasse 60/62, Basel 4055, Switzerland.
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Wallander JL, Dekker MC, Koot HM. Risk factors for psychopathology in children with intellectual disability: a prospective longitudinal population-based study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2006; 50:259-68. [PMID: 16507030 DOI: 10.1111/j.1365-2788.2005.00792.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND This study examined risk factors for the development of psychopathology in children with intellectual disability (ID) in the developmental, biological, family and social-ecological domains. METHODS A population sample of 968 children, aged 6-18, enrolled in special schools in The Netherlands for educable and trainable ID were assessed at Time 1. A random 58% were re-contacted about 1 year later, resulting in a sample of 474 at Time 2. RESULTS Psychopathology was highly consistent over 1 year. Risk factors jointly accounted for significant, but small, portions of the variance in development of psychopathology. Child physical symptoms, family dysfunction and previous parental mental health treatment reported at Time 1 were uniquely associated with new psychopathology at Time 2. CONCLUSIONS Prevention and early intervention research to find ways to reduce the incidence of psychopathology, possibly targeting family functioning, appear important.
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Affiliation(s)
- J L Wallander
- Sociometrics Corporation, Los Altos, CA 94022-2812, USA.
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Jackson Y. Testing the compensatory and immunity models of children's adaptive behaviors: the role of appraisal. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2005; 75:369-80. [PMID: 16060733 DOI: 10.1037/0002-9432.75.3.369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The present article examines the relations of negatively appraised and total life events and potential protective factors with adaptive behavior in 432 children (ages 8-12). Appraisal and protective factors were hypothesized to moderate the relation between stress exposure and adaptive behavior. Several significant interactions emerged between events rated as negative and variables reflecting social support, positive family environment, and intelligence level on adaptive behavior. Contrary to past research, the buffering role of protective factors was optimized only when the appraisal of the event was considered.
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Affiliation(s)
- Yo Jackson
- Clinical Child Psychology Program, University of Kansas, Lawrence 66405, UA.
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Sanford M, Byrne C, Williams S, Atley S, Miller J, Allin H. A pilot study of a parent-education group for families affected by depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2003; 48:78-86. [PMID: 12655904 DOI: 10.1177/070674370304800203] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study assessed the feasibility and efficacy of a parent-education group for families with young children and a parent with depression. We designed the program to be readily disseminated if shown to be effective. METHOD We recruited 44 parents with depression from clinics and family doctors in Hamilton, Ontario, and randomly assigned them to receive the parenting program or to a wait-list control group. The outcomes measured included knowledge of depression, parenting, family relationships, depression symptoms, child depressive symptoms, and functioning. We used analysis of covariance to test for posttreatment differences between experimental and control groups. RESULTS Of the treatment group, 27% dropped out at posttreatment, and 43% by follow-up. Those who dropped out had more severe depression at baseline than did those who completed the program, and there was selective loss of parents with more severe depression in the experimental group. In intention-to-treat analyses at posttreatment, probands in the experimental group reported more improvements on family functioning, parenting sense of competence, and family and parent conflict than did control subjects. Standardized effect sizes (ES) were medium (0.4 to 0.6). When baseline depressive symptom scores were controlled in the analyses, the between-group differences were reduced, showing that selective loss of participants may have influenced the findings. CONCLUSIONS On balance, the results are encouraging and support the further development and evaluation of the group intervention. However, the study does not provide unequivocal evidence in support of the program. Before it is transferred to other settings, the program needs further modification to improve participation by parents with more severe depression and further evaluation of its effectiveness.
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Affiliation(s)
- Mark Sanford
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Brook DW, Brook JS, Whiteman M, Arencibia-Mireles O, Pressman MA, Rubenstone E. Coping in adolescent children of HIV-positive and HIV-negative substance-abusing fathers. J Genet Psychol 2002; 163:5-23. [PMID: 11952264 DOI: 10.1080/00221320209597965] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors examined coping in the adolescent children of drug-abusing fathers who have, or are at risk for contracting, human immunodeficiency virus (HIV). The ability to cope is an important factor in the adolescent's own risk behaviors, including drug use and associated problems. Each father and his adolescent child were separately administered a structured interview regarding personality, drug use, relationships, coping, and other behaviors. Adolescent adaptive coping was found to be related to greater conventionality, less marijuana use, fewer intra- and interpersonal problems, paternal adaptive coping, and a close father-child bond. Moreover, analysis using a risk factor index indicated an exponential increase in adolescent maladaptive coping with each additional psychosocial risk. Implications for policy and intervention are also discussed.
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Affiliation(s)
- David W Brook
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
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Costello EJ, Keeler GP, Angold A. Poverty, race/ethnicity, and psychiatric disorder: a study of rural children. Am J Public Health 2001; 91:1494-8. [PMID: 11527787 PMCID: PMC1446810 DOI: 10.2105/ajph.91.9.1494] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined the effect of poverty on the prevalence of psychiatric disorder in rural Black and White children. METHODS A representative sample of 541 Black children and 379 White children aged 9 to 17 was drawn from 4 predominantly rural counties. Structured interviews with parents and children collected information on psychiatric disorders, absolute and relative poverty, and risk factors for psychiatric disorder. RESULTS Three-month prevalence of psychiatric disorder was similar to that found in other community samples (20%). Federal criteria for poverty were met by 18% of the White and 52% of the Black families. Black and White children were exposed to equal numbers of risk factors overall, but the association between poverty and psychopathology was stronger for White children (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.1, 4.2) than for Black children (OR = 1.5; 95% CI = 0.9, 2.6). Family history of mental illness, poor parenting, and residential instability mediated this association in both groups. CONCLUSIONS In this rural sample, poverty was only weakly associated with child psychiatric disorders. Risk factors for both racial/ethnic groups were family mental illness, multiple moves, lack of parental warmth, lax supervision, and harsh punishment.
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Affiliation(s)
- E J Costello
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Abstract
BACKGROUND Despite strong claims that 'genetic theory' should replace 'socialisation theory', there are good grounds for taking seriously the notion that there are psychosocial influences on child psychopathology. AIMS To re-evaluate this issue in the light of developments over the past half-century. METHOD A wide-ranging review of topics related to this issue, 1948-1998. RESULTS AND CONCLUSIONS The findings are used to consider the challenges still to be met as we enter the next century. It is argued that it is necessary to put aside the absurd brain-mind dualisms of the past.
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Affiliation(s)
- M L Rutter
- Social, Genetic and Developmental Psychiatry Research Centre, Institute of Psychiatry, London, UK
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Sandberg S, McGuinness D, Hillary C, Rutter M. Independence of childhood life events and chronic adversities: a comparison of two patient groups and controls. J Am Acad Child Adolesc Psychiatry 1998; 37:728-35. [PMID: 9666628 DOI: 10.1097/00004583-199807000-00012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the differences between independent and behavior-dependent stressful life events and chronic adversities in child psychiatric patients, community controls, and children with asthma. METHOD The Psychosocial Assessment of Childhood Experiences was used to assess recent severe events (life events with high long-term threat) and major adversities (long-term experiences with high negative impact on child) in children attending a psychiatric clinic (n = 99), community controls (n = 26), and children with chronic asthma (n = 94). RESULTS In the previous year, the psychiatric patients had, on average, experienced significantly more independent and behavior-dependent severe events and major adversities than either the controls or the asthmatic patients. The differences were most pronounced in relation to behavior-dependent high-threat life events and long-term-experiences. Among the psychiatric patients, one third of all severe events and one quarter of all major adversities were dependent on the child's behavior. The corresponding proportions in the controls and children with asthma were between one fifth and one twelfth. CONCLUSIONS Psychiatrically disturbed children have an increased risk of experiencing behavior-dependent life events and long-term adversities compared with their peers in the community at large and compared with children suffering from a chronic physical illness such as asthma. Future studies need to examine the possible contributions of such experiences to the development and maintenance of psychiatric and physical illness in children.
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Affiliation(s)
- S Sandberg
- Department of Psychology, University of Jyväskylä, Finland.
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Steiner H. Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 1997; 36:122S-39S. [PMID: 9334568 DOI: 10.1097/00004583-199710001-00008] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
These practice parameters address the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. Voluminous literature addresses the problem from a developmental, epidemiological, and criminological perspective. Properly designed treatment outcome studies of modern psychiatric modalities are rare. Ethnic issues are mentioned but not fully addressed from a clinical perspective. Clinical features of youth with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.
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Liakopoulou M, Alifieraki T, Katideniou A, Kakourou T, Tselalidou E, Tsiantis J, Stratigos J. Children with alopecia areata: psychiatric symptomatology and life events. J Am Acad Child Adolesc Psychiatry 1997; 36:678-84. [PMID: 9136503 DOI: 10.1097/00004583-199705000-00019] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To examine the nature of psychopathology of children with alopecia areata (AA) and to investigate the frequency and quality of life events in the year before AA developed in comparison with a control group. METHOD Thirty-three subjects with AA, mean age 10.5 +/- 0.3 years, were compared with 30 controls who visited a pediatrician for a mild condition. In addition, 16 preschool children with AA were compared with 17 preschool children who visited the pediatrician for a mild condition. The following measures were used: Child Psychiatric Interview, Children's Depression Inventory (CDI), Children's Manifest Anxiety Scale (CMAS), Life Events Scale for Children, and Child Behavior Checklist (CBCL). RESULTS On the CBCL, children with AA had more psychological problems, in total, than controls, and in particular, they were more anxious or depressed, withdrawn, aggressive, and delinquent. They also had more somatic problems as well as problems in social relations and in attention. Girls with AA seem to have been affected more in dimensions of total problems, anxiety/depression, and internalizing/externalizing syndromes. In terms of anxiety (CMAS), more children with AA than controls seemed to worry and to have difficulties in concentration and physiological symptoms of anxiety. In the Child Psychiatric Interview, all children with AA exhibited symptomatology of anxiety or depression or both, usually of mild or moderate nature. Major depression was not detected through the CDI. Fewer children with AA had positive life events the year before AA than controls in a similar time period. CONCLUSIONS Compared with controls, children with AA had more psychiatric symptoms in general and symptoms of anxiety or depression, or both, in particular. There is also evidence that lack of positive life events in the prealopecia period played a role in their lives. Psychiatric assessment, and if necessary treatment, is warranted for all children with this condition.
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Horesh N, Apter A, Ishai J, Danziger Y, Miculincer M, Stein D, Lepkifker E, Minouni M. Abnormal psychosocial situations and eating disorders in adolescence. J Am Acad Child Adolesc Psychiatry 1996; 35:921-7. [PMID: 8768353 DOI: 10.1097/00004583-199607000-00019] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the relationship between abnormal psychosocial situations and eating disorders in adolescents. METHOD Twenty girls with eating disorders, 20 girls with major psychiatric conditions, and 20 healthy controls took part in the study. They were interviewed using a semistructured interview designed by the World Health Organization to diagnose the psychosocial situations included in the International Classification of Disease Axis 5 classification for child and adolescent psychiatry. All subjects were also given the Eating Attitudes Test. RESULTS Many life events and psychosocial adversities differentiated significantly between the patients and controls. Inappropriate parental pressure was specific only for the subjects with eating disorders compared with the other psychiatric patients. In addition, Eating Attitudes Test scores correlated significantly with hostility toward child, sibling disability, parental overprotection, inappropriate parental pressures, and negative changes in family relationships. CONCLUSION These results support the growing literature on the interrelationship between disordered family relationships and eating disorders. They point the way for developing treatment programs dealing with these issues.
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Affiliation(s)
- N Horesh
- Geha Psychiatric Hospital, Sackler School of Medicine, University of Tel Aviv, Israel
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Champion LA, Goodall G, Rutter M. Behaviour problems in childhood and stressors in early adult life. I. A 20 year follow-up of London school children. Psychol Med 1995; 25:231-246. [PMID: 7675912 DOI: 10.1017/s003329170003614x] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The research presented in this paper examined the relationship between the presence of childhood behaviour problems and the rate of life events and difficulties in early adult life. Data are presented from a 20 year follow-up study of a sample of inner London school children first studied when they were aged 10. The key finding was that emotional or behavioural disturbance in childhood was associated with a marked increase in the rate of severely negative events and difficulties some two decades later. This increase was only obtained for stressors with severe negative impact of the type shown in previous investigation to be associated with the onset of psychiatric disorder. Additional results demonstrated that this main finding could not be accounted for by stressors that were a result of adult psychiatric disorder, by the respondent's own behaviour, or by continuing association with the family of origin. The need for a lifespan developmental approach to the well-established stressor-illness is discussed.
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Affiliation(s)
- L A Champion
- MRC Child Psychiatry Unit, Institute of Psychiatry, London
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Veerman JW. Family stress, family functioning and emotional/behavioural problems following child psychiatric treatment. Eur Child Adolesc Psychiatry 1995; 4:21-31. [PMID: 7788480 DOI: 10.1007/bf01987963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study assesses family stress, family functioning and emotional/behavioural problems in a sample of 80 formerly daytreated or residentially treated boys after a mean discharge period of four years. Family stress was assessed with a Questionnaire of Life Events (QLE) and family functioning with the Family Adaptability and Cohesion Evaluation Scales (FACES). Emotional/behavioural problems were measured with the Child Behavior Checklist (CBCL). The results showed that there were significant relationships between the QLE, FACES and CBCL scores. In particular, experiencing less negative life events and a more rigid type of family functioning appeared favourable with respect to several types of behavioural problems. When the interrelationships between the family factors and other factors such as age and socio-economic status were taken into account statistically, the number of negative life events appeared the most influential family factor.
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Affiliation(s)
- J W Veerman
- Paedologisch Instituut, Duivendrecht, The Netherlands
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Horesh N, Apter A, Lepkifker E, Ratzoni G, Weizmann R, Tyano S. Life events and severe anorexia nervosa in adolescence. Acta Psychiatr Scand 1995; 91:5-9. [PMID: 7754787 DOI: 10.1111/j.1600-0447.1995.tb09734.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The purpose of the study was to study the influence of life events on adolescent patients suffering from anorexia nervosa. Twenty one hospitalized adolescent inpatients with severe anorexia nervosa were compared with 79 adolescent nonanorectic psychiatric inpatients and 40 healthy adolescents for stressful life events throughout their lives. The nonanorectic patients suffered from schizophrenia, affective disorders, anxiety disorders, borderline personality disorder or conduct disorder. The assessment of the contribution of life events to the development of anorexia and the control mental disorders was based on semistructured interviewing of the patients, their parents and the patients' therapists. The instrument used was that developed by Pfeffer. The anorectic patients showed significantly higher negative life event scores than healthy controls in all the areas of life events examined. In addition, they showed significantly more negative life events concerning parents than patients in the other psychiatric diagnostic categories. These findings have relevance for the growing literature on the association between eating disorders and certain forms of child abuse.
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Affiliation(s)
- N Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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Monck E, Graham P, Richman N, Dobbs R. Adolescent girls. II. Background factors in anxiety and depressive states. Br J Psychiatry 1994; 165:770-80. [PMID: 7881779 DOI: 10.1192/bjp.165.6.770] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND This study investigated the prevalence and background variables associated with anxiety and depressive disorders occurring in a community population of older teenage girls. METHOD Girls aged 15-20 years (n = 529) whose names were drawn from general practitioner age/sex registers completed self-report Great Ormond Street Mood Questionnaires. From this sample, 143 girls (69 with high self-report scores and 74 controls) were intensively interviewed. Information was obtained on confiding/supportive relationships, family arguments and rows, quality of marital relationship, and degree of parental control. Psychiatric state was assessed by use of the Clinical Interview Schedule to provide a Total Weighted Score. A modified form of the Bedford Life Events and Difficulties Schedule was applied. RESULTS The estimated one-year prevalence rate for psychiatric disorder was 18.9%, and 16.9% for depression and anxiety disorders. Using a logit analysis, it was shown that maternal distress (P < 0.02) and the quality of the mother's marriage (P < 0.02) were independently associated with the presence of depression and anxiety disorders. CONCLUSIONS About 17% of girls in a community sample living at home showed a depression or anxiety disorder. Even in late adolescence, the presence of a mood disorder is closely linked to the quality of family relationships within the home.
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Affiliation(s)
- E Monck
- Institute of Child Health, London
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22
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Diseth TH, Emblem R, Solbraa IB, Vandvik IH. A psychosocial follow-up of ten adolescents with low anorectal malformation. Acta Paediatr 1994; 83:216-21. [PMID: 8193506 DOI: 10.1111/j.1651-2227.1994.tb13054.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Ten adolescents, aged 12-16 (mean 14.5) years, with corrected low anorectal anomalies were assessed with regard to somatic condition, psychopathology and psychosocial functioning by semistructured interviews and questionnaires. Half of the patients still had a persistent dysfunction involving problems with constipation and/or soiling. Six of 10 adolescents met the criteria for a psychiatric diagnosis and had scores indicating mild to severe impairment of psychosocial function. Psychosocial functioning was correlated with chronic family difficulties. The findings are in contrast to previous studies and reveal hidden problems and unmet social needs. To optimize their mental health and psychosocial functioning, children with low anorectal anomalies need both somatic and psychosocial follow-up.
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Affiliation(s)
- T H Diseth
- Division of Child and Adolescent Psychiatry, National Hospital of Norway
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23
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Sandberg S, Rutter M, Giles S, Owen A, Champion L, Nicholls J, Prior V, McGuinness D, Drinnan D. Assessment of psychosocial experiences in childhood: methodological issues and some illustrative findings. J Child Psychol Psychiatry 1993; 34:879-97. [PMID: 8408373 DOI: 10.1111/j.1469-7610.1993.tb01096.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The development of a new standardised investigator-based interview, PACE (Psychosocial Assessment of Childhood Experiences), for the assessment of acute life events and long-term psychosocial experiences is described. An application of PACE to a sample of 84 children referred to psychiatric clinics and 22 general population controls, is presented. Reliability was assessed using a separate clinic sample of 15 child-parent pairs. The findings showed that PACE has satisfactory reliability and discriminant validity.
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Affiliation(s)
- S Sandberg
- Department of Child and Adolescent Psychiatry, University of Glasgow, U.K
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Abstract
The context of voluntary befriending schemes to help mothers of young children is outlined. There is evidence that two main UK voluntary befriending schemes to help mothers of young children engage families where there is significant psychosocial morbidity. It is concluded that well conducted befriending schemes can make a significant contribution to the mental health of mothers and children. Whether they do so will depend on their experience and training and the elements they incorporate.
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Affiliation(s)
- A D Cox
- Division of Psychiatry, Bloomfield Clinic, Guy's Hospital, London Bridge, London
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25
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Glen S, Simpson A, Drinnan D, McGuinness D, Sandberg S. Testing the reliability of a new measure of life events and experiences in childhood: The Psychosocial Assessment of Childhood Experiences (PACE). Eur Child Adolesc Psychiatry 1993; 2:98-110. [PMID: 29871453 DOI: 10.1007/bf02098865] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There are few well validated instruments for measuring the impact of life events and experiences in childhood and adolescence. This study examines the reliability of a new instrument, the Psychosocial Assessment of Childhood Experiences of PACE. Fifteen children and parents were interviewed on two cassions ten days apart for the main test-retest reliability study. About half of the events recorded were reported on both occasions (0.45% and 0.55% concordance). When the impact of specific events was examined much higher levels of agreement were found. Inter-rater reliability tests also yielded higher rate (Kappa 0.74 and above). Possible reasons for these important differences are discussed and the inherent methodological difficulties considered.
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Affiliation(s)
| | | | | | | | - Seija Sandberg
- Department of Child and Adolescent Psychiatry, Royal Hospital for Sick Children, Yorkhill, G3 8SJ, Glasgow, Scotland
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Spurkland I, Bjørnstad PG, Lindberg H, Seem E. Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect. Acta Paediatr 1993; 82:71-6. [PMID: 8453226 DOI: 10.1111/j.1651-2227.1993.tb12520.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Twenty-six adolescents, aged 13-18 years, with severe congenital heart disease were matched for sex, age and living area with 26 adolescents with repaired atrial septal defect and regarded as physically fit. These two groups were compared according to somatic condition, psychopathology, psychosocial functioning and chronic family difficulties. A higher rate of psychiatric problems in the complex group, an association between psychosocial functioning and physical capacity, as well as an association between psychosocial functioning and chronic family difficulties were observed. These findings suggest that physical capacity is of crucial importance for mental health and functioning of adolescents with congenital heart disease. The association with chronic family difficulties also suggests that a comprehensive biopsychosocial approach is necessary in the treatment and rehabilitation of these patients.
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Affiliation(s)
- I Spurkland
- Child Psychiatric Clinic, University of Oslo, Norway
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