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Sebők-Welker T, Posta E, Ágrez K, Rádosi A, Zubovics EA, Réthelyi MJ, Ulbert I, Pászthy B, Bunford N. The Association Between Prenatal Maternal Stress and Adolescent Affective Outcomes is Mediated by Childhood Maltreatment and Adolescent Behavioral Inhibition System Sensitivity. Child Psychiatry Hum Dev 2024; 55:1-21. [PMID: 36738426 PMCID: PMC11362206 DOI: 10.1007/s10578-023-01499-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Prenatal maternal stress is linked to offspring outcomes; however, there is little research on adolescents, behavioral, transdiagnostic outcomes, or the mechanisms through which relations operate. We examined, in N = 268 adolescents (Mage = 15.31 years; SD = 1.063; 57.8% boys) whether prenatal maternal stress is associated with adolescent affective outcomes; whether this association is mediated, serially, by childhood home atmosphere and adolescent behavioral inhibition system (BIS) sensitivity; and whether mediational effects are moderated by adolescent attention-deficit/hyperactivity disorder or maternal internalizing symptomology. Prenatal maternal daily stress and major life events were associated with adolescent outcomes through childhood negative atmosphere/neglect and BIS sensitivity, with no evidence of moderation. Results have implications regarding the effect of prenatal maternal stress on offspring outcomes and regarding corresponding sensitive periods.
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Affiliation(s)
- T Sebők-Welker
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - E Posta
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - K Ágrez
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - A Rádosi
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - E A Zubovics
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - M J Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - I Ulbert
- Integrative Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Práter Utca 50/A, Budapest, 1083, Hungary
| | - B Pászthy
- 1st Department of Paediatrics, Semmelweis University, Bókay János U. 53-54, Budapest, 1083, Hungary
| | - N Bunford
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary.
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Frost A, Hagaman A, Bibi A, Bhalotra S, Chung EO, Haight SC, Sikander S, Maselko J. Childhood parental bonding and depression in adulthood: A study of mothers in rural Pakistan. J Affect Disord 2024; 356:715-721. [PMID: 38663557 PMCID: PMC11103589 DOI: 10.1016/j.jad.2024.04.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Parent-child relationship quality can have long-term impacts on child mental health into adulthood. The impact of parental behaviors on the future mental health of children has been understudied in South Asia, where parenting approaches differ from the dominant western approaches often represented in the literature. METHODS Mothers in rural Pakistan (N = 828) reported on their own mothers' parenting behaviors using the Parental Bonding Instrument (PBI) and were assessed for depression using the Structured Clinical Interview for DSM Disorders (SCID). The PBI includes scales for warmth (care scale) and over-control (protection scale), as well as subscales for behavioral control and psychological control. We used structural equation modeling to test the associations between depression and all PBI scales/subscales. RESULTS Increased parental care was associated with lower probability of depression (B = -0.19, SE = 0.09). Parental protection was associated with higher probability of depression (B = 0.25, SE = 0.11). Among the protection subscales, behavioral control was associated with increased risk of depression (B = 0.24, 95 % SE = 0.11) and psychological control was associated with decreased risk of depression (B = -0.28, SE = 0.12). LIMITATIONS This cross-sectional study used retrospective self-reports of parenting experiences. Participants only reported on their mothers, not fathers or other caregivers. CONCLUSIONS In a rural Pakistani sample, maternal warmth was protective against adulthood depression. The association between maternal control and depression varied based on the type of control (behavioral or psychological), emphasizing the importance of nuanced measures of parental control in this context.
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Affiliation(s)
- Allison Frost
- Carolina Population Center, University of North Carolina, Chapel Hill, United States of America.
| | - Ashley Hagaman
- Social Behavioral Sciences, Yale School of Public Health, Yale University, United States of America
| | - Amina Bibi
- Human Development Research Foundation, Islamabad, Pakistan
| | | | - Esther O Chung
- Carolina Population Center, University of North Carolina, Chapel Hill, United States of America; Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Sarah C Haight
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Siham Sikander
- Pakistan Institute of Living and Learning, Karachi, Pakistan; Department of Primary Care & Mental Health, University of Liverpool, UK
| | - Joanna Maselko
- Carolina Population Center, University of North Carolina, Chapel Hill, United States of America; Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, United States of America
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Pezzoli P, Pingault JB, Malanchini M, Voronin I, McCrory E, Fearon P, Viding E. Reciprocal Effects Between Negative Parenting and Children's Callous-Unemotional Traits From Mid to Late Childhood. Am J Psychiatry 2024; 181:310-321. [PMID: 38476045 DOI: 10.1176/appi.ajp.20230208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE The role of negative parenting in the development of callous-unemotional (CU) traits remains unclear. Both negative parenting and CU traits are influenced by genetic and environmental factors. The authors used genetically informed longitudinal cross-lagged models to examine the extent to which reciprocal effects between negative parenting and children's CU traits in mid-to-late childhood are genetic versus environmental in origin. METHODS In 9,260 twin pairs from the Twins Early Development Study, the authors estimated cross-lagged effects between negative parenting (discipline and feelings) and children's CU traits in mid (ages 7-9) and late (ages 9-12) childhood. RESULTS CU traits were strongly heritable and stable. Stability was explained largely by genetic factors. The influence of negative parenting on the development of CU traits was small and driven mostly by genetic and shared environmental factors. In mid childhood, the influence of children's CU traits on subsequent negative parenting (i.e., evoked by children's CU traits) was also small and mostly genetic in origin. In late childhood, CU traits showed no effects on negative parental discipline and small effects on negative parental feelings, which reflected mostly shared environmental factors. CONCLUSIONS In mid-to-late childhood, genetic factors strongly influenced the development of CU traits, whereas environmental effects of negative parenting were small. Negative parenting was also relatively unaffected by CU traits. The small reciprocal effects originated mostly from genetic and shared environmental factors. Therefore, repeated intensive interventions addressing multiple risk factors rather than negative parenting alone may be best positioned to support families of children with CU traits across development.
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Affiliation(s)
- Patrizia Pezzoli
- Division of Psychology and Language Sciences, University College London (Pezzoli, Pingault, McCrory, Fearon, Viding); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pingault, Malanchini); School of Biological and Behavioural Sciences, Queen Mary University of London, London (Malanchini); École de Psychologie, Université Laval, Quebec City, Quebec (Voronin); Department of Psychology, University of Cambridge, Cambridge, U.K. (Fearon)
| | - Jean-Baptiste Pingault
- Division of Psychology and Language Sciences, University College London (Pezzoli, Pingault, McCrory, Fearon, Viding); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pingault, Malanchini); School of Biological and Behavioural Sciences, Queen Mary University of London, London (Malanchini); École de Psychologie, Université Laval, Quebec City, Quebec (Voronin); Department of Psychology, University of Cambridge, Cambridge, U.K. (Fearon)
| | - Margherita Malanchini
- Division of Psychology and Language Sciences, University College London (Pezzoli, Pingault, McCrory, Fearon, Viding); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pingault, Malanchini); School of Biological and Behavioural Sciences, Queen Mary University of London, London (Malanchini); École de Psychologie, Université Laval, Quebec City, Quebec (Voronin); Department of Psychology, University of Cambridge, Cambridge, U.K. (Fearon)
| | - Ivan Voronin
- Division of Psychology and Language Sciences, University College London (Pezzoli, Pingault, McCrory, Fearon, Viding); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pingault, Malanchini); School of Biological and Behavioural Sciences, Queen Mary University of London, London (Malanchini); École de Psychologie, Université Laval, Quebec City, Quebec (Voronin); Department of Psychology, University of Cambridge, Cambridge, U.K. (Fearon)
| | - Eamon McCrory
- Division of Psychology and Language Sciences, University College London (Pezzoli, Pingault, McCrory, Fearon, Viding); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pingault, Malanchini); School of Biological and Behavioural Sciences, Queen Mary University of London, London (Malanchini); École de Psychologie, Université Laval, Quebec City, Quebec (Voronin); Department of Psychology, University of Cambridge, Cambridge, U.K. (Fearon)
| | - Pasco Fearon
- Division of Psychology and Language Sciences, University College London (Pezzoli, Pingault, McCrory, Fearon, Viding); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pingault, Malanchini); School of Biological and Behavioural Sciences, Queen Mary University of London, London (Malanchini); École de Psychologie, Université Laval, Quebec City, Quebec (Voronin); Department of Psychology, University of Cambridge, Cambridge, U.K. (Fearon)
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London (Pezzoli, Pingault, McCrory, Fearon, Viding); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pingault, Malanchini); School of Biological and Behavioural Sciences, Queen Mary University of London, London (Malanchini); École de Psychologie, Université Laval, Quebec City, Quebec (Voronin); Department of Psychology, University of Cambridge, Cambridge, U.K. (Fearon)
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Cronshaw G, Midouhas E. Harsh Parenting and Trajectories of Emotional and Behavioural Difficulties in Autistic Children. J Autism Dev Disord 2023:10.1007/s10803-023-06167-4. [PMID: 37925383 DOI: 10.1007/s10803-023-06167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Abstract
Autistic children show higher rates of co-occurring emotional and behavioural difficulties compared to other children in the general population. However, the environmental factors which contribute to the development of emotional (internalising) and behavioural (externalising) difficulties in autistic individuals are poorly understood. This study sought to investigate the association between harsh parenting (smacking, shouting, telling off) and the trajectories of emotional and behavioural difficulties in autistic children from ages 3 to 7. A sample comprising of 349 autistic children participated from the UK's Millennium Cohort Study. Associations between harsh parenting and child emotional and behavioural difficulties were modelled using multilevel growth curve models. In autistic children, harsh parenting was associated with total emotional and behavioural difficulties and behavioural (but not emotional) problems concurrently. Moreover, harsh parenting was not associated with changes in emotional and behavioural difficulties over time. Harsh parenting may have an important role in externalising problems in young autistic children indicating the need for public health strategies which educate parents on its effects.
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Affiliation(s)
- Georgia Cronshaw
- Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, London, UK.
| | - Emily Midouhas
- Department of Psychology and Human Development, IOE, UCL's Faculty of Education and Society, London, UK
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Penner-Goeke L, Belows M, Kristjanson A, Andrade BF, Cameron EE, Giuliano R, Katz LY, Kelly LE, Letourneau N, Mota N, Reynolds K, Zalewski M, Pharazyn A, Roos LE. Protocol for a randomized control trial of the Building Regulation in Dual Generations Program (BRIDGE): preventing the intergenerational transmission of mental illness in at-risk preschool children. Trials 2023; 24:597. [PMID: 37726821 PMCID: PMC10507827 DOI: 10.1186/s13063-023-07591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, the worldwide prevalence of maternal depression has risen sharply; it is now estimated that one quarter of mothers experience clinically significant depression symptoms. Exposure to maternal depression during early childhood increases the risk for the development of childhood mental illness (MI) in offspring, with altered parenting practices mediating the association between maternal depression and child outcomes. Dual-generation interventions, which aim to simultaneously treat parent and child mental health, show promise for improving outcomes for mothers with depression and their young children. The Building Regulation in Dual Generations (BRIDGE) program combines Dialectical Behavior Therapy (DBT) and parenting skills training to concurrently treat maternal depression and improve parenting practices. In pilot within-group studies, BRIDGE has led to large reductions in maternal depression and child MI symptoms. The aim of the current study is to evaluate the efficacy of BRIDGE in reducing maternal depression and child MI symptoms (primary outcomes) as well as parenting stress and harsh parenting (secondary outcomes). METHODS A three-armed randomized control trial with equal group sizes will be conducted to compare the efficacy of (1) BRIDGE (DBT + parenting skills), (2) DBT skills training, and (3) services-as-usual. Participants (n = 180) will be mothers of 3- to 5-year-old children who report elevated depression symptoms. Those randomized to BRIDGE or DBT skills training will complete a 16-week group therapy intervention. Assessments will be administered at pre-intervention(T1) post-intervention (T2), and 6-month follow-up (T3). DISCUSSION Dual-generation programs offer an innovative approach to prevent the intergenerational transmission of mental illness. The current study will add to the evidence base for BRIDGE by comparing it to a stand-alone mental health intervention and a services-as-usual group. These comparisons will provide valuable information on the relative efficacy of including parenting support in a mental health intervention for parents. The results will contribute to our understanding of how maternal depression affects children's development and how intervening at both a mental health and parenting level may affect child and family outcomes. TRIAL REGISTRATION Name of registry: Clinical Trials Protocol Registration and Results System; trial registration number: NCT05959538; date of registry: July 24, 2023; available: https://classic. CLINICALTRIALS gov/ct2/show/NCT05959538.
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Affiliation(s)
| | | | | | - Brendan F Andrade
- McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | | | | | - Lauren E Kelly
- Depts of Pharmacology and Therapeutics, Community Health Sciences, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | | | | | | | | | | | - Leslie E Roos
- University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
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Figas K, Giannouchos TV, Crouch E. Child and Adolescent Anxiety and Depression Prior to and During the COVID-19 Pandemic in the United States. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01536-7. [PMID: 37093526 PMCID: PMC10123555 DOI: 10.1007/s10578-023-01536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
Childhood anxiety and depression have been increasing for years, and evidence suggests the COVID-19 pandemic has exacerbated this trend. However, research has examined anxiety and depression primarily as exclusive conditions, overlooking comorbidity. This study examined relationships between the COVID-19 pandemic and anxiety and depression to clarify risk factors for singular and comorbid anxiety and depression in children. Using 2018-2019 and 2020-2021 samples from the National Survey of Children's Health, a nationally representative survey of children aged 0-17 in the United States, associations between the COVID-19 pandemic and child anxiety and depression were examined via survey-weights' adjusted bivariate and multiple regression analyses, controlling for demographic characteristics. The COVID-19 pandemic was associated with higher odds of having comorbid anxiety and depression but not singular anxiety or depression. Female sex, older age, having special healthcare needs, more frequent inability to cover basic needs on family income, and poorer caregiver mental health were associated with having been diagnosed with singular and comorbid anxiety and depression. Children that witnessed or were victims of violence in the neighborhood were also more likely to have comorbid anxiety and depression. Implications for prevention, intervention, and policy are discussed.
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Affiliation(s)
- Kristen Figas
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Theodoros V Giannouchos
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Kroshus E, Hawrilenko M, Tandon PS, Browning A, Steiner MK, Christakis DA. Structural Inequities in Self-compassion and Parental Burnout. Mindfulness (N Y) 2023; 14:1192-1203. [PMID: 37304655 PMCID: PMC10113733 DOI: 10.1007/s12671-023-02104-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 06/13/2023]
Abstract
Objectives When parenting-related stressors and coping resources are chronically imbalanced, there is risk of parental burnout, and consequent negative impact on parent and child wellbeing. The objective of this study was to determine the relations between structural and social determinants of health inequities, self-compassion (a theoretically indicated coping practice), and parental burnout during the COVID-19 pandemic. Method Participants were parents (n = 2324) with at least one child aged 4-17 in the household recruited from NORC's AmeriSpeak Panel (a probability-based panel providing coverage of 97% of the US household population). Parents completed an online or telephone questionnaire in English or Spanish in December 2020. Structural equation modeling was used to test a system of relations between income, race and ethnicity, parental burnout, and parent and child mental health. Indirect effects and moderation by self-compassion were also tested. Results On average, parents experienced symptoms of burnout several days per week. Symptoms were the most frequent among parents with the least income, as well as female-identified and Asian parents. More self-compassion was associated with less parental burnout, and fewer parent and child mental health difficulties. Black and Hispanic parents were more self-compassionate compared to white parents, helping to explain similar levels of parental burnout and relatively better mental health outcomes, despite comparatively more stressors. Conclusions Self-compassion is a potentially promising target for interventions aiming to address parental burnout; however, such efforts must not detract from critical structural changes to reduce parenting stressors, particularly those impacting parents experiencing systemic racism and other forms of socioeconomic disadvantage. Preregistration This study is not preregistered. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-023-02104-9.
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Affiliation(s)
- Emily Kroshus
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101 USA
- Department of Pediatrics, University of Washington, Seattle, USA
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195 USA
| | - Pooja S. Tandon
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101 USA
- Department of Pediatrics, University of Washington, Seattle, USA
| | - Anne Browning
- School of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195 USA
| | - Mary Kathleen Steiner
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101 USA
| | - Dimitri A. Christakis
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101 USA
- Department of Pediatrics, University of Washington, Seattle, USA
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8
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Roos LE, Kaminski L, Stienwandt S, Hunter S, Giuliano R, Mota N, Katz LY, Zalewski M. The Building Regulation in Dual-Generations Program (BRIDGE): A Mixed-Methods Feasibility Pilot of a Parenting Program for Depressed Mothers of Preschoolers, Matched with Dialectical Behavior Therapy Skills. Child Psychiatry Hum Dev 2023; 54:34-50. [PMID: 34347227 PMCID: PMC8335713 DOI: 10.1007/s10578-021-01219-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 01/27/2023]
Abstract
Early exposure to maternal depression is a key risk factor for child mental illness (MI), but there are limited programs that interrupt intergenerational transmission. The BRIDGE "Building Regulation in Dual Generations" Program treats maternal MI using Dialectical Behavior Therapy Skills with a paired curriculum that promotes non-reactive and emotionally validating parenting designed to improve child mental health and ultimately prevent MI. The pilot feasibility trial (n = 28 dyads) included mothers and their preschool-aged children. The 20-week program was completed in a group-based format using mixed methods questionnaires and interviews. Results indicate high feasibility and acceptability (86% retention). Consistent improvements were seen across program targets and outcomes including maternal depression (d = 1.02) and child mental health (d = 1.08), with clinically significant symptom reductions for 85% of clients. Mothers with higher adversity exhibited greater reductions in parenting stress. Qualitative results highlighted efficacy in promoting positive parent-child relationships, rewarding parenting experiences, competence, and child development. Evidence suggests high feasibility and accessibility for BRIDGE in addressing intergenerational mental health needs. There was strong satisfaction with the program material and efficacy across key outcomes. BRIDGE holds promise for offering a transdiagnostic approach to preventing child MI in families of at-risk preschool aged children.
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Affiliation(s)
- Leslie E Roos
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada.
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
| | - Lauren Kaminski
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada
| | - Shaelyn Stienwandt
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada
| | - Sandra Hunter
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada
| | - Ryan Giuliano
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Laurence Y Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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9
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Trust Beliefs in Significant Others, Interpersonal Stress, and Internalizing Psychopathology of Adolescents with Psychiatric Disorders. Child Psychiatry Hum Dev 2023; 54:450-459. [PMID: 34599722 PMCID: PMC9977849 DOI: 10.1007/s10578-021-01255-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
This study examined relations between trust beliefs in significant others (TBSO), interpersonal stress, and internalizing psychopathology for adolescents with psychiatric disorders. Two hundred and thirty-four adolescents from an acute inpatient unit (154 females, Mage = 14.72 years, SD = 1.39 years) completed standardized scales/interviews that assessed TBSO (mother, father, teacher, peers and TBSO as a total score), interpersonal stress, and internalizing psychopathology. It was found that adolescents' TBSO and trust beliefs in each significant other were negatively associated with interpersonal stress and internalizing psychopathology. The findings confirmed that the relation between the adolescents' interpersonal stress and internalizing psychopathology was moderated by TBSO, trust beliefs in mother, and trust beliefs in peers. The findings supported the conclusion that holding elevated TBSO (particularly trust beliefs in mother and peers) by adolescents with psychiatric disorders promotes their psychosocial adjustment including their resilience to the effects of interpersonal stress on internalizing psychopathology.
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Brym S, Mack JT, Weise V, Kopp M, Steudte-Schmiedgen S, Garthus-Niegel S. Mental health of working parents during the COVID-19 pandemic: can resilience buffer the impact of psychosocial work stress on depressive symptoms? BMC Public Health 2022; 22:2426. [PMID: 36567325 PMCID: PMC9790816 DOI: 10.1186/s12889-022-14582-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/09/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has confronted working parents with an accumulation of stressors regarding changes in work, family, and social life, putting their mental health at risk. Stressors include altered working conditions such as working from home or changes in working hours as well as the difficulty to reconcile work and childcare due to the closure of childcare facilities. The present study examined the relationship of psychosocial work stress (i.e., work-privacy conflict and effort-reward imbalance at work) and depressive symptoms in working parents and whether this association was moderated by individual resilience. METHODS Data of the present study (n = 452) were collected in Germany between May and June 2020 as part of the DREAMCORONA study. A subsample of working mothers (n = 191) and fathers (n = 261) completed the subscale for work-privacy conflict (WPC) of the Copenhagen Psychosocial Questionnaire, the Effort-Reward Imbalance (ERI) Questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), and the Edinburgh Postnatal Depression Scale (EPDS). Multiple linear regression analyses including moderation were performed, controlling for gender, working hours per week, and a lifetime history of depression as potential confounders. RESULTS Both WPC (β = 0.336, p < .001) and ERI (β = 0.254, p < .001) were significantly associated with depressive symptoms. Resilience moderated the relationship between ERI and depressive symptoms (β = - 0.101, p = .018), indicating that higher resilience weakened the relationship. However, this effect was not found regarding the relationship between WPC and depressive symptoms (β = 0.055, p = .167). CONCLUSIONS The results highlight the need for measures to reduce psychosocial work stressors such as WPC and ERI during the COVID-19 pandemic on the one hand and to promote resilience on the other hand. The findings partially support the potential protective role of resilience buffering the association between psychosocial stress and mental health in working parents. Longitudinal studies are needed to confirm this effect.
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Affiliation(s)
- Stephanie Brym
- grid.4488.00000 0001 2111 7257Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Judith T. Mack
- grid.4488.00000 0001 2111 7257Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Victoria Weise
- grid.4488.00000 0001 2111 7257Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Marie Kopp
- grid.4488.00000 0001 2111 7257Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susann Steudte-Schmiedgen
- grid.4488.00000 0001 2111 7257Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Susan Garthus-Niegel
- grid.4488.00000 0001 2111 7257Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany ,grid.4488.00000 0001 2111 7257Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany ,grid.461732.5Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany ,grid.418193.60000 0001 1541 4204Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
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Hanetz-Gamliel K, Dollberg DG. Links between mothers' ACEs, their psychopathology and parenting, and their children's behavior problems-A mediation model. Front Psychiatry 2022; 13:1064915. [PMID: 36620690 PMCID: PMC9813961 DOI: 10.3389/fpsyt.2022.1064915] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Children of mothers with a history of adverse childhoods are at greater risk of behavior problems. However, the mechanisms through which a mother's early adverse experiences (ACEs) are transmitted to her children need further study. Our goal was to examine a conceptual mediational model linking mothers' ACEs, maternal psychopathology symptoms, and parenting behaviors with children's internalizing and externalizing behaviors sequentially. Methods A sample of 153 Israeli mothers of children ages 3-12 (52% girls) participated in the study, and most of the mothers (94.7%) were cohabiting with a spouse. Mothers completed online questionnaires about their early adverse experiences, psychopathology symptoms, parenting behavior, and their children's internalizing and externalizing behavior. Results Results showed that mothers with higher ACE scores reported more maternal psychopathology symptoms and more internalizing behavior in their children. The mother's psychopathology in and of itself mediated the link between her ACEs and her child's internalizing and externalizing behavior. Moreover, an indirect sequential path emerged linking ACEs with the mother's psychopathology symptoms, which, in return, were linked with hostile parenting. Hostile parenting, in turn, was linked with children's internalizing and externalizing behavior. Discussion These findings highlight the complicated and intertwined ways in which adverse experiences early in the mother's life might put her child's wellbeing at risk. The findings suggest that ACEs are linked to maternal affect dysregulation, which interferes with parenting, increasing the risk of behavior problems in children. The findings underscore the need to assess mothers' adverse history, psychological distress, and parenting behavior, and provide treatments that can reduce the intergenerational transmission of early adverse experiences.
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Affiliation(s)
- Keren Hanetz-Gamliel
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
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12
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Gulde M, Köhler-Dauner F, Mayer I, Ziegenhain U, Fegert JM, Buchheim A. Negative effects of the SARS-CoV-2 pandemic: The interlinking of maternal attachment representation, coping strategies, parental behavior, and the child's mental health. Front Pediatr 2022; 10:939538. [PMID: 36389380 PMCID: PMC9663916 DOI: 10.3389/fped.2022.939538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
For more than two years, young families have been confronted with a large number of restrictions and following burdens as a result of the SARS-CoV-2 pandemic. In fact, it became evident, that the current circumstances are particularly stressful for child's mental health. With regard to the child's mental health in times of a pandemic, additional factors within the family, such as maternal attachment representations as well as coping strategies and parental behavior, may play an important role. This study aims to investigate the interplay of maternal attachment representation, coping strategies, parental behavior and child's mental health during the SARS-CoV-2 pandemic. In this longitudinal study, previously collected data regarding maternal attachment representation and newly attained data from the SARS-CoV-2-pandemic-assesment (lack of coping strategies, children's mental health and parental behavior) were combined and analyzed. The data were collected in an online survey since beginning of the pandemic, including N = 73 mothers. A path model was calculated in form of multiple linear regression. A path model could be confirmed, which indicates that insecure maternal attachment representation predicts lack of coping strategies during the pandemic [b = 5.55, 95%-CI = (4.51; 6.55), p = 0.001]. Furthermore, lack of coping strategies predicts harmful parental behavior during the pandemic [b = -0.77, 95%-CI = (-1.27; -0.21), p = 0.007], which in turn predicts children's mental health problems, namely behavioral problems [b = -0.08, 95%-CI = (-0.14; -0.01), p = 0.027]. Presence of short-time work and decrease in income since beginning of the pandemic were used as control variables. This means that since the pandemic mothers with insecure attachment representation have an increased risk of having only a few coping mechanisms available, leading to harmful parental behaviors and ultimately affecting the mental health of their children. In conclusion, the pandemic could potentially have a particularly negative influence on mothers with an insecure attachment type and therefore on their children. Therefore, tailored interventions for families should be offered that both focus on the different types of mental health problems in children and support parents in their coping skills.
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Affiliation(s)
- Manuela Gulde
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Franziska Köhler-Dauner
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Inka Mayer
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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13
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Mbiydzenyuy NE, Hemmings SMJ, Qulu L. Prenatal maternal stress and offspring aggressive behavior: Intergenerational and transgenerational inheritance. Front Behav Neurosci 2022; 16:977416. [PMID: 36212196 PMCID: PMC9539686 DOI: 10.3389/fnbeh.2022.977416] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Even though studies have shown that prenatal maternal stress is associated with increased reactivity of the HPA axis, the association between prenatal maternal stress and fetal glucocorticoid exposure is complex and most likely dependent on unidentified and poorly understood variables including nature and timing of prenatal insults. The precise mechanisms in which prenatal maternal stress influence neuroendocrine signaling between the maternal-placental-fetal interface are still unclear. The aim of this review article is to bring comprehensive basic concepts about prenatal maternal stress and mechanisms of transmission of maternal stress to the fetus. This review covers recent studies showing associations between maternal stress and alterations in offspring aggressive behavior, as well as the possible pathways for the “transmission” of maternal stress to the fetus: (1) maternal-fetal HPA axis dysregulation; (2) intrauterine environment disruption due to variations in uterine artery flow; (3) epigenetic modifications of genes implicated in aggressive behavior. Here, we present evidence for the phenomenon of intergenerational and transgenerational transmission, to better understands the mechanism(s) of transmission from parent to offspring. We discuss studies showing associations between maternal stress and alterations in offspring taking note of neuroendocrine, brain architecture and epigenetic changes that may suggest risk for aggressive behavior. We highlight animal and human studies that focus on intergenerational transmission following exposure to stress from a biological mechanistic point of view, and maternal stress-induced epigenetic modifications that have potential to impact on aggressive behavior in later generations.
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Affiliation(s)
- Ngala Elvis Mbiydzenyuy
- Department of Basic Science, School of Medicine, Copperbelt University, Ndola, Zambia
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Cape Town, South Africa
- *Correspondence: Ngala Elvis Mbiydzenyuy,
| | - Sian Megan Joanna Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lihle Qulu
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Cape Town, South Africa
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Magklara K, Lazaratou H, Barbouni A, Poulas K, Farsalinos K. The impact of COVID-19 lockdown on children's and adolescents' mental health in Greece. CHILDREN & SOCIETY 2022; 37:CHSO12605. [PMID: 35942023 PMCID: PMC9349383 DOI: 10.1111/chso.12605] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/16/2022] [Accepted: 05/11/2022] [Indexed: 05/07/2023]
Abstract
The aim of the study was to investigate the impact of the COVID-19 lockdown on children's and adolescents' mental health in Greece during the lockdown of spring 2020. A cross-sectional survey of 1232 Greek parents was conducted in spring 2020. 35.1% of parents reported that their children's psychological health was significantly affected. Parental unemployment, limited opportunity for tele-work and deteriorating psychological health, increased family conflicts and children's pre-existing physical health conditions were all significantly associated with mental health impact. Children and adolescents may experience adverse mental health effects due to the COVID-19 pandemic.
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Affiliation(s)
| | - Helen Lazaratou
- First Department of Psychiatry, Medical SchoolUniversity of AthensAthensGreece
| | - Anastasia Barbouni
- School of Public Health, Department of Public and Community HealthUniversity of West AtticaAthensGreece
| | | | - Konstantinos Farsalinos
- School of Public Health, Department of Public and Community Health, University of West Attica, Athens, Greece; Department of PharmacyUniversity of PatrasRioGreece
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15
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MacKinnon AL, Simpson KM, Salisbury MR, Bobula J, Penner-Goeke L, Berard L, Rioux C, Giesbrecht GF, Giuliano R, Lebel C, Protudjer JLP, Reynolds K, Sauer-Zavala S, Soderstrom M, Tomfohr-Madsen LM, Roos LE. Building Emotional Awareness and Mental Health (BEAM): A Pilot Randomized Controlled Trial of an App-Based Program for Mothers of Toddlers. Front Psychiatry 2022; 13:880972. [PMID: 35815022 PMCID: PMC9263095 DOI: 10.3389/fpsyt.2022.880972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Families have faced unprecedented challenges during the COVID-19 pandemic, leading to increased maternal mental health problems and barriers to accessing care. Innovative programs are needed to support both maternal mental health and parenting, and to buffer the long-term impacts of stress on young children. Using a patient-oriented approach, our research team aimed to co-develop and pilot test an App-based psychoeducation and social-connection platform: Building Emotional Awareness and Mental Health (BEAM). Methods The co-development process involved a parent advisory board from conceptualization and design, through to direct participation in the program delivery. The BEAM program includes weekly videos and activities based on Unified Protocol therapy modules and emotion-focused parenting strategies, a weekly telehealth group review session, and access to a private online forum for support from other mothers and clinical coaches. A parallel randomized control trial was conducted across two provinces in Canada. Mothers of preschool children (aged 18-36 months old), with moderate-to-severe depression (Patient Health Questionaire-9 ≥ 10), were recruited online and randomized to either the 10-week BEAM intervention or treatment as usual (TAU) control group. Online surveys (ensuring researcher blinding) included questions about feasibility and acceptability of the program and pre/post self-report measures of mental health, parenting, positive coping and child behavior outcomes. The primary outcome measures were symptoms of depression and parenting stress. Data were analyzed using mixed models and an intention-to-treat approach. Results 65 participants were randomized, by an online allocation tool, to the BEAM (n = 33) and TAU (n = 32) groups. Engagement was relatively high at the beginning of the program, with 78.8% starting the BEAM App and 70.6% attending ≥1 telehealth session. Most respondents felt socially supported, satisfied with the App, and found it easy to use. Pre-post results indicated interaction effects with greater reductions in overall mental health problems, and specifically anxiety and sleep symptoms, among BEAM vs. control participants. There were also time effects with reductions in depression symptoms across both groups. No significant treatment effects emerged for the other mental health symptoms, parenting problems, positive coping, or child behavior outcomes. Descriptive data are included to highlight possible areas of promise for future large efficacy trials. Technological difficulties and other challenges that may have led to attrition and impacted outcomes are discussed. There were no adverse events related to study participation. Conclusions The BEAM program has promise as a novel, feasible and acceptable intervention for improving mental health among mothers of young children. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT04772677].
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Affiliation(s)
- Anna L. MacKinnon
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Kaeley M. Simpson
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | | | - Janelle Bobula
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Penner-Goeke
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Lindsay Berard
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Charlie Rioux
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | | | - Ryan Giuliano
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | | | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | | | | | | | - Leslie E. Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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Lam YT, Cheng C. Parental Depression and Leisure Activity Engagement on Children's Gaming Disorder: A Dyadic Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105880. [PMID: 35627422 PMCID: PMC9140680 DOI: 10.3390/ijerph19105880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/02/2022]
Abstract
Nowadays, playing both online and offline video games is a popular leisure activity among youngsters, but excessive gaming activity engagement may lead to gaming disorder that disrupts daily functioning. Identifying risk and protective factors of this emerging problem is thus essential for devising prevention and intervention strategies. This mixed-method, cross-sectional study aimed to examine the roles of parental depressive symptoms and children’s leisure activity engagement on children’s gaming disorder symptoms. Furthermore, the moderating roles of risky and protective leisure activity engagement were investigated. The sample comprised 104 parent-child dyads recruited from a population-based survey (parents: Mage = 45.59 years, SD = 6.70; children: Mage = 11.26 years; SD = 4.12). As predicted, parental depressive symptoms and children’s gaming activity engagement were positively associated with children’s gaming disorder symptoms, whereas children’s literacy activity engagement was negatively associated with these symptoms. Moreover, engagement in these two types of leisure activity moderated the association between parental depressive symptoms and children’s gaming disorder symptoms in distinct manners, further indicating literacy activities as beneficial and gaming activities as risk-enhancing. These new findings imply that parental depressive symptoms and children’s leisure activity engagement should be considered when designing parent-based programs for gaming disorder prevention and intervention.
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Creech SK, Kroll‐Desrosiers A, Benzer JK, Pulverman CS, Mattocks K. The impact of military sexual trauma on parent-infant bonding in a sample of perinatal women veterans. Depress Anxiety 2022; 39:201-210. [PMID: 34633137 PMCID: PMC9044465 DOI: 10.1002/da.23218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/23/2021] [Accepted: 09/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The experience of sexual assault and harassment during military service (military sexual trauma [MST]) is associated with increased risk for perinatal and reproductive health problems among women veterans. The objective of this study was to examine the associations between mothers' MST exposure and mother-infant bonding, as well as to examine whether there are any salient sociodemographic or military service characteristics among women veterans with greater impairment to mother-infant bonding, including stress during pregnancy and posttraumatic stress disorder (PTSD) diagnosis. METHODS This study was a secondary analysis of data collected from prospective, longitudinal study of women veterans using VHA maternity care benefits at 15 VHA medical centers across the US between January 2016 and February 2020. Participants were 697 pregnant veterans using VHA maternity care benefits. RESULTS MST was associated with higher maternal depression, and higher maternal depression was associated with poorer mother-infant bonding. The effect of MST on bonding was indirect through depression. PTSD diagnosis and life stressors during pregnancy also had significant indirect pathways with bonding through maternal depression. CONCLUSIONS Results underscore the need for access to high quality and trauma-informed perinatal mental health treatment for women veterans, for education on the unique risks conveyed by MST provided to civilian providers treating this population outside VA, and for further research to understand how to ameliorate the harmful effects of MST on perinatal women veterans and their children.
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Affiliation(s)
- Suzannah K. Creech
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans and the Central Texas Veterans Health Care SystemWacoTexasUSA,Department of Psychiatry and Behavioral SciencesDell Medical School of the University of Texas at AustinAustinTexasUSA
| | - Aimee Kroll‐Desrosiers
- VA Central Western Massachusetts Healthcare SystemLeedsMassachusettsUSA,Departments of Population and Quantitative Health Sciences and PsychiatryUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Justin K. Benzer
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans and the Central Texas Veterans Health Care SystemWacoTexasUSA,Department of Psychiatry and Behavioral SciencesDell Medical School of the University of Texas at AustinAustinTexasUSA
| | - Carey S. Pulverman
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans and the Central Texas Veterans Health Care SystemWacoTexasUSA,Department of Psychiatry and Behavioral SciencesDell Medical School of the University of Texas at AustinAustinTexasUSA
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare SystemLeedsMassachusettsUSA,Departments of Population and Quantitative Health Sciences and PsychiatryUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
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Antony J, Sony M, McDermott O, Jayaraman R, Flynn D. An exploration of organizational readiness factors for Quality 4.0: an intercontinental study and future research directions. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2021. [DOI: 10.1108/ijqrm-10-2021-0357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Quality 4.0 incorporates the role of automation and digitization and provides competitive advantage for organizations by enhancing customer experience and increase profitability. The purpose of this study is to critically examine the organizational readiness factors for the successful implementation of Quality 4.0 implementation and assess their importance.Design/methodology/approach This study applies a quantitative research methodology to examine readiness factors of Quality 4.0 in organizations by 147 senior management professionals in various organizations including manufacturing and service companies in America, Asia and Europe participated through an online survey.FindingsThe readiness factors for Quality 4.0 were critically ranked amongst manufacturing and service organizations by senior management professionals from three continents. Five significant reasons for non-adoption of Quality 4.0 were lack of resources, inability to link Quality 4.0 with the corporate strategy and objectives, lack of understanding of benefits, high initial investment and the current quality management strategy and methods are already delivering good results hence unsure of the need for Quality 4.0. The handling of big data in quality management was the most important factor for adopting Quality 4.0, irrespective of the size and nature of the organization. More accuracy and less errors and improved decision-making the factors of adopting Quality 4.0 in service sector were not significant for manufacturing sector. Small and medium-sized enterprises (SMEs) reported that costs and time savings over the long run were not so significant.Practical implications This study is focussed on the significance of pros and cons of adopting Quality 4.0 in organizations. Senior managers in both large and SMEs can benefit immensely from understanding before investing heavily towards implementing Quality 4.0. The importance of identified organizational readiness factors for the successful adoption of Quality 4.0 can be used as indicators to understand how ready an organization is to implement Quality 4.0. The top three readiness factors for the successful adoption of Quality 4.0 were identified as: top management commitment, leadership and organizational culture. Improved understanding of the readiness factors can be highly beneficial to senior quality professionals in both manufacturing and service companies in the journey towards successful implementation of Quality 4.0.Originality/value This is the first empirical study on assessing Quality 4.0 readiness factors at an intercontinental level and therefore serves as a foundation for many future studies. The study provides a theoretical foundation for the Quality 4.0 in terms of organizational readiness for successful adoption and overcoming implementation challenges. During the planning, implementation and progress review of Quality 4.0, review the readiness factors while planning and resourcing a Quality 4.0 implementation strategy to ensure effective performance.
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Taubner S, Kasper L, Hauschild S, Wiegand-Grefe S, Georg A. [Bifocal perspective in the work with families with mentally ill parents]. PSYCHOTHERAPEUT 2021; 67:50-57. [PMID: 34903911 PMCID: PMC8656138 DOI: 10.1007/s00278-021-00557-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Mentally ill parents pose a risk factor for the transgenerational transmission of mental disorders. Contemporary psychiatry mainly focuses on the individual and patients are not always recognized as being parents. OBJECTIVE The development and evaluation of a training program for mental health professionals to support a family orientation in psychiatric treatment by using a bifocal perspective, which keeps an eye on the index patient and the family with a focus especially on children, are presented. METHODS In order to establish the bifocal perspective in attitudes, knowledge and skills, a half-day training program, consisting of a lecture and a seminar was developed. This was carried out as part of the Children of Mentally Ill Parents -Research Network (CHIMPS-NET) consortium at seven locations in Germany in the respective adult, pediatric and adolescent departments of psychiatry. The needs were evaluated before the training using an online questionnaire. The implementation was accompanied by a qualitative analysis of memory protocols of the trainers. RESULTS AND DISCUSSION The training could be successfully carried out with 120 participants, whereby the target of a comprehensive training of the complete personnel across occupational groups could not be realized, also partly due to the pandemic, and the exercising elements of training could not all be utilized. The evaluation of the questionnaire, which was completed by approximately 50% of the participants showed that the group of participating psychologists and physicians already had a strong family orientation. The qualitative analysis of protocols from all locations documented a strong need for networking across institutions and clear standard procedures, e.g. in dealing with child maltreatment.
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Affiliation(s)
- Svenja Taubner
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Deutschland
| | - Lea Kasper
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Deutschland
| | - Sophie Hauschild
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Deutschland
| | - Silke Wiegand-Grefe
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Deutschland
| | - Anna Georg
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Deutschland
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20
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Arnold RA, Burlingame GM. Treating Children Exposed to Domestic Violence: Group-Based Intervention. Int J Group Psychother 2021; 71:595-602. [PMID: 38449249 DOI: 10.1080/00207284.2020.1856668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Arikan G, Kumru A. Patterns of Associations Between Maternal Symptoms and Child Problem Behaviors: The Mediating Role of Mentalization, Negative Intentionality, and Unsupportive Emotion Socialization. Child Psychiatry Hum Dev 2021; 52:640-653. [PMID: 32852727 DOI: 10.1007/s10578-020-01046-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We examined how maternal depression, anxiety, hostility, mentalization, negative intentionality (NI), and unsupportive emotion socialization (UES) predict child internalizing and externalizing problem behaviors (CIEPB). Mothers (N = 537) of toddlers (Mage = 23.26 months, Range 10-44 months) completed the Brief Symptom Inventory, the Parental Reflective Functioning Questionnaire, the Infant Intentionality Questionnaire, the Coping with Children's Negative Emotions Scale, and the Child Behavior Checklist. All maternal symptoms negatively predicted mentalization and positively predicted NI, UES, and CIEPB. NI and UES mediated the relationship between maternal symptoms and CIEPB. Negative intentionality mediated the link between maternal hostility and internalizing behaviors, indicating a possible intervention area. Mentalization had an effect on externalizing behaviors only for high-SES, anxious mothers, underscoring the role of SES. Thus, the relationship between maternal symptoms, cognitive and behavioral parenting characteristics and CIEPB supports the multifinality principle for early childhood psychopathology development and shows the importance of screening for maternal symptoms and CIEPB.
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Affiliation(s)
- Gizem Arikan
- Department of Psychology, Ozyegin University, Nisantepe Mah. Orman Sok. Cekmekoy, Istanbul, Turkey.
| | - Asiye Kumru
- Department of Psychology, Ozyegin University, Nisantepe Mah. Orman Sok. Cekmekoy, Istanbul, Turkey
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Parent and Peer Emotion Responsivity Styles: An Extension of Gottman's Emotion Socialization Parenting Typologies. CHILDREN-BASEL 2021; 8:children8050319. [PMID: 33921937 PMCID: PMC8143508 DOI: 10.3390/children8050319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
This theoretical paper introduces six emotion socialization typologies that can be used for designating emotion responsivity styles of parents and peers of children in middle childhood, referred to as Parent and Peer Emotion Responsivity Styles (PPERS). This typology draws on theoretical foundations of meta-emotion and emotion socialization. These typologies are compliment with and extend Gottman's emotion-based parenting styles, as they are organized generally by whether the response is more positive or more negative and whether the response is more emotionally constructive or destructive, but extend the four styles to include whether the parent or peer targets the emotion directly when responding to a child's emotions, or whether they target the emotion-related behavior. On the positive end, there is the Emotion Constructive style, which targets the child's emotions directly. The other two positive styles include Emotion Responsive and Emotion Acceptive, which target the child's emotional behaviors with higher or lower levels of activity. On the negative side, there is the Emotion Destructive style which is employed to target the emotion itself, while the Emotion Punitive and Emotion Dismissive styles target the child's emotion-related behavior with varying levels of activity. Implications for the development and study of these theoretical typologies are discussed.
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Cameron EE, Joyce KM, Delaquis CP, Reynolds K, Protudjer JLP, Roos LE. Maternal psychological distress & mental health service use during the COVID-19 pandemic. J Affect Disord 2020; 276:765-774. [PMID: 32736186 PMCID: PMC7370903 DOI: 10.1016/j.jad.2020.07.081] [Citation(s) in RCA: 218] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Mental health problems are increasingly recognized as a significant and concerning secondary effect of the COVID-19 pandemic. Research on previous epidemics/pandemics suggest that families, particularly mothers, may be at increased risk, but this population has yet to be examined. The current study (1) described prevalence rates of maternal depressive and anxiety symptoms from an online convenience sample during the COVID-19 pandemic, (2) identified risk and protective factors for elevated symptoms, and (3) described current mental health service use and barriers. METHODS Participants (N = 641) were mothers of children age 0-8 years, including expectant mothers. Mothers completed an online survey assessing mental health, sociodemographic information, and COVID-19-related variables. RESULTS Clinically-relevant depression was indicated in 33.16%, 42.55%, and 43.37% of mothers of children age 0-18 months, 18 months to 4 years, and 5 to 8 years, respectively. Prevalence of anxiety was 36.27%, 32.62%, and 29.59% for mothers across age groups, respectively. Binary logistic regressions indicated significant associations between risk factors and depression/anxiety across child age groups. LIMITATIONS Cross-sectional data was used to describe maternal mental health problems during COVID-19 limiting the ability to make inferences about the long-term impact of maternal depression and anxiety on family well-being. CONCLUSIONS Maternal depression and anxiety appear to be elevated in the context of COVID-19 compared to previously reported population norms. Identified risk factors for depression and anxiety across different child age ranges can inform targeted early intervention strategies to prevent long-term impacts of the COVID-19 pandemic on family well-being and child development.
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Affiliation(s)
- Emily E Cameron
- Department of Psychology, University of Calgary, 2500 University Drive, NW, Calgary, AB T2N 1N4, Canada; Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada.
| | - Kayla M Joyce
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | | | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
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Suicidal behavior in problematic substance uses in South Gondar zone, Northwest Ethiopia: a cross-sectional survey. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:60. [PMID: 32811525 PMCID: PMC7436999 DOI: 10.1186/s13011-020-00303-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022]
Abstract
Background Suicidal behavior has a significant contribution to the global burden of disease that affects individuals, families and communities at different age groups. Sadly, up to 75% of suicides in the world occur in low-and- middle income countries which have no adequate resource to prevent it. The aim of this study was to assess suicidal behavior and associated factors among community residents with problematic substance use in South Gondar zone, northwest Ethiopia. Methods Community based cross-sectional survey was conducted by using a suicidal behavior revised questionnaire from January 15 to March 15, 2019. A total of 4035 participants were screened for problematic substance use by using multi stage cluster sampling and 846 participants were positive for problematic substance use then asked for suicidal behavior. Multiple logistic regression analyses used to see adjusted odd rations (AOR). Multilevel binary logistic regression was used to account for the hierarchical structure of the two-level data within individual and districts level. Results The prevalence of suicidal behavior over the last 12 months in problematic substance uses was found to be 41.4% with 95% of confidence interval (CI) (38.2–44.9). Perceived stigma, [AOR = 1.605, 95% CI (1.16–2.23)], family history of suicide [AOR = 3.22, 95% CI (1.46–7.10)], physical illness [AOR = 2.45 95% CI (1.157–3.84)], rural resident [AOR = 1.74, 95% CI (1.16–2.62)], depression [AOR = 4.44, 95% CI (3.15–6.27)] and living alone (AOR = 1.61, 95% CI (1.16–2.24) were risks factors for suicidal behavior. Conclusion Suicidal behavior in problematic substance uses found to be high. Health workers should pay attention to decrease suicidal behavior and to control amendable factors.
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Bellina M, Grazioli S, Garzitto M, Mauri M, Rosi E, Molteni M, Brambilla P, Nobile M. Relationship between parenting measures and parents and child psychopathological symptoms: a cross-sectional study. BMC Psychiatry 2020; 20:377. [PMID: 32680486 PMCID: PMC7367317 DOI: 10.1186/s12888-020-02778-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Increasing evidence suggests a complex role of family influences, such as the exposure to parent psychopathology through parenting behavior, in parent-to-child psychopathology transmission. Parenting behaviour could represent a relevant target of psychoeducative intervention. Given these premises, we aimed to evaluate homotypic and heterotypic relationships between parent and child psychopathology, mediated by parenting behaviours, taking into account the constructs of parent and offspring internalizing and externalizing psychopathology. METHODS Internalizing and externalizing symptoms in 272 clinically-referred subjects (mean age = 14.5 ± 2.3; F = 23.5%) and their parents (mothers n = 272, fathers n = 242) were assessed through the Child Behavior Checklist and the Adult Self Report; four areas of parenting behaviours were investigated through the Family Life Questionnaire. Multiple mediation models were built, considering mother and father psychopathology scales as independent variables, parenting measures and family functioning as mediators (Affirmation, Rules, Discipline and Special Allowances), child psychopathology scales as dependent variables and demographic variables as covariates. RESULTS Regression models showed a significant effect of maternal internalizing symptomatology on child externalizing behavioral problems; high levels of maternal pathology predicted high levels of children's psychopathology. A total mediating effect of parenting measures was found: high levels of internalizing symptoms in mothers predicted low levels of affirmation, which in turn predicted high levels of externalizing psychopathology in children. CONCLUSIONS Our study results confirmed the existence of interdependent links between mothers' psychiatric symptomatology, parenting behaviour and offspring outcomes, specifically in an Italian context. On a clinical and rehabilitation basis, this work offers suggestions about parenting practices, specifically maternal, involved in the maintenance of child psychopathology.
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Affiliation(s)
- Monica Bellina
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - Silvia Grazioli
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - Marco Garzitto
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, Pordenone, Italy
| | - Maddalena Mauri
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Bosisio Parini, Lecco, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Eleonora Rosi
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - Massimo Molteni
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Maria Nobile
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Bosisio Parini, Lecco, Italy
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Alsmeier N, Schulz W. Intergenerationale Transmission psychischer Auffälligkeiten unter Berücksichtigung von Geschlechtereffekten. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2020. [DOI: 10.1026/1616-3443/a000577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: Kinder psychisch kranker Eltern sind eine Hochrisikogruppe. Eine mütterliche Erkrankung scheint sich stärker negativ auf die Nachkommen auszuwirken als eine väterliche Erkrankung. Ob sich die Auswirkungen auf Mädchen und Jungen unterscheiden, ist unklar. Fragestellung: Ziel der Studie ist die Klärung von Geschlechtereffekten bei der intergenerationalen Transmission psychischer Auffälligkeiten. Methode: Es wurden N = 267 Familien untersucht, indem die Depressions- und Angstsymptome von Müttern und Vätern mit einem latenten Wachstumskurvenmodell über vier Messzeitpunkte (zehn Jahre) modelliert wurden. Die Überprüfung erfolgt mittels Strukturgleichungsmodellen. Ergebnisse: Es wurden Zusammenhänge zwischen elterlichen und kindlichen Auffälligkeiten gefunden. Dabei steht eine väterliche depressive Symptomatik stärker mit jugendlichen externalisierenden Auffälligkeiten in Verbindung als eine mütterliche depressive Symptomatik. Mädchen entwickeln tendenziell mehr als Jungen internalisierende Auffälligkeiten bei psychisch belasteten Eltern. Schlussfolgerung: Zukünftige Studien sollten Mütter und Väter gleichermaßen einbeziehen. Weiterhin sollten verstärkt Transmissionsmechanismen inklusive möglicher Mediatoren mit Berücksichtigung des elterlichen und kindlichen Geschlechtes untersucht werden.
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Affiliation(s)
- Nina Alsmeier
- Institut für Psychologie, Technische Universität Braunschweig
| | - Wolfgang Schulz
- Institut für Psychologie, Technische Universität Braunschweig
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Garland J, Miller S. Borderline personality disorder: part 1 – assessment and diagnosis. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARYGeneral adult psychiatrists are largely responsible for the care of patients with personality disorders in community and in-patient settings, and this can be associated with diagnostic and management challenges. In the first of two articles focusing specifically on borderline personality disorder (BPD), we summarise the core clinical features of the disorder and discuss appropriate diagnostic practice.
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Srinivasan R, Wolstencroft J, Erwood M, Raymond FL, van den Bree M, Hall J, Skuse D. Mental health and behavioural problems in children with XXYY: a comparison with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:477-488. [PMID: 30993819 DOI: 10.1111/jir.12607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 12/17/2018] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The phenotype of children with XXYY has predominantly been defined by comparison to other sex chromosome aneuploidies trisomies affecting male children; however, the intellectual ability of children with XXYY is lower than children with other sex chromosome aneuploidies trisomies. It is not known to what extent the phenotype identified to date is specific to XXYY, rather than a reflection of lower IQ. This study evaluates the mental health and behaviour of children with XXYY, in comparison to children with intellectual disabilities of heterogeneous genetic origin. METHODS Fifteen children with XXYY and 30 controls matched for age (4-14 years), sex and intellectual ability were ascertained from the IMAGINE ID study. IMAGINE ID participants have intellectual disabilities due to genetic anomalies confirmed by National Health Service Regional Genetic Centre laboratories. The mental health and behaviour of participants was examined with the Development and Well-being Assessment and the Strengths and Difficulties Questionnaire. RESULTS Children with XXYY experienced significantly more frequent and intense temper outbursts than the control group. CONCLUSION Our results suggest that temper outbursts may be specifically associated with the XXYY phenotype. These problems have a significant impact on the daily lives of boys with XXYY and their families. It is crucial to ensure that families are well supported to manage these difficulties.
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Affiliation(s)
- R Srinivasan
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Wolstencroft
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - M Erwood
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - F L Raymond
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Biomedical Campus, Cambridge, UK
| | - M van den Bree
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - J Hall
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - D Skuse
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Alsarhi K, Rahma, Prevoo MJL, Alink LRA, Mesman J. Maternal Harsh Physical Parenting and Behavioral Problems in Children in Religious Families in Yemen. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1485. [PMID: 31035515 PMCID: PMC6540290 DOI: 10.3390/ijerph16091485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/21/2022]
Abstract
The present study examined maternal religiosity as an underlying cultural factor in the effect of harsh physical parenting on child behavioral problems. Data was collected via a discipline observational task, religiosity-based vignettes, and a questionnaire in a group of 62 mothers and their children in slum areas in Yemen. Moderation and mediation models were tested, where the role of maternal religiosity as a predictor and a moderator in the association between harsh physical parenting and child behavioral problems was explored. Findings showed no direct association between harsh physical parenting, maternal religiosity, and child behavioral problems. However, maternal religiosity was found to significantly moderate the relationship between harsh physical parenting and child behavioral problems such that the positive association between harsh physical parenting and child behavior problems was stronger when parents were more religious. Implications of the moderating role of maternal religiosity on the association between harsh physical parenting and child behavioral problems are discussed.
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Affiliation(s)
- Khadija Alsarhi
- Education and Child Studies, Leiden University, 2333AK Leiden, The Netherlands; (R.); (M.J.L.P.); (L.R.A.A.); (J.M.)
| | - Rahma
- Education and Child Studies, Leiden University, 2333AK Leiden, The Netherlands; (R.); (M.J.L.P.); (L.R.A.A.); (J.M.)
- Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia
| | - Mariëlle J. L. Prevoo
- Education and Child Studies, Leiden University, 2333AK Leiden, The Netherlands; (R.); (M.J.L.P.); (L.R.A.A.); (J.M.)
| | - Lenneke R. A. Alink
- Education and Child Studies, Leiden University, 2333AK Leiden, The Netherlands; (R.); (M.J.L.P.); (L.R.A.A.); (J.M.)
| | - Judi Mesman
- Education and Child Studies, Leiden University, 2333AK Leiden, The Netherlands; (R.); (M.J.L.P.); (L.R.A.A.); (J.M.)
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McAnee G, Shevlin M, Murphy J, Houston J. Where are all the males? Gender-specific typologies of childhood adversity based on a large community sample. CHILD ABUSE & NEGLECT 2019; 90:149-159. [PMID: 30780010 DOI: 10.1016/j.chiabu.2019.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/23/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Methodological issues have been identified when quantifying exposure to adversity and abuse. To address a single type may obscure covarying effects. To sum multiple exposures gives equal weight to each. Latent class analysis (LCA) addresses this by identifying homogenous subpopulations. Most studies using LCA have pooled gender data in spite of evidence that the nature and frequency of exposure differs by gender. Males report more interpersonal abuse, females report more of other exposures, particularly sexual. OBJECTIVE This study aimed to identify if stratifying data by gender resulted in different profiles of adversity/abuse Participants and setting: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave II, a large community-based survey, nationally representative of the US population. METHOD This study used 14 indicators of childhood adversity as the basis for LCA. RESULTS The number and nature of classes differed by gender. The best solution for females was 4-class: a low risk class; a class at higher risk of sexual abuse; a class at higher risk of physical abuse; a class at higher risk of combined physical and sexual abuse. The best solution for males had only 3-classes; a low risk class, a class at higher risk of sexual abuse; a class at higher risk of physical abuse. The combined dataset resulted in a solution similar to the female solution. CONCLUSION The importance of developing models for males and females separately was evidenced by the male and female classes being differentially associated with mental health variables.
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Affiliation(s)
- Grainne McAnee
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, United Kingdom.
| | - Mark Shevlin
- School of Psychology, Ulster University, Northern Ireland, United Kingdom
| | - Jamie Murphy
- School of Psychology, Ulster University, Northern Ireland, United Kingdom
| | - James Houston
- School of Psychology, Ulster University, Northern Ireland, United Kingdom
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Reinelt T, Samdan G, Kiel N, Petermann F. Frühkindliche Prädiktoren externalisierender Verhaltensauffälligkeiten. KINDHEIT UND ENTWICKLUNG 2019. [DOI: 10.1026/0942-5403/a000268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Externalisierende Verhaltensauffälligkeiten sind mit hohen gesellschaftlichen Kosten verbunden. Damit wirksame Präventions- und frühe Therapieprogramme entwickelt werden können, ist es notwendig, bereits in den ersten Lebensjahren Risiken für einen externalisierenden Entwicklungsverlauf zu identifizieren. In einer systematischen Literaturrecherche konnten aus 21 Publikationen zu 12 längsschnittlichen Geburtskohorten mit insgesamt 55 077 Kindern frühe Risiken bezogen auf eine elterliche Psychopathologie, einen niedrigen sozio-ökonomischen Status und ungünstige Eltern-Kind-Interaktionen identifiziert werden. Insbesondere eine mütterliche Depression, ein niedriger sozio-ökonomischer Status und ein harsches Erziehungsverhalten in den ersten Lebensjahren waren prädiktiv für externalisierende Verhaltensauffälligkeiten im Kindergarten und bei Schuleintritt. Implikationen für die klinische Praxis werden vorgestellt.
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Affiliation(s)
- Tilman Reinelt
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Gizem Samdan
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Natalie Kiel
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
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Dean K, Green MJ, Laurens KR, Kariuki M, Tzoumakis S, Sprague T, Lenroot R, Carr VJ. The impact of parental mental illness across the full diagnostic spectrum on externalising and internalising vulnerabilities in young offspring. Psychol Med 2018; 48:2257-2263. [PMID: 29331151 DOI: 10.1017/s0033291717003786] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The intergenerational risk for mental illness is well established within diagnostic categories, but the risk is unlikely to respect diagnostic boundaries and may be reflected more broadly in early life vulnerabilities. We aimed to establish patterns of association between externalising and internalising vulnerabilities in early childhood and parental mental disorder across the full spectrum of diagnoses. METHODS A cohort of Australian children (n = 69 116) entering the first year of school in 2009 were assessed using the Australian Early Development Census, providing measures of externalising and internalising vulnerability. Parental psychiatric diagnostic status was determined utilising record-linkage to administrative health datasets. RESULTS Parental mental illness, across diagnostic categories, was associated with all child externalising and internalising domains of vulnerability. There was little evidence to support interaction by parental or offspring sex. CONCLUSIONS These findings have important implications for informing early identification and intervention strategies in high-risk offspring and for research into the causes of mental illness. There may be benefits to focusing less on diagnostic categories in both cases.
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Affiliation(s)
- Kimberlie Dean
- School of Psychiatry,University of New South Wales,Sydney,Australia
| | - Melissa J Green
- School of Psychiatry,University of New South Wales,Sydney,Australia
| | | | - Maina Kariuki
- School of Psychiatry,University of New South Wales,Sydney,Australia
| | - Stacy Tzoumakis
- School of Social Sciences,University of New South Wales,Sydney,Australia
| | | | - Rhoshel Lenroot
- School of Psychiatry,University of New South Wales,Sydney,Australia
| | - Vaughan J Carr
- School of Psychiatry,University of New South Wales,Sydney,Australia
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Husky MM, Boyd A, Bitfoi A, Carta MG, Chan-Chee C, Goelitz D, Koç C, Lesinskiene S, Mihova Z, Otten R, Pez O, Shojaei T, Kovess-Masfety V. Self-reported mental health in children ages 6-12 years across eight European countries. Eur Child Adolesc Psychiatry 2018; 27:785-795. [PMID: 29082450 DOI: 10.1007/s00787-017-1073-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/24/2017] [Indexed: 11/26/2022]
Abstract
Worldwide, approximately one in eight children or adolescents suffers from a mental disorder. The present study was designed to determine the self-reported prevalence of mental health problems in children aged 6-11 years across eight European countries including Italy, France, Germany, the Netherlands, Lithuania, Bulgaria, Romania, and Turkey. Data were drawn from 6245 children participating in the School Children Mental Health in Europe (SCHME) study and a large cross-sectional survey in France. Self-reported child mental health was assessed using the Dominique Interactive (DI). Overall, 22.0% of children were identified per their own evaluation as having at least one mental disorder, ranging from 16.4% in the Netherlands to 27.9% in Bulgaria. The prevalence of internalizing disorders was 18.4% across countries and ranged from 11.8% in the Netherlands to 24.3% in Turkey. The prevalence of externalizing disorders was lower with an average of 7.8%, ranging from 3.5% in Turkey to 10.5% in Bulgaria. Combining samples across European countries, 1 in 5 children reported internalizing problems and 1 in 12 children externalizing problems. The net completion rates of 4.1-74.3% preclude conclusions about national differences in prevalence rates.
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Affiliation(s)
- Mathilde M Husky
- Department of Psychology EA4139, Institut Universitaire de France, University of Bordeaux, 3 ter, place de la Victoire, 33076, Bordeaux, France.
| | - Anders Boyd
- INSERM, UMR_S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Adina Bitfoi
- The Romanian League for Mental Health, Bucharest, Romania
| | - Mauro Giovanni Carta
- Centro di Psichiatria di Consulenza e Psicosomatica Azienda Ospedaliero, Universitaria di Cagliari, Cagliari, Italy
| | - Christine Chan-Chee
- Mental Health Programme, Department of Chronic Disease and Trauma, Institut de Veille Sanitaire, Paris, France
| | - Dietmar Goelitz
- Institute of Psychology, University of Koblenz-Landau (Campus Koblenz), Koblenz, Germany
| | - Ceren Koç
- Yeniden Health and Education Society, Istanbul, Turkey
| | - Sigita Lesinskiene
- Clinic of Psychiatry, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
| | | | - Roy Otten
- Behavioural Science Institute, Radboud University Nijmegen, Pluryn, Research and Development, Nijmegen, The Netherlands
| | - Ondine Pez
- EHESP Rennes, Sorbonne Paris Cite, Paris, France
| | - Taraneh Shojaei
- Screening and Prevention Bureau, SDS/DASES, Mairie de Paris, Paris, France
| | - Viviane Kovess-Masfety
- EHESP Rennes, Sorbonne Paris Cite, Paris, France
- EA 4057, Paris Descartes University, Sorbonne Paris Cite, Paris, France
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Lesinskiene S, Girdzijauskiene S, Gintiliene G, Butkiene D, Puras D, Goodman R, Heiervang E. Epidemiological study of child and adolescent psychiatric disorders in Lithuania. BMC Public Health 2018; 18:548. [PMID: 29699524 PMCID: PMC5921298 DOI: 10.1186/s12889-018-5436-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/10/2018] [Indexed: 11/27/2022] Open
Abstract
Background From the public health perspective, epidemiological data of child mental health and psychosocial correlates were necessary and very lacking in Lithuanian society that has been undergoing rapid socio-economic change since the past decades. Together with determining the prevalence rates of disorders and assessing the needs for the services, this study has also shifted attention from the highly selective samples of children attending children and adolescent mental health services towards less severe cases of psychopathology as well as different attitudes of parents and teachers. The aim of the first epidemiological study in Lithuania was to identify the prevalence of psychiatric disorders in the community sample of children. Methods Child psychiatric disorders were investigated in a representative sample of 3309 children aged 7–16 years (1162 7–10-year-olds and 2147 11–16-year-olds), using a two-phase design with the Lithuanian version of the Strengths and Difficulties Questionnaire (SDQ) in the first screening phase, and the Development and Well-Being Assessment (DAWBA) in the second diagnostic phase. Results The estimated point prevalence of ICD-10 psychiatric disorders was 13.1% for the total sample (14.0% for the child sample and 12.1% for adolescent sample). The most common groups of disorders were Conduct disorders 6.6% (7.1% for child sample and 6.0% for adolescent sample), Anxiety disorders 5.0% (5.9% for child sample and 6.0% for adolescent sample), with Hyperkinesis being less common 2.0% (2.7% for child sample and 1.2% for adolescent sample). Potential risk factors were related to individual characteristics of the child (gender, poor general health, and stressful life experiences), and the family (single parenthood, foster care, unfavourable family climate, disciplining difficulties, worries related to TV or computer use). Conclusions The overall prevalence of youth psychiatric disorders was relatively high in this representative Lithuanian sample compared to Western European countries. The SDQ and DAWBA measures appear useful for the further research and clinical practice in this society.
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Affiliation(s)
- Sigita Lesinskiene
- Faculty of Medicine, Institute of Clinical Medicine, Clinic of Psychiatry, Vilnius University, Vilnius, Lithuania.
| | | | - Grazina Gintiliene
- Faculty of Philosophy, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Dovile Butkiene
- Faculty of Philosophy, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Dainius Puras
- Faculty of Medicine, Institute of Clinical Medicine, Clinic of Psychiatry, Vilnius University, Vilnius, Lithuania
| | - Robert Goodman
- King's college London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Einar Heiervang
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Madsen KB, Ravn MH, Arnfred J, Olsen J, Rask CU, Obel C. Characteristics of undiagnosed children with parent-reported ADHD behaviour. Eur Child Adolesc Psychiatry 2018; 27:149-158. [PMID: 28733915 DOI: 10.1007/s00787-017-1029-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/15/2017] [Indexed: 12/01/2022]
Abstract
There is an ongoing public debate on the diagnosis of attention deficit hyperactivity disorder (ADHD) in which critics have claimed that the disorder is over-diagnosed, while the potential under-diagnosis of children with ADHD has received little attention. In this study we estimate the number of children with parent-reported ADHD behaviour at age 7 and absence of recorded ADHD diagnosis through adolescence, and investigate whether socio-demographic characteristics of this group differed from the children diagnosed with ADHD during follow-up. Our study was based on data from the Danish National Birth Cohort, where parents of 51,527 children completed questionnaires, including the Strength and Difficulties Questionnaire (SDQ). ADHD diagnosis was identified through Danish registers and parent-reported ADHD behaviour by the specific SDQ subscale. Socio-demographic predictors of positive parent-reported SDQ ADHD behaviour and absence of recorded ADHD diagnosis in their children were examined using logistic regression analyses. Children with parent-reported ADHD behaviour and no diagnosis (1.3%) were more likely to be girls (OR 1.83; 95% CI 1.45; 2.29), more likely to have mothers with a low socioeconomic status (OR high vs. low 1.49; 95% CI 1.10; 2.02), and to live in certain regions of the country (OR: Capital vs. Southern: 2.04; 95% CI 1.51; 2.73) than children with an ADHD diagnosis. The children showed markedly impairments on all the SDQ subscales. The results demonstrate a considerable number of children with ADHD symptoms who potentially go undetected and underline the influence of socio-demographic factors in the pathway to a diagnosis of ADHD.
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Affiliation(s)
- Kathrine Bang Madsen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Mette Holmelin Ravn
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Jon Arnfred
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Charlotte Ulrikka Rask
- Child and Adolescent Psychiatric Center, Aarhus University Hospital, Skovagervej 2, 8240, Risskov, Denmark.,Department of Clinical Medicine, Aarhus University, Barthsgade 5, 8200, Aarhus N, Denmark
| | - Carsten Obel
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Center for Collaborative Health, Aarhus University, Høegh Guldbergsgade 6, 8000, Aarhus C, Denmark
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36
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Jenkins R, Meltzer H, Brugha T, Bebbington P. A comment on the yield from national surveys of mental health. Int Psychiatry 2018. [DOI: 10.1192/s1749367600005452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Henderson and Andrews have written a timely paper to examine the yield from national surveys, and pose questions of value for money, survey methods, delineation of pathology by categorical boundaries rather than dimensions, and breadth of risk factors examined. We would like to address the points they raise, exemplified by the purposes (Jenkins et al, 1997) and yield of the British survey programme.
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Getanda EM, Vostanis P, O'Reilly M. Exploring the challenges of meeting child mental health needs through community engagement in Kenya. Child Adolesc Ment Health 2017; 22:201-208. [PMID: 32680411 DOI: 10.1111/camh.12233] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite growing evidence on the extent of child mental health problems in low-middle-income countries, the gap between need and provision remains high. Previous research in high income countries has demonstrated that evidence-based interventions can be scaled-up through community consultation, particularly by engaging key stakeholders. AIMS This study aimed to explore community stakeholders' views on children's mental health needs and culturally acceptable interventions in Kenya, to ascertain how to integrate global service standards with culturally-specific expectations. METHODS Focus groups were conducted with community stakeholders (seven young people 14-17 years, seven parents, nine teachers and 11 other professionals). These participants were recruited from an urban community of internally displaced and disadvantaged families in Nakuru. RESULTS Results indicated that Kenya faced similar challenges in meeting mental health needs as in other countries, including economic constraints, limited knowledge, stigma and systemic issues, but that these were manifested in culturally specific ways that were linked to societal and professional's attitudes and local context. CONCLUSIONS Stakeholders' views are important in informing the planning, delivery and evaluation of interventions. However, for such interventions to be sustained, a clear therapeutic framework, evidence-base and sociocultural adaptation are likely to be important factors.
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Affiliation(s)
- Elijah Mironga Getanda
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, UK
| | - Panos Vostanis
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, UK
| | - Michelle O'Reilly
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, UK
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Julian M, Lawler J, Rosenblum K. Caregiver-Child Relationships in Early Childhood: Interventions to Promote Well-Being and Reduce Risk for Psychopathology. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0110-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Owen DA, Hutchings J. An Evaluation of the Online Universal Programme COPING Parent: A Feasibility Study. J Public Health Res 2017; 6:819. [PMID: 28660177 PMCID: PMC5477476 DOI: 10.4081/jphr.2017.819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/05/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COPING parent (Confident Parent Internet Guide) is an online universal parenting programme designed for parents of children aged 3-8 who are interested in learning positive parenting strategies to address everyday parenting challenges. Most people now have access to the internet and many parents seek online parenting advice, so it is important to ensure that advice is both evidence-based and freely available. The 10-week online COPING parent programme presents information and activities based on core social learning theory principles. The programme provides information and video examples of parenting skills, uses quizzes to test knowledge and suggests home practice activities. This study was undertaken to obtain feedback on the usefulness and acceptability of the programme to inform its further development. DESIGN AND METHODS The programme was created using the LifeGuide software and participants (n=20) were asked to complete one chapter of the programme each week and provide feedback. This feasibility study was undertaken to highlight any technical issues and suggest modifications prior to a more rigorous evaluation. RESULTS Both participant feedback and programme usage data are reported. Thirteen feedback forms were returned and programme usage data was downloaded for all participants. Feedback suggested modifications that included adaptations to enable the programme to be accessed by tablet users, an option to look back over previously completed chapters, the inclusion of more video examples of positive parenting and text message prompting to address attrition challenges.
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Affiliation(s)
- Dawn Adele Owen
- Centre for Evidence Based Early Intervention, School of Psychology, Bangor University, UK
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A Randomized Controlled Trial of the Impact of a Family-Based Adolescent Depression Intervention on both Youth and Parent Mental Health Outcomes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 46:169-181. [DOI: 10.1007/s10802-017-0292-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Thomas PA, King JS, Mendelson JL, Nelson-Gray RO. Parental psychopathology and expectations for the futures of children with autism spectrum disorder. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:98-105. [DOI: 10.1111/jar.12337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Andrew Thomas
- Department of Psychology; The University of North Carolina at Greensboro; Greensboro NC USA
| | - Jake S King
- Department of Psychology; The University of North Carolina at Greensboro; Greensboro NC USA
| | - Jenna L Mendelson
- Department of Psychology; The University of North Carolina at Greensboro; Greensboro NC USA
| | - Rosemery O Nelson-Gray
- Department of Psychology; The University of North Carolina at Greensboro; Greensboro NC USA
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Bright MA, Knapp C, Hinojosa MS, Alford S, Bonner B. The Comorbidity of Physical, Mental, and Developmental Conditions Associated with Childhood Adversity: A Population Based Study. Matern Child Health J 2017; 20:843-53. [PMID: 26694043 DOI: 10.1007/s10995-015-1915-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) are associated with myriad health conditions and risk behaviors in both adolescents and adults. In this study we examine the association between ACEs and specific physical, mental, and developmental conditions, as well as their comorbidity, in a nationally representative sample of children 0-17 years. METHODS Data from the 2011-2012 National Survey for Child Health (NSCH) were used. A total of 95,677 random-digit-dial interviews with parents of children 0-17 years were conducted across all 50 states and the District of Columbia. Outcomes included singular condition domains (physical, mental, and developmental) as well as combinations of condition domains (e.g., physical plus mental, mental plus developmental, etc.). RESULTS Twenty-three percent of parents reported that their child experienced 1 ACE; 9.2 % experienced 2 ACEs, and 10.3 % experienced three or more. Across all three condition domains and combinations of domains, children who experienced at least one ACE were more likely than children who experienced 0 ACEs to have at least one condition. Additionally, greater ACEs was associated with increased likelihood of at least one condition in each domain and in multiple domains. CONCLUSIONS for practice These findings support the extension of existing family environment screening tools in pediatric practices as well as the establishment of a system for monitoring ACEs in families with multiple or complex conditions.
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Affiliation(s)
- Melissa A Bright
- Institute for Child Health Policy, University of Florida, 1329 SW 16th ST, Gainesville, FL, 32611, USA.
| | - Caprice Knapp
- Department of Health Policy and Administration, The Pennsylvania State University, State College, PA, USA
| | - Melanie S Hinojosa
- Department of Sociology, University of Central Florida, Orlando, FL, USA
| | - Shannon Alford
- Institute for Child Health Policy, University of Florida, 1329 SW 16th ST, Gainesville, FL, 32611, USA
| | - Brandy Bonner
- Institute for Child Health Policy, University of Florida, 1329 SW 16th ST, Gainesville, FL, 32611, USA
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Han ZR, Lei X, Qian J, Li P, Wang H, Zhang X. Parent and child psychopathological symptoms: the mediating role of parental emotion dysregulation. Child Adolesc Ment Health 2016; 21:161-168. [PMID: 32680355 DOI: 10.1111/camh.12169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Parental psychopathological symptoms have been associated with a number of child psychological problems, yet little research has examined the role of parental emotion dysregulation on the intergenerational transmission of psychopathological symptoms. This study aims to examine the relationship between parents' and children's psychopathological symptoms with a focus on the mediating mechanism of parental emotion dysregulation on these relationships. METHODS Eighty-nine Chinese parents and their school-age children between the ages of 7 and 12 (49 males, M age = 8.79, SD = 1.81) participated in the study. In the initial phase of the study, parents filled out a series of questionnaires reporting their own psychopathological symptoms via SCL-90 and difficulties with emotion regulation via Difficulties in Emotion Regulation Scale. After 9 months, the parents reported their children's internalizing and externalizing problems via Child Behavior Checklist, and the children self-reported anxiety symptoms via Screen for Child Anxiety Related Emotional Disorders in the second phase of the study. RESULTS The results showed that parental emotion dysregulation played an important role as a mediator of the relationship between parental psychopathological symptoms and child internalizing problems and separation anxiety, which indicates that parents' mental health problems were significantly associated with their difficulties with emotion regulation, which in turn led to more internalizing problems and separation anxiety in their children. However, we did not find a mediating effect of parental emotion dysregulation on the links between parent psychopathology and child externalizing problems or other types of self-reported anxiety symptoms. CONCLUSIONS Our findings highlighted the importance of implementing more psycho-education programs that specifically target parents' emotion regulation abilities in both community and clinical settings to ameliorate the intergenerational transmission of psychopathological symptoms between generations.
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Affiliation(s)
- Zhuo Rachel Han
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Xuemei Lei
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Jing Qian
- Beijing Normal University, 19 Xinjiekou Outer Street, Haidian District, Beijing, 100875, China
| | - Peipei Li
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Hui Wang
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Xutong Zhang
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China
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Schwenck C, Schneider W, Reichert A. Universal parent training as a supplement to inpatient psychiatric treatment for children and adolescents. Eur Child Adolesc Psychiatry 2016; 25:879-89. [PMID: 26707493 DOI: 10.1007/s00787-015-0810-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
Parent trainings constitute an effective method to target aspects of parenting in child and adolescent psychiatric and psychotherapeutic care. Past research has mainly been conducted in outpatient contexts, with parents of children with externalizing disorders and often included only small sample sizes. The aim of the current study was first to assess the effectiveness of a novel parent training which is characterized by a universal approach, an open group concept, and short duration, and second to identify variables that have an influence on the effectiveness. A sample of n = 151 parent-child dyads treated in an inpatient clinic was included in the study and randomly assigned to a treatment group and a waiting-list control group. As dependent measures served child behavior problems, dysfunctional parenting, parental mental health, and parental self-efficacy measured with parent-rated questionnaires prior to the training, post training and 3 months after discharge of the clinic. Additionally, a parent-child-interaction observation was conducted and rated by blind raters. Results indicated a general inpatient treatment effect on all dependent measures assessed with questionnaires. An additional effect of the parent training was only shown for parenting and parental mental health with the treatment group revealing better outcomes post training and at follow-up. No effects were found for the measures assessed by interaction observation. Out of a number of variables, only a low monthly income was associated with a higher reduction of dysfunctional parenting. Results indicate that parent training does not contribute additionally to standard inpatient care with respect to child behavior, but does have an influence on parental well-being, which might have a positive effect on the long run.
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Affiliation(s)
- Christina Schwenck
- Department of Clinical Child and Adolescent Psychology, University of Giessen, Otto-Behaghel-Str. 10 C, 35394, Giessen, Germany. .,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany.
| | - Wolfgang Schneider
- Department of Educational Psychology, University of Würzburg, Würzburg, Germany
| | - Andreas Reichert
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
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Van Assche E, Moons T, Van Leeuwen K, Colpin H, Verschueren K, Van Den Noortgate W, Goossens L, Claes S. Depressive symptoms in adolescence: The role of perceived parental support, psychological control, and proactive control in interaction with 5-HTTLPR. Eur Psychiatry 2016; 35:55-63. [PMID: 27077378 DOI: 10.1016/j.eurpsy.2016.01.2428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/28/2016] [Accepted: 01/30/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Parenting dimensions are associated with depressive symptoms in adolescents. We investigated the role of perceived parenting dimensions and gene-environment interactions between these perceived parenting dimensions and five well-known variable number of tandem repeats (VNTRs): 5-HTTLPR, STin2, DAT1, DRD4, and MAO-A, in depressive symptoms. METHODS From a non-clinical sample of 1111 Belgian adolescents (mean age: 13.79 years, SD=.94; 51% boys), 1103 adolescents consented for genetic research. Five VNTRs were analyzed using DNA from saliva samples. Perceived parenting dimensions (i.e., support, proactive control, psychological control, punishment, and harsh punishment) were examined using self-report scales completed by adolescents and their parents. Depressive symptoms were investigated using the CES-D self-report scale. Statistical analyses were performed in R using linear regression. RESULTS Parental support, as perceived by the adolescent, was negatively associated with depressive symptoms (CES-D) and psychological control was positively associated with these symptoms. The only interaction effect withstanding correction for multiple testing was observed for 5-HTTLPR and the difference in proactive control as perceived by adolescents in comparison to parents. Short-allele carriers showed more depressive symptoms when there was a higher discrepancy in proactive control as perceived by adolescents versus parents. CONCLUSIONS Our results suggest that perceived parenting dimensions are associated with depressive symptoms, as measured by the CES-D. We only found modest evidence for 5-HTTLPR as a moderator in the association between the difference in perception of proactive control (adolescents vs. parents) and depressive symptoms.
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Affiliation(s)
- E Van Assche
- GRASP-Research Group, Department of Neuroscience, University of Leuven, Leuven, Belgium; University Psychiatric Center KU Leuven, Leuven, Belgium.
| | - T Moons
- GRASP-Research Group, Department of Neuroscience, University of Leuven, Leuven, Belgium; OPZ Geel, Dr. Sanodreef 4, Geel, Belgium
| | - K Van Leeuwen
- Department of Parenting and Special Education, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - H Colpin
- Department of School Psychology and Child and Adolescent Development, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - K Verschueren
- Department of School Psychology and Child and Adolescent Development, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - W Van Den Noortgate
- Department of Methodology of Educational Sciences, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - L Goossens
- Department of School Psychology and Child and Adolescent Development, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - S Claes
- GRASP-Research Group, Department of Neuroscience, University of Leuven, Leuven, Belgium; University Psychiatric Center KU Leuven, Leuven, Belgium
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Preschoolers' psychophysiological responses to mood induction tasks moderate the intergenerational transmission of internalizing problems. Biol Psychol 2016; 117:159-169. [PMID: 27045275 DOI: 10.1016/j.biopsycho.2016.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 11/23/2022]
Abstract
To identify factors that can both exacerbate risk for, and protect against, internalizing problems during early childhood, the present study examined whether children's respiratory sinus arrhythmia (RSA) suppression in response to emotionally-laden film clips would moderate the association between maternal and child anxious/depressive symptoms in a cross-sectional sample of 108 mothers (M age=30.68years, SD=6.06) and their preschool-age children (M age=3.50years, SD=0.52, 61.30% male). Results indicated that RSA suppression in response to the fear clip moderated the positive association between maternal and child anxious/depressive symptoms, such that higher suppression served a protective-stabilizing function while lower suppression exacerbated children's risk for internalizing symptoms in the context of higher maternal symptoms. Moderation findings involving RSA suppression in response to a happiness-inducing clip were consistent with biological sensitivity to context; the association between maternal and child symptoms was strongest for children higher in suppression.
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Bowers ME, Yehuda R. Intergenerational Transmission of Stress in Humans. Neuropsychopharmacology 2016; 41:232-44. [PMID: 26279078 PMCID: PMC4677138 DOI: 10.1038/npp.2015.247] [Citation(s) in RCA: 262] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 01/03/2023]
Abstract
The hypothesis that offspring are affected by parental trauma or stress exposure, first noted anecdotally, is now supported empirically by data from Holocaust survivor offspring cohorts and other populations. These findings have been extended to less extreme forms of stress, where differential physical, behavioral, and cognitive outcomes are observed in affected offspring. Parental stress-mediated effects in offspring could be explained by genetics or social learning theory. Alternatively, biological variations stemming from stress exposure in parents could more directly have an impact on offspring, a concept we refer to here as 'intergenerational transmission', via changes to gametes and the gestational uterine environment. We further extend this definition to include the transmission of stress to offspring via early postnatal care, as animal studies demonstrate the importance of early maternal care of pups in affecting offsprings' long-term behavioral changes. Here, we review clinical observations in offspring, noting that offspring of stress- or trauma-exposed parents may be at greater risk for physical, behavioral, and cognitive problems, as well as psychopathology. Furthermore, we review findings concerning offspring biological correlates of parental stress, in particular, offspring neuroendocrine, epigenetic, and neuroanatomical changes, in an attempt to determine the extent of parental stress effects. Although understanding the etiology of effects in offspring is currently impeded by methodological constraints, and limitations in our knowledge, we summarize current information and conclude by presenting hypotheses that have been prompted by recent studies in the field.
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Affiliation(s)
- Mallory E Bowers
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA,Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Neuroscience, Icahn School of Medicine at Mount, NY, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, James J. Peters Veterans Affairs Medical Center, 526 OOMH PTSD 116/A, JJP VAMC, 130 W Kingsbridge Road, Bronx, NY 10468, USA, Tel: +718 741 4000, ext. 6964, Fax: +718 741 4703, E-mail:
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Petfield L, Startup H, Droscher H, Cartwright-Hatton S. Parenting in mothers with borderline personality disorder and impact on child outcomes. EVIDENCE-BASED MENTAL HEALTH 2015; 18:67-75. [PMID: 26205740 PMCID: PMC11234925 DOI: 10.1136/eb-2015-102163] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 06/16/2015] [Indexed: 11/03/2022]
Abstract
QUESTION This systematic review explores two questions: what parenting difficulties are experienced by mothers with borderline personality disorder (BPD); and what impact do these have on her children? STUDY SELECTION AND ANALYSIS Studies had to include mothers with a diagnosis of BPD, who was the primary caregiver to a child/children under 19 years. PsycINFO and MEDLINE were screened (update: July 2014), yielding 17 relevant studies. FINDINGS Mothers with BPD are often parenting in the context of significant additional risk factors, such as depression, substance use and low support. Interactions between mothers with BPD and their infants are at risk of low sensitivity and high intrusiveness, and mothers have difficulty in correctly identifying their emotional state. Levels of parenting stress are high, and self-reported competence and satisfaction are low. The family environment is often hostile and low in cohesion, and mothers with BPD show low levels of mind-mindedness but high levels of overprotection of older children. Outcomes for children are poor compared with both children of healthy mothers, and mothers with other disorders. Infants of mothers with BPD have poorer interactions with their mother (e.g., less positive affect and vocalising, more dazed looks and looks away). Older children exhibit a range of cognitive-behavioural risk factors (e.g., harm avoidance, dysfunctional attitudes and attributions), and have poorer relationships with their mothers. Unsurprisingly, given these findings, children of mothers with BPD have poorer mental health in a range of domains. CONCLUSIONS This review highlights the elevated need for support in these mother-child dyads.
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Affiliation(s)
- Lara Petfield
- School of Psychology, University of Sussex, Brighton, UK
| | - Helen Startup
- Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, UK
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Williams LK, McCarthy MC. Parent perceptions of managing child behavioural side-effects of cancer treatment: a qualitative study. Child Care Health Dev 2015; 41:611-9. [PMID: 25163511 DOI: 10.1111/cch.12188] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very little research has examined the role of parenting in managing behavioural side-effects of cancer treatment. The purpose of this paper was to explore parent perceptions of (a) parenting in the context of childhood cancer; (b) the parenting strategies used in the context of managing child behavioural side-effects of cancer treatment; and (c) the perceived impact that cancer-specific parenting strategies have on child behaviour. METHODS Participants were 15 mothers of children aged 2-6 years in the maintenance phase of treatment for acute lymphoblastic leukaemia at the Royal Children's Hospital Children's Cancer Centre, Melbourne, Australia. Mothers participated in a one-on-one semi-structured telephone interview using an interview guide which included questions on parenting in the context of childhood cancer, specifically in relation to behavioural side-effects (problems with behaviour, sleep and eating) and any perceived impact cancer-specific parenting may have on the ill child. RESULTS Many parents reported that following their child's cancer diagnosis, they had to implement a suite of 'new' strategies that 'pre-diagnosis' were used only in moderation, if at all. The most salient theme that emerged was parents' perception that their parenting became more lax since their child's diagnosis. Parents further reported specific parenting strategies for each of the main child behavioural side-effects of cancer treatment. CONCLUSION Data from the current qualitative exploratory study highlight the role of specific parenting strategies in managing or assisting child behavioural side-effects of cancer treatment. Further quantitative research is needed to more fully examine the association between parenting and child behavioural outcomes in order to develop modifiable approaches to improving child behavioural side-effects in a paediatric oncology context.
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Affiliation(s)
- L K Williams
- Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - M C McCarthy
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,Children's Cancer Centre, Royal Children's Hospital, Parkville, Vic., Australia
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Erkan M, Gencoglan S, Akguc L, Ozatalay E, Fettahoglu EC. Attachment styles and psychopathology among adolescent children of parents with bipolar disorder. Med Sci Monit 2015; 21:1083-8. [PMID: 25877235 PMCID: PMC4410723 DOI: 10.12659/msm.893372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to compare attachment styles and psychopathology in adolescent children of parents with bipolar disorder (BD) with a healthy control group. MATERIAL AND METHODS We studied 25 adolescents who had at least 1 parent with BD (BD group) and 28 adolescents who had no parents with BD (control group). The adolescent participants were between the ages of 12 and 17 years. We used the Adolescent Relationship Scales Questionnaire (A-RSQ) for the adolescents in the BD vs. control groups, and we used the Schedule for Affective Disorders and Schizophrenia for School-age Children - present and lifetime version (K-SADS-PL). We used the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version for each parent of adolescents in the BD and control groups to rule out psychopathologies. RESULTS Attachment styles of participants were assessed according to A-RSQ, dismissing attachment style scores of adolescents in BD group were found significantly higher compared to the healthy control group (p<0.05). As a result of the assessments, 12 adolescents (48%) out of 25 in the BD group and 5 adolescents (18%) out of 28 in the control group were given DSM-IV Axis I diagnosis, which is a statistically significant result (p<0.05). However, when psychiatric diagnoses were assessed separately, the difference was not statistically significant. CONCLUSIONS We found that the adolescent children of parents with BD have increased risk of developing mental illnesses, and that these adolescents adopt dismissing attachment styles.
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Affiliation(s)
- Mustafa Erkan
- Department of Child and Adolescent Psychiatry, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Salih Gencoglan
- Department of Child and Adolescent Psychiatry, Yuzuncu Yil University School of Medicine, Van, Turkey
| | - Leyla Akguc
- Department of Psychiatry, Mardin State Hospital, Mardin, Turkey
| | - Esin Ozatalay
- Department of Child and Adolescent Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey
| | - Emine Cigil Fettahoglu
- Department of Child and Adolescent Psychiatry , Akdeniz University School of Medicine, Antalya, Turkey
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