Prospective community study of family stress and anxiety in (pre)adolescents: the TRAILS study

Depression, anxiety, stress, and fear of COVID-19 among Bangladeshi medical students during the first wave of the pandemic: a mixed-methods study

Aim

This study aims to investigate depression, anxiety, stress, and fear of the COVID-19 pandemic and the associated risk factors among Bangladeshi medical students. It also explored qualitative insights on mental health from medical students during the first wave of the pandemic.

Methods

This mixed-methods study was conducted online in Bangladesh from June 2020 to September 2020. Participants were Bangladeshi medical students from the first year to the final year. The quantitative part included a structured online survey. One focus group discussion (FGD) was organized using the Zoom platform to collect qualitative insights from the students. To determine levels of stress, anxiety, and depression, the Bangla-validated version of the Depression, Anxiety, and Stress Scale 21 (DASS-21) was used. A 7-item and Bangla-validated Fear of COVID-19 Scale, also known as FCV-19S, was used to explore the COVID-19-specific fear of the students. A semi-structured topic guide was used for exploring the qualitative insights of medical students' perceptions of fear of COVID-19, mental health impacts during COVID-19, overall recommendations to support students, and the impact of the pandemic on the future of the medical curriculum.

Results

The study reported that 51.20%, 59.40%, and 64% of the 406 respondents had moderate to severe stress, anxiety, and depressive symptoms, respectively, according to the DASS-21. The mean fear score for the COVID-19 scale was 19.4 (SD 6.4). Respondents with family members aged 50 years or older (B = 2.1; CI: 0.3-3.9) and those who had infected family members (B = 1.9; 95% CI: 0.1-3.7) exhibited a higher level of fear of COVID-19. Moreover, depression was associated with a history of having cancer among family members (AOR = 2.9, CI: 1.1-7.5), anxiety was strongly associated with having symptoms of COVID-19 (AOR = 2, CI: 1.3-3.2), and stress was associated with having symptoms of COVID-19 infection among family members (AOR = 1.9, CI: 1.3-3). Altered sleep was a potential risk factor for developing stress, anxiety, and depression symptoms. Manual thematic analysis of qualitative data generated four major themes, including the perception of fear of COVID-19, the perception of mental health impacts during COVID-19, the change in the medical curriculum along with the pandemic, and recommendations from the medical students to support the mental health concerns of medical students during public health crises like this pandemic. Qualitative findings showed that the participants experienced fear of their parents becoming infected by COVID-19, and this fear was more prominent in those who had their loved ones hospitalized. They were also stressed and anxious, with thoughts of death. Their fear also extended to their thoughts on academic progress and the effectiveness of online classes.

Conclusion

A substantial proportion of medical students experienced mental health difficulties in Bangladesh. Appropriate interventions should be designed, and adequate support should be provided to the medical students to protect their mental health and wellbeing, considering their potential impact on the future health system in a low-resource setting like Bangladesh.

Family Socioeconomic Status and Parental Involvement in Chinese Parents of Children with Autism Spectrum Disorder: A Moderated Mediation Model

Parental involvement benefits children with autism spectrum disorder (ASD) in multiple developmental areas. We conducted the present study to examine the role of parenting stress and ASD symptom severity in the relationship between family socioeconomic status (SES) and parental involvement. A total of 165 Chinese parents of children with ASD participated in this study. Mediation analyses indicated that family SES was positively related to parental involvement; parenting stress partially mediated the relationship between family SES and parental involvement. The analyses also found that ASD symptom severity moderated the influence of parenting stress on parental involvement. Specifically, the decreased parenting stress improved parental involvement when ASD symptom severity was low. The findings enhanced our understanding of the mechanism underlying the relationship between family SES and parental involvement among parents facing considerable child-rearing challenges. Implications for devising evidenced-based interventions to promote parental involvement for low SES children with ASD are discussed.

The relationship between negative life events and non-suicidal self-injury (NSSI) among Chinese junior high school students: the mediating role of emotions

BACKGROUND

Adolescent non-suicidal self-injury (NSSI) is common and adolescence is the most common period of first self-injury, and the occurrence of NSSI is influenced by negative life events and emotional symptoms. The mediating role of emotional symptoms in the interaction between negative life events and NSSI has not been carefully investigated yet.

METHODS

For middle school students in three schools in a Chinese province, the Adolescents Self-Harm Scale was used to investigate NSSI, the Adolescent Self-Rating Life Events Check List was used to investigate adolescent negative life events, and the Self-Rating Anxiety Scale and Self-Rating Depression Scale were used to assess their emotional symptoms. After the description of general data and the test for differences between groups, the relationship between negative life events, emotional symptoms and NSSI was analyzed using Pearson correlation analysis. Structural equation modeling was used to analyze the mediating role of emotions in negative life events and NSSI.

RESULTS

A total of 2376 junior high school students completed this survey, which revealed an annual NSSI prevalence of 37.1% (n = 881) and a higher prevalence of NSSI among girls and rural adolescents. Among adolescents who developed NSSI, 67.4% (N = 594) used multiple means of self-injury. The most common means of self-injury was hair pulling (51.0%), and the most common NSSI purpose and external factors/events were venting bad emotions or feelings (57.5%) and poor academic performance (44.9%), respectively. Negative life events, emotional symptoms and NSSI were positively associated (P < 0.05). Structural equation modeling with negative life events, emotional symptoms and NSSI as variables showed that the model-fit index matched the data well, with RMSEA = 0.073, AGFI = 0.945, GFI = 0.980, CFI = 0.985, NFI = 0.982, TLI = 0.968, IFI = 0.985, and negative life events, emotional symptoms (anxiety, depression) and NSSI all had direct effects with standardized path coefficients of 0.16, 0.19, and 0.23, respectively, with negative life events playing an indirect role in NSSI through emotional symptoms and emotional symptoms playing an incomplete mediating role in negative life events and NSSI.

CONCLUSION

The prevalence of NSSI was higher among Chinese junior high school students. Both negative life events and emotional symptoms were direct risk factors for NSSI. In addition, negative life events were also indirect risk factors for NSSI, and emotional symptoms played an incomplete mediating role in the relationship between the effects of negative life events and NSSI. This indicates that the combination of reducing the frequency of negative life events while maintaining individual emotional stability during adolescent development can effectively reduce the prevalence of NSSI in adolescents.

Does Child Anxiety Exacerbate or Protect Against Parent–Child Relationship Difficulties in Children with Elevated ADHD Symptoms?

Pediatric ADHD is associated with parent–child relationship difficulties. However, the extent to which these relations are attributable to specific ADHD symptom clusters (i.e., inattentive vs. hyperactive/impulsive), and the extent to which child anxiety symptoms may exacerbate or protect against these difficulties, remains unclear. To address these gaps in the literature, the current study combined multi-informant measures (parent, teacher, child) with a clinically-evaluated and carefully-phenotyped sample of 188 children with and without ADHD and anxiety (ages 8–13; 63 girls). Results indicated that child-reported anxiety (β = .46) and teacher-reported inattentive (β = .71) symptoms, and their interaction (β = -1.06), along with child age and IQ (β = -.14 to -.15), predict the extent to which parents perceive themselves as confident and competent parents (all p < .05). In contrast, only comorbid oppositional-defiant disorder conferred risk for increased parent-reported relational frustration, and we were unable to detect any reliable child-level demographic, diagnostic, or behavioral predictors of parent-reported discipline practices. These findings were robust to control for child demographic characteristics, clinical diagnoses, and intellectual functioning, with sensitivity analyses highlighting the importance of assessing ADHD inattentive vs. hyperactive/impulsive symptoms separately for understanding parenting outcomes. Taken together, the current findings suggest that child ADHD and anxiety symptoms may influence specific rather than broad-based aspects of the parent–child relationship, and produce differently valenced outcomes in the presence vs. absence of the other condition. Interestingly, it appears that the combination of greater child inattention and anxiety, rather than elevations in either symptom domain independently, predict adverse parenting outcomes in terms of reduced parental confidence.

Neural correlates of distraction and reappraisal in the family context: Associations with symptoms of anxiety and depression in youth

Objective: Youth coping is consistently associated with risk and resilience for youth internalizing psychopathology. Integrating questionnaire and experimental methods is an important next step in understanding how youth develop, learn, and implement these skills and to identify possible neurobiological mechanisms that underlie these processes. The current study aims to explore associations among youth self-reported and laboratory-based measures of two methods of coping (distraction and reappraisal). Further, the current study aims to examine associations among neural correlates of distraction and reappraisal with symptoms of anxiety and depression in youth.Methods: Youth (N = 69; M = 12.24, SD = 1.83; 52.9% female) completed self-report measures of secondary control coping (RSQ) and symptoms of anxiety (SCARED) and depression (CES-D) and a laboratory coping task. While completing the task, prefrontal hemodynamic changes were measured using functional near-infrared spectroscopy (fNIRS).Results: Neural activation during reappraisal was significantly negatively correlated with youth anxiety symptoms, and both neural activation and self-reported coping were significant independent predictors of anxiety. Youth self-reported coping was not associated with neural activation during reappraisal or distraction.Conclusions: The measurement of possible neural markers of risk and resilience in youth is an important area of continued research. Identification of possible mechanisms of change related to anxiety and depression in youth may inform targets of intervention.

School-related pressure and parental support as predictors of change in student stress levels from early to middle adolescence

INTRODUCTION

One major stressor of adolescents relates to the pressure students perceive from their parents accompanied by high academic expectations, while in contrast parental support is related to low levels of stress. However, it is not clear whether the perceived parental pressure and support contribute to a change in students' stress level from early to middle adolescence and if there are differences among students from low vs. high track schools.

METHODS

Thus, based on the conservation of resources theory, this two-wave study examined the role of perceived maternal and paternal pressure and support for students' general stress level from grades 8 to 9 among students attending high- and low-track schools by applying multigroup multilevel latent change modeling based on data from 1088 8^th grade students (M_Age = 13.70, SD = 0.53, 53.9% girls at Time 1).

RESULTS

Results indicate that the general stress level from early to middle adolescence increases for students from low-track schools only. This change increases even more if students from lowtrack schools perceive pressure from their fathers, whereas perceived paternal support dampen the increase of stress. For students from high-track schools, perceived maternal pressure is positively and maternal support negatively related to students' stress level in grade 8. Overall, boys tend to report lower stress levels compared to girls.

CONCLUSIONS

The findings of the present study support the conservation of resources theory, as both perceived support and pressure from parents and the educational context predict students' stress development during adolescence.

Abnormal asymmetry of thalamic volume moderates stress from parents and anxiety symptoms in children and adolescents with social anxiety disorder

Social anxiety disorder (SAD) usually onsets in childhood or adolescence and is associated with brain development and chronic family stress during this period. As an information hub, the thalamus plays a crucial role in the development of emotion processing and stress regulation. Its structural and functional lateralization have been related to mental disorders. This study examined the age-dependent asymmetry of the thalamic volume in children and adolescents with SAD. We further examined the role of the thalamic asymmetry in moderating the relationships between parental alienation, which is a main source of familial stress for children and adolescents, and anxiety symptoms in this population. Fifty-three medication-free children and adolescents with SAD and 53 typical developing controls (age: 8-17) were included. Anxiety severity was measured using the Screen for Child Anxiety-Related Emotional Disorders (SCARED). We estimated the bilateral thalamic volume and examined diagnosis effect and age-group difference on the thalamic asymmetry. We further examined the moderation of the thalamic asymmetry on the associations between scores on the parental alienation, social phobia, and total SCARED. Compared with controls, the SAD group exhibited significantly abnormal asymmetry in thalamic volume. This asymmetry became more evident in the older age group. Furthermore, this asymmetry significantly weakened the relationships between parental attachment and total SCARED score. The asymmetry of the thalamic volume and its age-group difference provide novel evidence to support brain developmental abnormalities in children and adolescents with SAD. The findings further revealed interactions between physiological and chronic stress in children and adolescents with SAD. This article is part of the special issue on 'Stress, Addiction and Plasticity'.

The association of developmental trajectories of adolescent mental health with early-adult functioning

Background

Mental health problems during adolescence may create a problematic start into adulthood for affected individuals. Usually, categorical indicators of adolescent mental health issues (yes/no psychiatric disorder) are used in studies into long-term functional outcomes. This however does not take into account the full spectrum of mental health, nor does it consider the trajectory of mental health problem development over time. The aim of this study was twofold: (1) to identify distinct developmental trajectories of (co-occurring) internalizing and externalizing mental health symptoms over the course of adolescence (ages 11–19), and (2) to document the associations between these adolescent trajectories and economic, social, and health outcomes in young adulthood (age 22), unadjusted and adjusted for childhood functioning, putative confounders and current mental health.

Methods

Data were used from the Dutch TRAILS cohort study (subsample n = 1524, 47.3% males). Self-reported INT and EXT symptoms using the Youth/Adult Self Report were assessed four times (ages 11y, 13y, 16y, 19y). Adolescent mental health trajectories were estimated using Parallel-Processes Latent Class Growth Analyses. Self-reported economic, social, and health outcomes and parent-reported current mental health (using Adult Behaviour Checklist) were assessed at age 22. Multiple logistic regression analyses were performed to test associations between trajectories and outcomes.

Results

Four distinct trajectory classes were identified: (1) a normative class with decreasing-low INT+EXT symptoms (n = 460), (2) continuous moderately-high INT+EXT (n = 298), (3) continuous moderate, INT>EXT (n = 414), and (4) decreasing moderate, EXT>INT (n = 352). Compared to the normative class, the other three trajectories generally predicted less optimal early-adult outcomes, with the strongest effects observed for individuals with continuous moderate-high levels of both INT and EXT symptoms throughout adolescence. The associations largely remained after adjustment for pre-adolescent functioning, selected confounders and current mental health.

Conclusions

Both adolescent trajectories and current mental health had substantial independent effects on early-adult functioning.

Relationships Among Emerging Adult Psychological Problems, Maltreatment, and Parental Psychopathology: Moderation by Parent-Child Relationship Quality

Current research supports clear relationships between parental psychopathology, parental maltreatment, and emerging adult child psychopathology. Less research has examined how the role of the parent-child relationship influences these existing associations. The current study tested two models that examined the moderating effect of parent-child relationship quality on parental psychopathology and emerging adult mental health as well as the effect on parental maltreatment and emerging adult mental health. It was expected that high parent-child relationship quality would buffer against the negative effects of parental psychopathology and maltreatment while enhancing the effects of functional parenting characteristics. Participants included 1,452 emerging adults, predominantly Caucasian (73.3%) college students who completed surveys on their mental health, recent experienced maltreatment, and their parents' mental health problems. Results suggested lowest rates of mental health problems for emerging adults were associated with higher parent-child relationship quality and lower parental psychological problems, whereas negative outcomes were associated with higher parental psychopathology, regardless of parent-child relationship quality. Additionally, physical maltreatment was associated with lower rates of mental health concerns in the context of higher mother-daughter relationship quality. Results emphasize the continuing impact of the parent-child relationship, particularly the mother-daughter relationship, on emerging adults' mental health. Moreover, the current study demonstrates the continuing influence of parents on their emerging adult children.

Association Between Caregiver Stress and Behavioral Problems in the Children of Incarcerated Fathers in Hong Kong

Objectives Caregivers of children with incarcerated parents have received little attention in the literature, though they face unique incarceration-related challenges. General caregiver research has highlighted associations between caregiver distress and children's behavioral problems, even implying that the depressive tendencies of caregivers can be 'transmitted'. The current study investigated the applicability of this notion to caregivers responsible for children of incarcerated fathers. Methods Fifty-four female caregivers of children with incarcerated parents were recruited via collaboration with a non-governmental organization. Their levels of stress and depression were measured using questionnaires, as were the behavioral problems of children under their care. The relationships between the variables were examined. Results The results firstly suggest that these caregivers are vulnerable to psychological distress, with around 57 % of them suffering from borderline to severe depression. Obtained socio-demographic characteristics were not found to have any bearing on the psychosocial functioning of caregivers or children-rather, all psychosocial variables were interlinked, and further analyses revealed that the depression of caregivers mediated the relationship between their perceived stress and internalizing/externalizing behavioral problems of the child (β = .628 and β = .468 respectively), implicating depression as a mechanism via which adversity can be transferred from a caregiver to a child. Conclusions Increasing the focus on a caregiver's mental health may be an efficacious strategy in research and practice, perhaps by providing more support for caregivers and implementing joint caregiver-child interventions to more holistically alleviate problems in families affected by parental incarceration. Limitations of the current study and further recommendations are also discussed.

Stressful Life Events and Child Anxiety: Examining Parent and Child Mediators

While a number of factors have been linked with excessive anxiety (e.g., parenting, child temperament), the impact of stressful life events remains under-studied. Moreover, much of this literature has examined bivariate associations rather than testing more complex theoretical models. The current study extends the literature on life events and child anxiety by testing a theory-driven meditational model. Specifically, one child factor (child cognitions/locus of control), two parent factors (parent psychopathology and parenting stress), and two parent-child relationship factors (parent-child dysfunctional interaction and parenting style) were examined as mediators in the relationship between stressful life events and severity of child anxiety. One hundred and thirty anxious parents and their nonanxious, high-risk children (ages ranged from 7 to 13 years) participated in this study. Results indicated that levels of parenting stress, parental anxious rearing, and dysfunctional parent-child interaction mediated the association between stressful life events and severity of anxiety symptoms. Child cognition and parent psychopathology factors failed to emerge as mediators. Findings provide support for more complex theoretical models linking life events and child anxiety and suggest potential targets of intervention.

Associations between parents' subjective time pressure and mental health problems among children in the Nordic countries: a population based study

Background

The home, the family and the parents represent a context of everyday life that is important for child health and development, with parent-child relationships highlighted as crucial for children’s mental health. Time pressure is an emerging feature of modern societies and previous studies indicates that parents with children living at home experience time pressure to a greater extent than people with no children living at home. Previous studies of children’s mental health in relation to parents’ time pressure are lacking. Hence, the purpose of this study was to examine the association between parents’ subjective time pressure and mental health problems among children in the Nordic countries as well as potential disparities between boys and girls in different age groups.

Methods

4592 children, aged 4-16 from Denmark, Finland, Norway and Sweden, participating in the 2011 version of the NordChild study, were included. The Strength and Difficulties Questionnaire was used to measure children’s mental health and associations to parents’ time pressure were assessed by multiple logistic regression analysis.

Results

Among children of parents experiencing time pressure, 18.6% had mental health problems compared to 10.1% among children of parents experiencing time pressure not or sometimes. The odds of mental health problems were higher among both boys (OR 1.80 95% CI 1.32-2.46) and girls (OR 1.95 95% CI 1.42-2.66) if their parents experienced time pressure when adjusted for financial stress. The highest prevalence of mental health problems in the case of parental time pressure was found among girls 13-16 years old (23.6%) and the lowest prevalence was found among boys 13-16 years old (10.7%).

Conclusions

In this study an association between parents’ subjective time pressure and increased mental health problems among children was found. Given that time pressure is a growing feature of modern societies, the results might contribute to an explanation as to mental health problems are common among children in the Nordic countries in spite of otherwise favourable conditions. Additional research on the linkage between parents’ experienced time pressure and children’s and adolescents’ mental health problems is needed to confirm the novel findings of this study.

The role of the mother-child relationship for anxiety disorders and depression: results from a prospective-longitudinal study in adolescents and their mothers

This study aims to examine whether (a) low child valence (emotional connectedness) within the mother-child relationship increases the risk for offspring depression, (b) low child potency (individual autonomy) increases the risk for offspring anxiety, and (c) maternal psychopathology pronounces these associations. We used data from a prospective-longitudinal study of adolescents (aged 14-17 at baseline) and their mothers (N = 1,015 mother-child dyads). Anxiety disorders and depression were assessed repeatedly over 10 years in adolescents (T0, T1, T2, T3) and their mothers (T1, T3) using the DSM-IV/M-CIDI. Valence and potency were assessed in mothers (T1) with the Subjective Family Image Questionnaire. Odds ratios (OR) from logistic regression were used to estimate associations between low child valence/potency and offspring psychopathology (cumulated lifetime incidences; adjusted for sex and age). In separate models (low valence or low potency as predictor), low child valence predicted offspring depression only (OR = 1.26 per SD), while low child potency predicted offspring anxiety (OR = 1.24) and depression (OR = 1.24). In multiple models (low valence and low potency as predictors), low child valence predicted offspring depression only (OR = 1.19), while low child potency predicted offspring anxiety only (OR = 1.22). Low child potency interacted with maternal anxiety on predicting offspring depression (OR = 1.49), i.e. low child potency predicted offspring depression only in the presence of maternal anxiety (OR = 1.33). These findings suggest that low child valence increases the risk for offspring depression, while low child potency increases the risk for offspring anxiety and depression and interacts with maternal psychopathology on predicting offspring depression.

Psychosocial determinants of mental health and risk behaviours in adolescents

This study aimed at identifying the prevalence of emotional problems among children and adolescents in Portugal. Gender, developmental aspects, their psychosocial determinants, and the time trends over 8 years were also explored.

The three waves of a cross-sectional survey obtained from the HBSC nationally representative samples of 10-17 year old children and adolescents in 1998, 2002, and 2006, were used. Specific composite indexes included emotional and somatic symptoms, substances’ use, demographic and psychosocial factors.

Girls reported more emotional symptoms, and boys reported more substances’ use. Emotional symptoms and substances’ use increased with age, in contrast school commitment and perception of safe neighbourhood decreased with age. With age, the communication with the family tends to become more difficult, while communication with the friends tends to become easier. Along the three waves, substances’ use and emotional symptoms have shown a general pattern of decrease.

Results were discussed according to literature and their consequences for the understanding of emotional problems and substance use in childhood and adolescence.

Mental health promotion includes both the prevention of emotional problems and risk behaviours; determinants include individual factors and a range of psychosocial factors. Mental health problems have a huge impact on adolescents’ well-being; however it is often a poorer area of intervention in school based interventions. Gender differences are highlighted.

Discrepancies in Adolescents' and their Mothers' Perceptions of the Family and Adolescent Anxiety Symptomatology

OBJECTIVE

This study examines relations between adolescents' and their mothers' perceptions of the family and adolescent anxiety symptomatology.

DESIGN

Surveys were administered to 145 15- to 18-year-old adolescents and their mothers.

RESULTS

Adolescents viewed the family more negatively than did their mothers. In addition, adolescent girls' perceptions of the family (satisfaction and communication) negatively predicted later adolescent anxiety symptomatology. Significant interactions between adolescent and mother reports of family satisfaction and communication also were found for girls, but not for boys. For girls, discrepant family perceptions with their mothers appeared to protect them from anxiety if their mothers had negative perceptions of the family.

CONCLUSIONS

Understanding the similarities and differences among family members' perspectives yields useful predictive information that cannot be obtained from studying these perspectives in isolation from one another.

Postnatal depression mediates the relationship between infant and maternal sleep disruption and family dysfunction

BACKGROUND

Previous research has linked family sleep disruption and dysfunction in children; however, the mechanism is unknown.

AIMS

This study examined whether maternal sleep and postnatal depression (PND) mediate the relationship between infant sleep disruption and family dysfunction.

STUDY DESIGN AND PARTICIPANTS

Mothers of infants aged 12 months old (N=111; 48% male) completed infant and parent sleep surveys, the Edinburgh Postnatal Depression Scale and the Family Assessment Device.

RESULTS

Poor infant sleep was related to poor maternal sleep, which was associated with higher PND and higher level of family dysfunction.

CONCLUSIONS

Results are consistent with the proposition that identification of both infant and maternal sleep problems during infancy can be relevant to reduction of PND and improved family functioning.

The TRacking Adolescents' Individual Lives Survey (TRAILS): design, current status, and selected findings

OBJECTIVES

The objectives of this study were as follows: to present a concise overview of the sample, outcomes, determinants, non-response and attrition of the ongoing TRacking Adolescents' Individual Lives Survey (TRAILS), which started in 2001; to summarize a selection of recent findings on continuity, discontinuity, risk, and protective factors of mental health problems; and to document the development of psychopathology during adolescence, focusing on whether the increase of problem behavior often seen in adolescence is a general phenomenon or more prevalent in vulnerable teens, thereby giving rise to diverging developmental pathways.

METHOD

The first and second objectives were achieved using descriptive statistics and selective review of previous TRAILS publications; and the third objective by analyzing longitudinal data on internalizing and externalizing problems using Linear Mixed Models (LMM).

RESULTS

The LMM analyses supported the notion of diverging pathways for rule-breaking behaviors but not for anxiety, depression, or aggression. Overall, rule-breaking (in both genders) and withdrawn/depressed behavior (in girls) increased, whereas aggression and anxious/depressed behavior decreased during adolescence.

CONCLUSIONS

TRAILS has produced a wealth of data and has contributed substantially to our understanding of mental health problems and social development during adolescence. Future waves will expand this database into adulthood. The typical development of problem behaviors in adolescence differs considerably across both problem dimensions and gender. Developmental pathways during adolescence suggest accumulation of risk (i.e., diverging pathways) for rule-breaking behavior. However, those of anxiety, depression and aggression slightly converge, suggesting the influence of counter-forces and changes in risk unrelated to initial problem levels and underlying vulnerability.

Life course pathways to prenatal maternal stress

OBJECTIVE

To evaluate the impact of childhood stressors, recalled childhood stress, and stressors in adulthood on perceived stress in pregnancy.

DESIGN

Prospective cohort study.

SETTING

Pregnant women were recruited from pre-birth clinics in two communities.

PARTICIPANTS

Four-hundred and twenty-one pregnant women.

RESULTS

Perceived prenatal maternal stress was the main outcome measure. Recalled childhood stress was positively associated with prenatal stress (β = .54) after adjusting for other child and adult factors. Low family cohesion during childhood was indirectly associated with prenatal stress through its effects on recalled childhood stress, current family cohesion, and current subjective socioeconomic position (SEP). Low levels of adult subjective SEP (β = -.44) and family cohesion (β = -.25) were directly associated with prenatal stress. Perceived social support during childhood was indirectly associated with prenatal stress through its effect on recalled childhood stress and perceived social support in adulthood. Childhood subjective SEP indirectly influenced prenatal stress through its effect on adult subjective SEP and recalled childhood stress.

CONCLUSIONS

Prenatal stress is a result of the interplay between factors from childhood and adulthood. The study findings can be used to inform psychosocial risk assessment and interventions across the lifespan to decrease prenatal stress and its adverse outcomes.