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Ipekci B, Thibeau H, Barnard E, Keshavan MS, Bye AV, Kline ER. First episode psychosis caregiver perspectives on motivational interviewing for loved ones training: A qualitative study. Early Interv Psychiatry 2024; 18:553-560. [PMID: 38323386 PMCID: PMC11236525 DOI: 10.1111/eip.13500] [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: 01/30/2023] [Revised: 10/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Past research has found that family involvement in psychosis treatment leads to better patient outcomes. Thus, caregiver communication skills training can be a viable approach to reducing caregiver stress and increasing self-efficacy and communication. AIM The purpose of this qualitative study was to describe family caregivers' perceptions of changes in themselves and their family member with psychosis following their participation in Motivational Interviewing in Loved Ones (MILO), a brief four to five-hour psychoeducational intervention for caregivers. METHODS Sixty-three participants in the MILO trials provided written qualitative responses to the prompt, "Since learning the ideas and techniques in this course, what is the most significant change you noticed in yourself, your family, or your relationships?" Responses were collected immediately following MILO participation and 12 weeks later. Qualitative themes were identified through an iterative consensus process. RESULTS Most participants reported positive changes in multiple domains of their lives. Major themes included: (1) Changes in Self, (2) Changes in Relationships, (3) Changes in Mindset, (4) Use of MILO Skills, and (5) Challenges. CONCLUSION Qualitative results support and add context to the previously reported quantitative results from this study. MILO is a promising family intervention that positively influenced family environment and communication in pilot trials. Adaptations of MILO for families outside of a highly educated North American context should be considered.
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Affiliation(s)
- Bediha Ipekci
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather Thibeau
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
| | - Emily Barnard
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Akansha Vaswani Bye
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Emily R Kline
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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2
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Stiede JT, Spencer SD, Onyeka O, Mangen KH, Church MJ, Goodman WK, Storch EA. Obsessive-Compulsive Disorder in Children and Adolescents. Annu Rev Clin Psychol 2024; 20:355-380. [PMID: 38100637 DOI: 10.1146/annurev-clinpsy-080822-043910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Obsessive-compulsive disorder (OCD) in children and adolescents is a neurobehavioral condition that can lead to functional impairment in multiple domains and decreased quality of life. We review the clinical presentation, diagnostic considerations, and common comorbidities of pediatric OCD. An overview of the biological and psychological models of OCD is provided along with a discussion of developmental considerations in youth. We also describe evidence-based treatments for OCD in childhood and adolescence, including cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) and pharmacotherapy. Finally, research evaluating the delivery of CBT in different formats and modalities is discussed, and we conclude with suggestions for future research directions.
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Affiliation(s)
- Jordan T Stiede
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Ogechi Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Katie H Mangen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Molly J Church
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
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3
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Selah K, Gustafsson HC, Morton HE, Sims Z, Peris T, Karalunas SL, Nigg JT. Associations between Computationally Derived Parent Emotional Sentiment Scores and Child ADHD and ODD Over Time. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01217-6. [PMID: 38898357 DOI: 10.1007/s10802-024-01217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
Family emotional climate is often assessed as expressed emotion (EE) using the five-minute speech sample (FMSS). Parent EE is related to child externalizing behavior, but the relationship with ADHD apart from externalizing is unclear. We report the largest ADHD-non-ADHD study of EE to date, introduce computational scoring of the FMSS to assay parent negative sentiment, and use this to evaluate reciprocal parent-child effects over time in ADHD while considering comorbid ODD. Parents of 810 children (nADHD = 509), aged 7-13 years old, completed the FMSS at three points. The FMSS was expert-coded for EE-Criticism at Time 1 and Time 2, negative sentiment was scored at all three time points. Sentiment and EE-Criticism were moderately correlated (r =.39, p <.001, 95% CI [0.32, 0.46]), and each was similarly correlated with baseline ADHD symptoms (r's range 0.31-0.33, p <.001) and ODD symptoms (r(ODD-EE) = 0.35, p <.001; r(ODD-sentiment = 0.28, p <.001). A longitudinal, cross-lagged panel model revealed that increases over time in parental negative sentiment scores led to increased ODD symptoms. Parent sex (namely fathers, but not mothers) showed an interaction effect of sentiment with ADHD. ADHD and ODD are independently and jointly associated with parental EE-Criticism and negative sentiment assessed by the FMSS cross-sectionally. A recursive effects model is supported for ODD, but for ADHD effects depend on which parent is assessed. For fathers, ADHD was related to negative sentiment in complex manners but for mothers, negative sentiment was related primarily to ODD.
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Affiliation(s)
| | | | | | - Zachary Sims
- Oregon Health & Science University, Portland, OR, USA
| | - Tara Peris
- University of California, Los Angeles, CA, USA
| | | | - Joel T Nigg
- Oregon Health & Science University, Portland, OR, USA
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4
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Girdhar A, Patil R, Bezalwar A. Understanding the Dynamics: A Comprehensive Review of Family Therapy's Impact on Expressed Emotions in Schizophrenia Patients. Cureus 2024; 16:e59491. [PMID: 38826934 PMCID: PMC11143378 DOI: 10.7759/cureus.59491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
This comprehensive review examines the impact of family therapy on expressed emotions (EE) within the context of psychiatric disorders. EE, characterized by high levels of criticism, hostility, or emotional over-involvement, have been consistently linked to poorer treatment outcomes and increased severity of psychiatric symptoms. The review explores various family therapy approaches and their effectiveness in reducing high EE levels in families of psychiatric patients. It synthesizes existing literature to highlight the mechanisms underlying the changes in EE, such as modifying communication patterns and enhancing family cohesion. Additionally, the review discusses the implications for clinical practice, emphasizing the importance of integrating family therapy into psychiatric treatment plans and providing psychoeducation to empower families to manage emotions effectively. Future research directions are also outlined, including investigating the long-term sustainability of changes brought about by family therapy and exploring cultural considerations in therapeutic approaches. Overall, the review underscores the pivotal role of family therapy in addressing EE and promoting recovery and resilience in psychiatric patients and their families.
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Affiliation(s)
- Anshita Girdhar
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ragini Patil
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Apurva Bezalwar
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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5
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Lo HHM, Lam J, Zhang ZJW, Cheung M, Chan SKC, Wong EWY, Bögels SM, Chui WH. Effects of an online mindfulness-based program for parents of children with attention deficit/hyperactivity disorder: a pilot, mixed methods study. Front Psychiatry 2024; 15:1376867. [PMID: 38807691 PMCID: PMC11131379 DOI: 10.3389/fpsyt.2024.1376867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/09/2024] [Indexed: 05/30/2024] Open
Abstract
Objectives Online mindfulness-based program (MBP) for parents and families especially in clinical population is limited. Engagement and significant dropout are major issues in MBP implementation. This pilot study examined the effects of an online mindfulness-based program (MBP) on parents of children with Attention Deficit/Hyperactivity Disorder (ADHD). Methods A mixed methods study was applied to evaluate the effects of the MBP. A total of 43 parents were recruited and were randomly assigned into intervention group and waitlist control group. The online MBP lasted for 28 days, including 20 psychoeducation videos, homework audio guidance, and four instructor-led online group meetings. Purposive sampling was used to recruit parents who completed the program to share their experiences and suggestions for improving the program in semi-structured online interviews. Results Quantitative data showed that participants from the online MBP reported a medium to large effect on the reduction of child ADHD symptoms. In semi-structured interviews, participants reported positive experiences in their help seeking intention, and personal changes, such as emotion regulation and quality attention to their children. Participants further made suggestions for improvement. Conclusions The effect of online MBP is promising, and the program should be conducted. A large scale randomized controlled trial should be conducted to investigate the effects of MBP in clinical populations. Clinical trial registration ClinicalTrials.gov NCT05480423.
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Affiliation(s)
- Herman Hay Ming Lo
- Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Professional Practice and Assessment Centre, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Jason Lam
- University of Southampton, Southampton, United Kingdom
| | - Zoe Ji-wen Zhang
- Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Marsena Cheung
- Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | | | | | - Susan M. Bögels
- UvA minds Academic Treatment Centre for Parent and Child, University of Amsterdam, Amsterdam, Netherlands
| | - Wing Hong Chui
- Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Professional Practice and Assessment Centre, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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6
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Thompson RJ, Whalen DJ, Gilbert K, Tillman R, Hennefield L, Donohue MR, Hoyniak CP, Barch DM, Luby JL. Preadolescent Suicidal Thoughts and Behaviors: An Intensive Longitudinal Study of Risk Factors. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00184-9. [PMID: 38604472 DOI: 10.1016/j.jaac.2024.03.018] [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: 09/05/2023] [Revised: 03/06/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Dramatic increases in rates of suicidal thoughts and behaviors (STBs) among youth highlight the need to pinpoint early risk factors. This study used intensive longitudinal sampling to assess what the concurrent associations were between risk factors and STB status, how proximal changes in risk factors were related to STB status, and how risk factors prospectively predicted changes in STB status in a preadolescent sample enriched for early childhood psychopathology. METHOD A total of 192 participants were included from the Parent-Child Interaction Therapy-Emotional Development (PCIT-ED) Study, a longitudinal study of children with and without preschool depression. Participants 7 to 12 years of age completed a diagnostic interview, followed by 12 months of intensive longitudinal sampling, assessing experiences of suicidal ideation and 11 psychosocial variables with known links to STBs in adolescents and adults. Preadolescents with STB history (high-risk) received surveys weekly, and those without STB history (lower-risk) received surveys monthly. RESULTS Female sex, elevated depressive symptoms, greater use of expressive suppression and rumination, emotional clarity, and perceived burdensomeness were uniquely concurrently associated with the likelihood of STB endorsement. Within the high-risk group, (1) increases in depression, expressive suppression, rumination, and perceived burdensomeness, and decreases in positive affect from weekt to weekt+1 were associated with a higher likelihood of a positive STB status at weekt+1; and (2) higher expressive suppression, perceived burdensomeness, and caregiver criticism and conflict at weekt compared to participants' mean levels prospectively predicted increases in the likelihood of a positive STB report from weekt to weekt+1. CONCLUSION Psychosocial factors influencing STBs in adolescents and adults also affect preadolescents in day-to-day life. Expressive suppression and perceived burdensomeness consistently emerged as novel risk indicators and potential targets for treatment. In addition, increases in depression, rumination, and caregiver criticism and conflict, as well as decreases in positive affect, might prompt heightened STB screening and assessments for preadolescents with a history of STBs.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Joan L Luby
- Washington University in St. Louis, St. Louis, Missouri
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7
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Balachandran KP, Bhuvaneswari M. Expressed Emotion in Families of Children with Neurodevelopmental Disorders: A Mixed-Method Approach. Ann Neurosci 2024; 31:105-114. [PMID: 38694716 PMCID: PMC11060128 DOI: 10.1177/09727531231181014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/09/2023] [Indexed: 05/04/2024] Open
Abstract
Background Family interaction plays a pivotal role in the overall well-being of each member of a family unit. It is foreseeable that a family caring for an individual with a mental or physical health condition could experience negative family interactions for various reasons. Expressed emotion refers to the family environment based on the relatives' interaction with the individual diagnosed with a specific illness. Expressed emotion in the families of a person with any form of mental condition could pose potential psychological distress and burden to family members, notably the primary caregivers. Purpose The current study intends to explore the expressed emotion of the primary caregivers toward children with neurodevelopmental disorders (NDDs). The association between expressed emotion, stress experienced by the caregiver, and the self-sufficiency of the child diagnosed with neurodevelopmental disorders was examined. Methods The Five-Minute Speech Sample (FMSS), Kingston Caregivers' Stress Scale (KCSS), and Waisman Activities of Daily Living (WADL) were used to assess expressed emotion, stress, and a child's self-sufficiency, respectively. The snowball sampling technique was adopted, and data were collected from 35 primary caregivers through telephonic interviews. A mixed-method research design was adopted, and the data were analyzed qualitatively and quantitatively. Results The findings reveal that there is a significant association between expressed emotion and caregivers' stress, expressed emotion, and the child's self-sufficiency and a significant relationship between the caregivers' stress and the child's self-sufficiency. The qualitative analysis suggests the influence of factors such as future concerns, family factors, and relationship strains contribute to expressed emotion. Conclusion It can be concluded that those primary caregivers who reported extreme caregivers' stress and low self-sufficiency in their child exhibited high negative expressed emotion and diverse individual and systemic factors influenced the display of high expressed emotion within the family.
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Affiliation(s)
- Krishna Priya Balachandran
- Department of Social Sciences, School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Mohanraj Bhuvaneswari
- Department of Social Sciences, School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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8
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Mirheidari B, Bittar A, Cummins N, Downs J, Fisher HL, Christensen H. Automatic detection of expressed emotion from Five-Minute Speech Samples: Challenges and opportunities. PLoS One 2024; 19:e0300518. [PMID: 38512817 PMCID: PMC10956846 DOI: 10.1371/journal.pone.0300518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/24/2024] [Indexed: 03/23/2024] Open
Abstract
Research into clinical applications of speech-based emotion recognition (SER) technologies has been steadily increasing over the past few years. One such potential application is the automatic recognition of expressed emotion (EE) components within family environments. The identification of EE is highly important as they have been linked with a range of adverse life events. Manual coding of these events requires time-consuming specialist training, amplifying the need for automated approaches. Herein we describe an automated machine learning approach for determining the degree of warmth, a key component of EE, from acoustic and text natural language features. Our dataset of 52 recorded interviews is taken from recordings, collected over 20 years ago, from a nationally representative birth cohort of British twin children, and was manually coded for EE by two researchers (inter-rater reliability 0.84-0.90). We demonstrate that the degree of warmth can be predicted with an F1-score of 64.7% despite working with audio recordings of highly variable quality. Our highly promising results suggest that machine learning may be able to assist in the coding of EE in the near future.
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Affiliation(s)
- Bahman Mirheidari
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | - André Bittar
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Nicholas Cummins
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- CAMHS Digital Lab, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Johnny Downs
- CAMHS Digital Lab, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom
| | - Heidi Christensen
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
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9
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Marshall C, Hoshi R, Gregory J. Parental Expressed Emotion and Behavioural Outcomes in Autistic Children and Adolescents: A Systematic Review. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01660-4. [PMID: 38319471 DOI: 10.1007/s10578-023-01660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 02/07/2024]
Abstract
Growing interest in the links between parent-child relationships and child behavioural presentations in families of autistic children has led to an increased use of the Five Minute Speech Sample (FMSS) measure of parental expressed emotion (EE) in autism research. This review focuses on studies exploring the relationships between parental EE and behavioural outcomes in autistic children. Electronic searches of six databases and grey literature wielded eight studies that met eligibility criteria. Study designs were a mixture of cross-sectional and longitudinal and quality of studies was variable. Parental criticism was largely positively related to, and showed some predictive value for, child behaviour problems. Warmth was mostly negatively related to, and showed some predictive value for, child behaviour problems. Preliminary evidence from one study showed paternal warmth to be significantly related to child behaviours, whilst child behaviours were also significantly related to paternal warmth, suggesting a bidirectional relationship. Analysis of additional EE components produced variable results, however parental stress and depressive symptoms were consistently related to child behaviour, and preliminary evidence suggests a possible role of maternal education level and family cohesion. Outcomes were variable across FMSS coding systems and greater consistency in their application is needed in future research. The current findings suggest that parental EE has an important relationship with child behaviour and future intervention efforts may benefit from aiming to reduced EE in order to improve child outcomes.
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Affiliation(s)
- Corinne Marshall
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK.
- Cardiff University, 70 Park Place, Tower Building, 11th Floor, Cardiff, CF10 3AT, UK.
| | - Rosa Hoshi
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK
| | - James Gregory
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK
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10
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van Houtum LAEM, Wever MCM, van Schie CC, Janssen LHC, Wentholt WGM, Tollenaar MS, Will GJ, Elzinga BM. Sticky criticism? Affective and neural responses to parental criticism and praise in adolescents with depression. Psychol Med 2024; 54:507-516. [PMID: 37553965 DOI: 10.1017/s0033291723002131] [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: 08/10/2023]
Abstract
BACKGROUND Parent-adolescent interactions, particularly parental criticism and praise, have previously been identified as factors relevant to self-concept development and, when negative, to adolescent depression. Yet, whether adolescents with depression show aberrant emotional and neural reactivity to parental criticism and praise is understudied. METHODS Adolescents with depression (n = 20) and healthy controls (n = 59) received feedback supposedly provided by their mother or father in the form of negative ('untrustworthy'), neutral ('chaotic'), and positive ('respectful') personality evaluations while in an MRI-scanner. After each feedback word, adolescents reported their mood. Beforehand, adolescents had rated whether these personality evaluations matched their self-views. RESULTS In both groups, mood decreased after criticism and increased after praise. Adolescents with depression reported blunted mood responses after praise, whereas there were no mood differences after criticism. Neuroimaging analyses revealed that adolescents with depression (v. healthy controls) exhibited increased activity in response to criticism in the subgenual anterior cingulate cortex, temporal pole, hippocampus, and parahippocampal gyrus. Praise consistent with adolescents' self-views improved mood independent of depression status, while criticism matching self-views resulted in smaller mood increases in adolescents with depression (v. healthy controls). Exploratory analyses indicated that adolescents with depression recalled criticism (v. praise) more. CONCLUSIONS Adolescents with depression might be especially attentive to parental criticism, as indexed by increased sgACC and hippocampus activity, and memorize this criticism more. Together with lower positive impact of praise, these findings suggest that cognitive biases in adolescent depression may affect how parental feedback is processed, and may be fed into their self-views.
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Affiliation(s)
- Lisanne A E M van Houtum
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Mirjam C M Wever
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Charlotte C van Schie
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - Loes H C Janssen
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Wilma G M Wentholt
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Marieke S Tollenaar
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Geert-Jan Will
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Bernet M Elzinga
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
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11
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Poletti M, Preti A, Raballo A. Focusing on modifiable early protective factors to prevent negative neurodevelopmental and psychiatric outcomes in at-risk infants. Front Psychiatry 2023; 14:1302474. [PMID: 38144475 PMCID: PMC10739498 DOI: 10.3389/fpsyt.2023.1302474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Michele Poletti
- Child and Adolescent Neuropsychiatry Service, Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Raballo
- Chair of Psychiatry, Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland
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12
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Fogelman N, Schwartz J, Chaplin TM, Jastreboff AM, Silverman WK, Sinha R. Parent Stress and Trauma, Autonomic Responses, and Negative Child Behaviors. Child Psychiatry Hum Dev 2023; 54:1779-1788. [PMID: 35674991 PMCID: PMC9729425 DOI: 10.1007/s10578-022-01377-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/03/2022]
Abstract
Cumulative stress and trauma in parents may alter autonomic function. Both may negatively impact child behaviors, however these links have not been well established. We tested hypotheses that parent stress and trauma are associated with and interact with altered autonomic function during the toy wait task, an acute parent-child interaction challenge, to predict greater negative child behaviors. Sixty-eight parents and their 2-5 year old children were enrolled. More parent major and traumatic life events, and more parent recent life events coupled with increased heart rate and decreased heart rate variability (HRV), each related to more child disruptive/aggressive behavior. More major life and traumatic life events coupled with greater HRV predicted more child attention seeking behavior. Our novel approach to assessing parental life stress offers a unique perspective. Interventions mitigating parent stress and regulating physiological coping during parent-child interactions may both promote better parent health and improve child behavioral outcomes.
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Affiliation(s)
- Nia Fogelman
- Department of Psychiatry, Yale Stress Center, Yale University School of Medicine, 2 Church Street South, Suite 209, New Haven, CT, 06519, USA
| | - Julie Schwartz
- Department of Psychiatry, Yale Stress Center, Yale University School of Medicine, 2 Church Street South, Suite 209, New Haven, CT, 06519, USA
| | - Tara M Chaplin
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Ania M Jastreboff
- Department of Internal Medicine (Endocrinology) and Department of Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT, USA
| | | | - Rajita Sinha
- Department of Psychiatry, Yale Stress Center, Yale University School of Medicine, 2 Church Street South, Suite 209, New Haven, CT, 06519, USA.
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13
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Davis BJ, Fenley A, Sanders A, Ipekci B, Thibeau H, Khan T, Shashidhar G, Keshavan M, Kline E. Development of the motivational interviewing for loved ones skills assessment (MILO-SA). Early Interv Psychiatry 2023; 17:792-797. [PMID: 36638835 PMCID: PMC10627348 DOI: 10.1111/eip.13376] [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: 03/18/2022] [Revised: 09/19/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
AIM Expressed emotion of family members is a key target for intervention for bettering psychosocial outcomes for transitional-age youth experiencing mental health crises. Motivational Interviewing for Loved Ones (MILO) seeks to reduce expressed emotion by teaching parents motivational interviewing skills such as taking a non-judgmental stance, exploring their loved one's thoughts and feelings, expressing optimism and confidence, and avoiding taking an expert role. This report details the creation of the Motivational Interviewing for Loved Ones- Skills Assessment (MILO-SA), its psychometric properties, and convergent validity with other measures of motivational interviewing adeptness. METHODS Our sample (n = 54) consisted of baseline assessments from parents participating in a pilot study of MILO. Parents were assessed for baseline knowledge of motivational interviewing as well as MILO skills with the MILO-SA and a traditional assessment clinician application of motivational interviewing skills. RESULTS We found that the MILO-SA displayed high interrater reliability (k = 0.81), and convergent validity with motivational interviewing knowledge (r = 0.32) as well as traditional assessments of clinician adeptness applying motivational interviewing skills (r = 0.67). CONCLUSIONS Our findings suggest that the MILO-SA has strong psychometric properties and is a useful tool for assessing parent acquisition of motivational interviewing skills. Specifically, the MILO-SA can be used in future studies focused on teaching non-clinicians motivational interviewing skills.
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Affiliation(s)
- Beshaun J. Davis
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alicia Fenley
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Aliyah Sanders
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Bediha Ipekci
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
| | - Heather Thibeau
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
| | - Tabinda Khan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gautami Shashidhar
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Kline
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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14
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Wang GY, Crook-Rumsey M, Sumich A, Dulson D, Gao TT, Premkumar P. The relationships between expressed emotion, cortisol, and EEG alpha asymmetry. Physiol Behav 2023:114276. [PMID: 37364671 DOI: 10.1016/j.physbeh.2023.114276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Families can express high criticism, hostility and emotional over-involvement towards a person with or at risk of mental health problems. Perceiving such high expressed emotion (EE) can be a major psychological stressor for individuals, especially those at risk of mental health problems. To reveal the biological mechanisms underlying the effect of EE on health, this study investigated physiological response (salivary cortisol, frontal alpha asymmetry (FAA)) to verbal criticism and their relationship to anxiety and perceived EE. Using a repeated-measures design, healthy participants attended three testing sessions on non-consecutive days. On each day, participants listened to one of three types of auditory stimuli, namely criticism, neutral or praise, and Electroencephalography (EEG) and salivary cortisol were measured. Results showed a reduction in cortisol following criticism but there was no significant change in FAA. Post-criticism cortisol concentration negatively correlated with perceived EE after controlling for baseline mood. Our findings suggest that salivary cortisol change responds to criticism in non-clinical populations might be largely driven by individual differences in the perception of criticism (e.g., arousal and relevance). Criticisms expressed by audio comments may not be explicitly perceived as an acute emotional stressor, and thus, physiological change responds to criticisms could be minimum.
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Affiliation(s)
- Grace Y Wang
- School of Psychology and Wellbeing, University of Southern Queensland, Australia; Centre for Health Research, University of Southern Queensland, University of Southern Queensland, Australia.
| | | | | | - Deb Dulson
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, UK; Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, New Zealand
| | - Terry T Gao
- Morton Bay Regional Council, Queensland, Australia
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15
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Henry LM, Watson KH, Cole DA, Torres S, Vreeland A, Siciliano RE, Anderson AS, Gruhn MA, Ciriegio A, Broll C, Ebert J, Kuhn T, Compas BE. Mean-level correspondence and moment-to-moment synchrony in adolescent and parent affect: Exploring associations with adolescent age and internalizing and externalizing symptoms. Dev Psychopathol 2023; 35:809-822. [PMID: 35387703 PMCID: PMC9881583 DOI: 10.1017/s0954579422000062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Interactions with parents are integral in shaping the development of children's emotional processes. Important aspects of these interactions are overall (mean level) affective experience and affective synchrony (linkages between parent and child affect across time). Respectively, mean-level affect and affective synchrony reflect aspects of the content and structure of dyadic interactions. Most research on parent-child affect during dyadic interactions has focused on infancy and early childhood; adolescence, however, is a key period for both normative emotional development and the emergence of emotional disorders. We examined affect in early to mid-adolescents (N = 55, Mage = 12.27) and their parents using a video-mediated recall task of 10-min conflict-topic discussions. Using multilevel modeling, we found evidence of significant level-2 effects (mean affect) and level-1 effects (affective synchrony) for parents and their adolescents. Level-2 and level-1 associations were differentially moderated by adolescent age and adolescent internalizing and externalizing symptoms. More specifically, parent-adolescent synchrony was stronger when adolescents were older and had more internalizing problems. Further, more positive adolescent mean affect was associated with more positive parent affect (and vice versa), but only for dyads with low adolescent externalizing problems. Results underscore the importance of additional research examining parent-child affect in adolescence.
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Affiliation(s)
- Lauren M. Henry
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Kelly H. Watson
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - David A. Cole
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Sofia Torres
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Allison Vreeland
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | | | - Meredith A. Gruhn
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Abagail Ciriegio
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Cassandra Broll
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Jon Ebert
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tarah Kuhn
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce E. Compas
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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16
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Narayan AJ, Frederick DE, Merrick JS, Sayyah MD, Larson MD. Childhood Centeredness is a Broader Predictor of Young Adulthood Mental Health than Childhood Adversity, Attachment, and Other Positive Childhood Experiences. ADVERSITY AND RESILIENCE SCIENCE 2023; 4:191-210. [PMID: 37139097 PMCID: PMC10033291 DOI: 10.1007/s42844-023-00089-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/25/2023]
Abstract
This study introduced the novel concept of Centeredness, a measure of the emotional atmosphere of the family of origin and a target adult individual's perception of feeling safe, accepted, and supported from childhood primary caregivers and other family members. This study developed a Centeredness scale for adult respondents and tested hypotheses that higher levels of overall Centeredness would predict lower levels of depression and anxiety symptoms; suicidal thoughts and behaviors (STBs); and aggressive behavior; and higher levels of life satisfaction. Predictive effects of Centeredness were compared against attachment-related anxiety and avoidance, and adverse and benevolent childhood experiences (ACEs and BCEs). Participants were recruited via the Prolific-Academic (Pro-A) survey panel into two large independent samples of US young adults aged 19-35 years [Sample 1 (test sample), N = 548, 53.5% female, 2.2% gender non-conforming, 68.3% White, recruited before the pandemic; Sample 2 (replication sample), N = 1,198, 56.2% female, 2.3% gender non-conforming, 66.4% White; recruited during the pandemic]. Participants completed the novel Centeredness scale, which showed strong psychometric properties, and standardized, publicly available assessments of childhood experiences and mental health outcomes. Centeredness was the only variable that significantly predicted each mental health outcome across both samples. BCEs predicted all outcomes except aggressive behavior in the test sample. Centeredness and BCEs were also the only two variables that significantly predicted a dimensional mental health composite in both samples. Neither attachment-related anxiety and avoidance nor ACEs were as broadly predictive. The Centeredness scale assesses emotional aspects of childhood family relationships with individuals of diverse backgrounds and family compositions. Clinical and cultural implications are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s42844-023-00089-x.
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Affiliation(s)
| | - Donald E. Frederick
- Institute for Quantitative Social Science, Harvard University, Cambridge, USA
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17
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Khafif TC, Kleinman A, Rocca CCDA, Belizário GO, Nader E, Caetano SC, Lafer B. Self-regulation in youth with bipolar disorder. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:20-27. [PMID: 35995462 PMCID: PMC9976910 DOI: 10.47626/1516-4446-2022-2668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the composition of self-regulation in pediatric bipolar disorder (PBD) through the relationship between executive functions, emotion processing, and family environmental factors. METHODS 58 participants (36 with PBD and 22 controls), ages 12-17, were assessed using the Barratt Impulsiveness Scale (BIS), Conners' Continuous Performance Test (CPT-II), Wisconsin Cards Sorting Test (WCST), Computerized Neurocognitive Battery Emotion Recognition Test-Facial Emotion Recognition Test (PENNCNB ER-40), and Expressed Emotion Adjective Checklist Questionnaire (EEAC). RESULTS Adolescents with PBD displayed significant deficits in all three spheres when compared to the control group. Emotion processing correlated negatively with inhibition and attention, and correlated positively with mental flexibility/working memory. Family environmental factors correlated negatively with mental flexibility/working memory and emotion processing, and positively with attention and inhibition. These correlations indicate that better inhibitory control, attention, and mental flexibility/working memory are associated with greater emotion processing and a fitter family environment. CONCLUSION This study is the first to investigate all of the components of self-regulation deficits simultaneously in patients with PBD. Results suggest that self-regulation is essential for a comprehensive perspective of PBD and should be assessed in an integrative and multifaceted way. Understanding that self-regulation is impacted by the abovementioned factors should influence treatment and improve the functional impairments of daily life observed in this population.
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Affiliation(s)
- Tatiana Cohab Khafif
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana Kleinman
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Cristiana Castanho de Almeida Rocca
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Unidade de Psicologia e Neuropsicologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Gabriel Okawa Belizário
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Edmir Nader
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Sheila C Caetano
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Beny Lafer
- Programa de Transtorno Bipolar, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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18
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Kline ER, Thibeau H, Sanders AS, Davis BJ, Fenley A, McIntyre T, English K, Keshavan MS. The School of Hard Talks: A telehealth parent training group for caregivers of adolescents and young adults. Early Interv Psychiatry 2023; 17:244-251. [PMID: 35715966 PMCID: PMC10588675 DOI: 10.1111/eip.13321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/19/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
AIM A large body of evidence demonstrates the importance of the family environment in the developmental trajectory of mental illness in young people. Caregiver communication skills training represents a potential model for influencing the outcomes of adolescents and young adults struggling with emerging mental health and behavioural difficulties. The aim of the current study is to describe the development of a telehealth group training intervention for caregivers of adolescents and young adults, and to report the results of a pilot feasibility-effectiveness study that took place in 2020-2021. METHODS The "School of Hard Talks" intervention consisted of 8 h of training in communication skills consistent with motivational interviewing techniques. All pilot study participants were assigned to receive the intervention. Outcomes of interest were family conflict, caregiver stress, caregiver self-efficacy and expressed emotion (EE). Participants were assessed three times: prior to the intervention, after the intervention and 12 weeks later. RESULTS A total of 62 participants enrolled in the study, of whom 49 completed the intervention. Large, significant improvements were observed over time in all four domains of interest. Qualitative feedback from parents was very positive and added context to quantitative observations. CONCLUSIONS The School of Hard Talks was a feasible and effective intervention targeting both caregiver wellbeing as well as important mechanisms of risk for youth psychopathology, namely family conflict and EE. Further research involving a larger sample and a control condition are needed to confirm these findings.
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Affiliation(s)
- Emily R. Kline
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Heather Thibeau
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - A. Simone Sanders
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Beshaun J. Davis
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia Fenley
- Department of Psychology, Boston University, Boston, Massachusetts, USA
| | - Theresa McIntyre
- Children’s Behavioral Health Knowledge Center, Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Kelly English
- Children’s Behavioral Health Knowledge Center, Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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19
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Bäckström B, Rask O, Knutsson J. Adolescent and Family-Focused Cognitive-Behavioral Therapy for Pediatric Bipolar Disorders: An Open Trial and Individual Trajectories Study in Routine Psychiatric Care. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01504-1. [PMID: 36849847 DOI: 10.1007/s10578-023-01504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/01/2023]
Abstract
Psychosocial treatments improve outcome in Pediatric bipolar disorder (PBD), but few are developed specifically for adolescents and none has been evaluated in Europe. This study evaluates family-focused cognitive-behavioral therapy for adolescents (ages 13-18) with PBD in routine psychiatric care in Sweden, adapted for teenagers in a European setting from the Child and Family-Focused Cognitive Behavioral Therapy for PBD (ages 8-12) developed in the US. In a repeated-measure open trial, psychosocial functioning, depression, skills and knowledge about PBD, and family climate were assessed at pre-treatment, post-treatment, and after 6 months. Assessments were made by adolescents (n = 45), parents (n = 61) and clinicians. Both group statistics and individual trajectories are reported. Psychosocial function, as rated by parents and clinicians, improved at post-treatment, and parents reported less mania and improved family climate at post-treatment. Both parents and adolescents reported improved skills and knowledge. Most results after treatment showed medium effect sizes. Significant improvements were seen in most individual trajectories, however no change and even deterioration was observed in some. The present trial shows that AFF-CBT is well accepted and associated with improved psychosocial function in adolescents and improved skills and knowledge about PBD in adolescents and their parents. Regarding mood symptoms and family climate the results showed more individual variability, indicating that adjustments in delivery of the treatment according to the unique patient could be of importance. AFF-CBT seems to be a valuable addition to pharmacological treatments in PBD.
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Affiliation(s)
- Beata Bäckström
- Department of Psychosis and Bipolar Disorders, Clinic for Child and Adolescent Psychiatry, Skane University Hospital, Region Skane, Lovisastigen 13, 22185, Lund, Sweden.
| | - Olof Rask
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Jens Knutsson
- Department of Psychology, Lund University, Lund, Sweden
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20
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Stiles-Shields C, Kritikos TK, Winning AM, Starnes M, Holmbeck GN. Caregiver Expressed Emotion in Families of Youth With Spina Bifida: Demographic, Medical, and Family Correlates. J Pediatr Psychol 2023; 48:144-155. [PMID: 36164839 PMCID: PMC9941830 DOI: 10.1093/jpepsy/jsac073] [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: 05/06/2022] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Caregiver expressed emotion (EE), an interview-based measure of emotional valence within an interpersonal relationship, is associated with psychosocial outcomes across multiple conditions. Guided by a model implicating a bidirectional role of "Chronic Family Stress" in the unfolding of EE in family environments, the current study examined demographic, medical, and family-level variables in association with EE in caregivers of children with spina bifida (SB). METHODS Data were combined from 2 distinct studies of families with a child with SB, resulting in a sample of 174 (ages 8-17). Linear regressions examined the family stressors and child variables in association with maternal and paternal warmth and criticism, as coded from EE interviews. RESULTS Higher levels of family stress were associated with paternal criticism (p = .03), while having non-Hispanic White children was associated with both maternal and paternal criticism (ps < .005). Having children younger in age (ps < .01) and without a shunt (ps < .01) was associated with higher warmth. CONCLUSIONS Family stressors, absence of the negative impacts of systemic racism, shunt status, and age appear to be associated with the expression of EE in caregivers of a child with SB. Findings highlight multiple assessment considerations, including assessing EE when children are younger to engage caregivers with children with SB when they are more likely to be expressing more warmth. Pinpointing factors associated with caregiver EE in SB will help to better identify families at risk for high levels of criticism and also aid in the development of targeted prevention and intervention programs.
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Affiliation(s)
- Colleen Stiles-Shields
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA
| | - Tessa K Kritikos
- Department of Clinical, Health, and Applied Sciences, University of Houston Clear Lake, USA
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21
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Kline ER, Thibeau H, Davis BJ, Fenley A, Sanders AS, Ipekci B, Oblath R, Yen S, Keshavan MS. Motivational interviewing for loved ones: Randomized controlled trial of brief training for first episode psychosis caregivers. Schizophr Res 2022; 250:43-49. [PMID: 36279833 PMCID: PMC10593126 DOI: 10.1016/j.schres.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research shows that family involvement in psychosis treatment leads to better patient outcomes. Interventions that involve and counsel family members may improve patient outcomes by addressing barriers to treatment adherence and lowering family expressed emotion, thereby creating a less stressful and more supportive home environment. Learning to use motivational interviewing communication skills may help caregivers to decrease conflict and expressed emotion and improve treatment adherence. METHODS The current study is a pilot randomized controlled trial testing the impact of "Motivational Interviewing for Loved Ones" (MILO), a brief five-hour psychoeducational intervention for caregivers, in a sample of family members of individuals with early course psychosis (N = 40). Using a randomized crossover design, caregivers were randomized to either immediate MILO or a six-week waitlist control condition; all participants eventually received the intervention. RESULTS Caregiver participants experienced large (d = 1.08-1.43) and significant improvements in caregiver wellbeing, caregiver self-efficacy, family conflict, and expressed emotion. There was no change over time in caregiver-reported patient treatment adherence. Relative to waitlist, MILO had significant effects on family conflict and expressed emotion, a trending effect on perceived stress, and no effect on parenting self-efficacy or treatment adherence. CONCLUSIONS MILO showed benefits for caregivers of FEP patients in this small, controlled trial. Further testing in a larger randomized controlled trial is warranted to better characterize MILO's effects for caregivers and patients across a range of diagnoses.
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Affiliation(s)
- Emily R Kline
- Boston University School of Medicine, Department of Psychiatry, 720 Harrison Avenue, Boston, MA 02118, United States of America; Boston Medical Center, Department of Psychiatry, 850 Harrison Avenue, Boston, MA 02118, United States of America; Harvard Medical School, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America.
| | - Heather Thibeau
- Boston Medical Center, Department of Psychiatry, 850 Harrison Avenue, Boston, MA 02118, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| | - Beshaun J Davis
- Harvard Medical School, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| | - Alicia Fenley
- Boston University, Department of Psychology, 900 Commonwealth Avenue, Boston, MA 02215, United States of America
| | - Aliyah Simone Sanders
- Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| | - Bediha Ipekci
- Boston University School of Medicine, Department of Psychiatry, 720 Harrison Avenue, Boston, MA 02118, United States of America; Boston Medical Center, Department of Psychiatry, 850 Harrison Avenue, Boston, MA 02118, United States of America
| | - Rachel Oblath
- Boston University School of Medicine, Department of Psychiatry, 720 Harrison Avenue, Boston, MA 02118, United States of America; Boston Medical Center, Department of Psychiatry, 850 Harrison Avenue, Boston, MA 02118, United States of America
| | - Shirley Yen
- Harvard Medical School, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
| | - Matcheri S Keshavan
- Harvard Medical School, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America; Beth Israel Deaconess Medical Center, Department of Psychiatry, 75 Fenwood Road, Boston, MA 02215, United States of America
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22
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García-Anaya M, Caballero-Romo A, González-Macías L. Maintaining Factors of Anorexia Nervosa Addressed from a Psychotherapeutic Group for Parents: Supplementary Report of a Patient's Therapeutic Success. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11396. [PMID: 36141668 PMCID: PMC9517022 DOI: 10.3390/ijerph191811396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Anorexia nervosa is an eating disorder (ED) where up to 30% of individuals remain unresponsive to treatments, whether they partially respond, or do respond and later relapse. It has been broadly reported how presenting maladaptive family functioning and communication style contributes to treatment drop-out, poor treatment compliance, and poor long-term outcomes. We studied the mother and father of a patient with AN, binge-purge subtype (according to DSM-IV TR) who achieved remission after her parents but not her attended an intervention through a psychotherapy group for parents (PGP). (2) Methods: We previously reported this patient's case report, and now, through an Interpretative Phenomenological Analysis (IPA) approach, we aimed to explore the understanding and meanings ascribed by the mother and father to their experience at the PGP and to their daughter's clinical and functional improvement. (3) Results: We identified two main stages along the process: one related to the presence of maintaining factors of their daughter's disorder, and the other related to the emergence of a reflective function and to the implementation of behavioral, emotional and cognitive changes. (4) Conclusions: The interview revealed both parents' experience at the PGP promoted a change process, where they were able to modify their previous style of communication and functioning, and to identify them as a contributors to maintain their daughter's disorder. Reflective function (RF) emerged in the mother and father throughout the psychotherapeutic process. Both parents also revealed some elements that were intergenerationally transmitted, that affected three generations and contributed to maintaining the ED. We observed the multilevel open-group structure of the PGP, enhancing the mother's and father's change process.
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Affiliation(s)
- María García-Anaya
- Clinical Research Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Alejandro Caballero-Romo
- Eating Disorders Clinic, Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Laura González-Macías
- Eating Disorders Clinic, Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
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23
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Kennedy-Turner J, Sawrikar V, Clark L, Griffiths H. Do attachment-related differences in reflective functioning explain associations between expressed emotion and youth self-harm? CURRENT PSYCHOLOGY 2022; 42:1-15. [PMID: 36043216 PMCID: PMC9411045 DOI: 10.1007/s12144-022-03614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
Youth self-harm is associated with poor health outcomes and attempted and completed suicide. Associations exist between self-harm and expressed emotion (EE), attachment insecurity, and reflective functioning (RF), but these associations are poorly understood. This study evaluates a mediation model in which perceived caregiver EE (pEE) exerts an indirect effect on youth self-harm through attachment insecurity and RF uncertainty. 461 participants aged 16-24 years completed an online survey. Statistical analyses revealed significant direct effects of pEE on attachment insecurity, and of RF uncertainty on self-harm; however, some direct effects were specific to pEE from female caregivers, and attachment insecurity in youth relationships with female caregivers. A significant direct effect of pEE on self-harm was found for pEE from male caregivers only. Significant indirect effects of pEE on self-harm through attachment anxiety and RF uncertainty were found only in relation to female caregivers. The findings encourage family-, attachment-, and mentalization-based approaches to preventing and treating youth self-harm, with a recommendation that caregivers are given adequate support, education, and skills-based training following youth disclosures of self-harm. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-03614-w.
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Affiliation(s)
- Jamie Kennedy-Turner
- Clinical Psychology Department, School of Health in Social Science, The University of Edinburgh, Doorway 6, Elsie Inglis Quad, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- Pennywell All Care Centre, CAMHS North Edinburgh, 1 Macmillan Crescent, Edinburgh, EH4 4WL UK
| | - Vilas Sawrikar
- Clinical Psychology Department, School of Health in Social Science, The University of Edinburgh, Doorway 6, Elsie Inglis Quad, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Lucy Clark
- NHS Education for Scotland, 102 West Port, Edinburgh, EH3 9DN UK
| | - Helen Griffiths
- Clinical Psychology Department, School of Health in Social Science, The University of Edinburgh, Doorway 6, Elsie Inglis Quad, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
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Tschan T, Pfeiffer S, Gutzweiler R, In-Albon T. A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury. Child Adolesc Psychiatry Ment Health 2022; 16:64. [PMID: 35941688 PMCID: PMC9361609 DOI: 10.1186/s13034-022-00500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expressed Emotion refers to the extent to which close relatives express critical/hostile and/or emotionally overinvolved attitudes and feelings when speaking about a family member. High Expressed Emotion is a valuable predictor of clinical outcomes and is related to the presence of various mental disorders, including nonsuicidal self-injury (NSSI). Interpersonal factors have been shown to be relevant in initiating and in maintaining with NSSI, as interpersonal difficulties are often reported as triggers for emotional dysregulation. The parental role in the etiology and treatment of NSSI needs to be further investigated. This study assesses Expressed Emotion in adolescents who engage in NSSI and their mothers. METHOD We examined Expressed Emotion levels of mother-daughter dyads among adolescents who engage in NSSI, clinical controls (CCs), and nonclinical controls (NCs). The sample consisted of 70 female adolescents aged 12-20 years (M = 15.28 years, SD = 1.81; NSSI: n = 21, CC: n = 17, NC: n = 32) and 24 mothers aged 38-56 years (M = 46.47 years, SD = 4.61) using The Five-Minute Speech Sample (FMSS). RESULTS Adolescents who engage in NSSI exhibited significantly more covert criticism and critical tone toward their mothers than CCs (d = 0.65, d = 1.10) and NCs (d = 1.30, d = 1.10). CONCLUSION The findings highlight the importance of family-based interventions for the treatment of NSSI in order to enhance a positive relationship quality between parents and adolescents.
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Affiliation(s)
- Taru Tschan
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Simone Pfeiffer
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Raphael Gutzweiler
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829, Landau, Germany.
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Using structural equation modeling to understand family and psychological factors of childhood obesity: from socioeconomic disadvantage to loss of control eating. Eat Weight Disord 2022; 27:1809-1819. [PMID: 34731454 DOI: 10.1007/s40519-021-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 06/17/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Current study aimed to empirically test the Hemmingsson's theoretical model of childhood obesity which emphasizing the importance of family environment and the emotional distress of parents as influential variables in the emotional distress of the child and subsequent weight gain. This study also tested the hypothesis that the emotional distress of the child triggers a weight gain-inducing behavior (loss of control eating) to suppress negative emotions. METHODS Families of 220 Spanish children participated in the study (28.2% normal, 35.1% overweight and 32.2% obesity), aged between 8 and 12. The evaluation included a clinical interview and a battery of questionnaires. RESULTS Structural equation models were computed according to the steps proposed by theoretical model. Fit indices were acceptable suggesting that the data adequately fit the hypothesized model. Path coefficients in the final model were statistically significant showing a relationship between socioeconomic status, the emotional distress of parents, family environment, the emotional distress of children, loss of control eating and child's BMI Z-score. CONCLUSION Considering this relation between emotional distress and child weight status, childhood obesity intervention programs may benefit from targeting family environment and the potential role that food is playing in the regulation of children's distress. LEVEL OF EVIDENCE Level III: Cohort analytic study.
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Uçar HN, Çetin FH, Türkoğlu S. Perceived Expressed Emotion and Irritability in Adolescents With Attention-Deficit/Hyperactivity Disorder Inattentive Type: The Moderating Effect of Subtype. J Psychosoc Nurs Ment Health Serv 2022; 60:11-20. [PMID: 35522933 DOI: 10.3928/02793695-20220429-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study aimed to investigate perceived expressed emotion (EE) and irritability among adolescents with inattentive and combined type attention-deficit/hyperactivity disorder (ADHD-I and ADHD-C, respectively), and to assess whether the subtype plays a moderating role in the relationship between perceived EE and irritability. The current cross-sectional, case-control study comprised 37 adolescents with ADHD-I, 62 adolescents with ADHD-C, and 58 age- and sex-matched adolescents without ADHD. After controlling for confounding factors, adolescents with ADHD-C were found to exhibit significantly higher levels of perceived lack of emotional support than adolescents with ADHD-I (p = 0.029). Results of moderation analysis showed ADHD subtype to be a moderating factor in the relationship between perceived EE and irritability. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Parental Expressed Emotion, Parenting Stress, and Behavioral Problems of Young Children with 22q11.2 Deletion Syndrome and Idiopathic Autism Spectrum Disorder. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01310-7. [PMID: 35083589 DOI: 10.1007/s10578-021-01310-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/03/2022]
Abstract
This study examined the associations of parents' expressed emotion (EE) and parenting stress, with behavioral problems of children with 22q11.2 deletion syndrome, idiopathic autism (iASD) and typically developing (TD) children. Parents of children aged 3-8 years completed the five-minute-speech-sample (FMSS), parental stress index and children behavioral checklist. Parents' FMSS-EE-criticism was higher among parents of children with 22q11DS and iASD compared to parents of TD children. FMSS-EE scores predicted children's behavioral problems, above and beyond parenting stress. The associations between FMSS-EE, parenting stress and children's behavioral problems were consistent across 22q11DS, iASD and TD children. These findings highlight the need for targeting parents' EE and parenting stress as integral elements in the screening and prevention of behavioral problems of young children with 22q11DS and iASD.
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Gregg L, Calam R, Drake RJ, Wolfenden L. Expressed Emotion and Attributions in Parents With Schizophrenia. Front Psychiatry 2021; 12:799626. [PMID: 34966315 PMCID: PMC8710699 DOI: 10.3389/fpsyt.2021.799626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
We examined expressed emotion (EE) and attributions in parents with schizophrenia and compared them to parents without serious mental illness (SMI) in order to better understand the emotional climate of families in which a parent has schizophrenia. Parenting practices and parental reports of child behavior were also compared between the two groups. The relationship of EE to attributions was examined in each group separately. Relationships between parental mental health, EE, and attributions were explored in the parents with schizophrenia only. The Camberwell Family Interview was used to determine both EE and attributions in 20 parents with schizophrenia and 20 parents without SMI. We found that more parents with schizophrenia were rated as high EE than those without (60 and 35%, respectively) although this was not a statistically significant difference. Parents with schizophrenia demonstrated significantly more hostility and criticism toward their children than those without SMI and made more child-blaming attributions. Blame was associated with increased hostility, less warmth, and fewer positive remarks. Parental warmth was related to greater parenting self-efficacy, less harsh parenting practices, better child behavior, and a more positive parent-child relationship. We conclude that EE and attributions are potential explanatory variables to be considered in the development of preventative and early intervention strategies for families with a parent with schizophrenia or other psychotic disorder. Blame and warmth are modifiable factors that could be targeted within family and parenting interventions.
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Affiliation(s)
- Lynsey Gregg
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Richard J. Drake
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Lauren Wolfenden
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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Łada-Maśko AB, Kaźmierczak M. Measuring and Predicting Maturity to Parenthood: What Has Personality Got to Do with It? J Clin Med 2021; 10:5802. [PMID: 34945098 PMCID: PMC8706419 DOI: 10.3390/jcm10245802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Maturity to parenthood is essential for taking on parental roles but remains an understudied issue. Still, close relations between maturity and personality dimensions are commonly emphasized. Thus, conducting research on maturity in context of personality seems a valuable research direction. The present research consists of two studies, focusing on the development and validation of Maturity to Parenthood Scale (MPS), in relation to personality, emotional regulation, coping with challenges, and intimate relationship satisfaction. In both studies, childless adults aged 20-35 years took part: (1) 718 participants (Mage = 25.49; SD = 2.89; 479 women), (2) 150 participants (Mage = 23.69; SD = 3.15; 104 women). All the participants had been in an intimate relationship for at least six months at the time of the study, the majority declared their willingness to have children in the future, had higher education, and were professionally active. The results showed that MPS is a reliable, valid measure comprising the following three subscales: valence, behavioral, and cognitive-emotional maturity to parenthood. The findings also confirmed the importance of broad- and narrow-band individual differences and contextual factors for maturity. MPS may be used in psychoeducation, supporting the transition to biological or adoptive/foster parenthood, as well as in medical and psychological care.
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Affiliation(s)
- Ariadna Beata Łada-Maśko
- Division of Developmental Psychology and Psychopathology, Institute of Psychology, Faculty of Social Sciences, University of Gdańsk, 80-309 Gdańsk, Poland
| | - Maria Kaźmierczak
- Division of Family Studies and Quality of Life, Institute of Psychology, Faculty of Social Sciences, University of Gdańsk, 80-309 Gdańsk, Poland;
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Weintraub MJ, Schneck CD, Singh MK, Walshaw PD, Chang KD, Sullivan AE, Miklowitz DJ. Longitudinal relationship between maternal distress and pediatric mood symptoms in youth with mood disorders. J Psychiatr Res 2021; 144:353-359. [PMID: 34735839 PMCID: PMC8667659 DOI: 10.1016/j.jpsychires.2021.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
Parents of a child with a mood disorder report significant levels of distress and burden from caregiving. This study examined whether maternal distress varies over time with levels of mood symptoms in youth with mood disorders, and whether expressed emotion (EE) and family functioning moderate these associations. We recruited youth (ages 9-17 years) with mood disorders and familial risk for bipolar disorder (BD) for a randomized trial of family-focused therapy compared to standard psychoeducation. Participants were assessed every 4-6 months for up to 4 years. Using repeated-measures mixed effects modeling, we examined the longitudinal effects of youths' mood symptoms and maternal distress concurrently, as well as whether each variable predicted the other in successive study intervals. Secondary analyses examined the moderating effects of EE and ratings of family cohesion and adaptability on maternal distress. In sample of 118 youth-mother dyads, levels of self-reported parental distress decreased over time, with no differences between treatment conditions. Youths' depressive symptoms and, most strongly, mood lability were associated with greater maternal distress longitudinally; however, maternal distress did not predict youths' mood symptoms or lability. The effect of youth symptoms on maternal distress was greater among mothers who were high EE. Family cohesion was associated with reduced concurrent ratings of maternal distress, whereas family adaptability was associated with reduced maternal distress at successive follow-ups. While maternal distress decreases over time as youths' symptoms decrease, mothers of youth with mood disorders experience significant distress that is directly linked to the youths' depressive symptom severity and lability. Improved family functioning appears to be an important mechanism by which to intervene.
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Affiliation(s)
- Marc J. Weintraub
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA,Corresponding author. UCLA Semel Institute, Department of Psychiatry, 760 Westwood Plaza, A7-370, Los Angeles, CA, 90095, USA. (M.J. Weintraub)
| | | | | | - Patricia D. Walshaw
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | | | - David J. Miklowitz
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Rienecke RD, Gorrell S, Blalock DV, Smith K, Lock J, Le Grange D. Expressed emotion and long-term outcome among adolescents with anorexia nervosa. Int J Eat Disord 2021; 54:2019-2024. [PMID: 34553396 PMCID: PMC8810289 DOI: 10.1002/eat.23613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of the current study is to examine expressed emotion (EE) and long-term treatment outcome among adolescents participating in a randomized controlled trial (RCT) for treatment of anorexia nervosa (AN). It was hypothesized that patients with high EE parents at baseline would show more severe symptoms at end-of-treatment, 12-month follow-up, and 4-year follow-up than patients from low EE families. METHOD Secondary data analysis was conducted of original RCT data from a two-site eating disorder treatment trial conducted in the United States. Participants were 121 adolescents with AN who completed measures of EE, eating disorder psychopathology, depression, and self-esteem. RESULTS Generalized estimating equations showed that participants who were in the Low EE group achieved a more accelerated drop in depression scores in the context of treatment (first 12 months) than participants in the High EE group. No other significant Group × Time interactions were found. DISCUSSION Findings suggest that high parental EE at baseline does not indicate that adolescent patients with AN will fare poorly 4 years later.
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Affiliation(s)
- Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Chicago, Illinois, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathryn Smith
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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Zimmer-Gembeck MJ, Rudolph J, Kerin J, Bohadana-Brown G. Parent emotional regulation: A meta-analytic review of its association with parenting and child adjustment. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2021. [DOI: 10.1177/01650254211051086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We conducted a meta-analytic review of 53 studies published between 2000 and 2020 to quantify associations of parents’ emotion regulation with parenting behavior and children’s emotion regulation and internalizing and externalizing symptoms. Twelve meta-analyses, which included between 4 to 22 effect sizes ( N from 345 to 3609), were conducted to summarize associations of parent emotion regulation with positive or negative parenting behaviors and child outcomes of emotion regulation, difficulties in emotion regulation, internalizing symptoms, or externalizing behavior. Given the range of behavioral parent emotion regulation measures used across studies, effect sizes for parent emotion regulation strategy use ( skill) were analyzed separately from effect sizes for parents’ difficulties with emotion regulation. Summary effect sizes ranged from |.08| to |.28| for relations of parent emotion regulation skill with parenting behaviors and children’s adjustment. Summary effect sizes ranged from |.03| to |.42| for relations of parent emotion regulation difficulties with parenting behaviors and children’s adjustment. In general, parents with better emotion regulation skill or fewer difficulties are higher in positive parenting behaviors and have children with better emotion regulation and fewer internalizing symptoms. Evidence was less clear-cut for child externalizing behaviors. Significant effect size heterogeneity was observed in most analyses, and study characteristics (measures, child age, parent gender, sampling, and region where the study was conducted) were examined as moderators. Measures used, child age, and participant risk status moderated effect size in some analyses.
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Affiliation(s)
- Melanie J. Zimmer-Gembeck
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
| | - Julia Rudolph
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
| | - Jessica Kerin
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
| | - Gal Bohadana-Brown
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
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Mullins JL, Zhou E, Glenn DE, Moroney E, Lee SS, Michalska KJ. Paternal expressed emotion influences psychobiological indicators of threat and safety learning in daughters: A preliminary study. Dev Psychobiol 2021; 63:e22205. [PMID: 34674231 DOI: 10.1002/dev.22205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/13/2021] [Accepted: 09/18/2021] [Indexed: 12/27/2022]
Abstract
This preliminary study examined the association of children's anxiety, paternal expressed emotion (EE), and their interaction with psychophysiological indices of children's threat and safety learning. Participants included 24 father-daughter dyads. Daughters (ages 8-13 years, 100% Latina) self-reported their anxiety levels and completed a differential threat conditioning and extinction paradigm, during which psychophysiological responding was collected. Fathers completed a Five-Minute Speech Sample, from which paternal EE (i.e., criticism, emotional overinvolvement) was assessed. Anxiety-dependent associations emerged between paternal EE and individual differences in daughters' psychophysiological responding to safety signals during threat conditioning. Paternal EE was positively associated with psychophysiological responding to safety in daughters with high and mean, but not low, levels of anxiety. Although previous work suggests that chronic harsh maternal parenting is a potential risk factor for children's general threat and safety learning, these preliminary findings implicate milder forms of negative parenting behavior in fathers, particularly for highly anxious children.
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Affiliation(s)
- Jordan L Mullins
- Department of Psychology, University of California, Riverside, Riverside, California, USA
| | - Elayne Zhou
- Department of Psychology, University of California, Riverside, Riverside, California, USA
| | - Dana E Glenn
- Department of Psychology, University of California, Riverside, Riverside, California, USA
| | - Elizabeth Moroney
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Steve S Lee
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Kalina J Michalska
- Department of Psychology, University of California, Riverside, Riverside, California, USA
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Van Noppen B, Sassano-Higgins S, Appasani R, Sapp F. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:430-443. [PMID: 35747293 PMCID: PMC9063577 DOI: 10.1176/appi.focus.20210015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this update of a previous review, the authors discuss cognitive-behavioral therapy (CBT) with exposure and response prevention for obsessive-compulsive disorder (OCD). This efficacious modality avoids side effects common to psychotropic medication and reduces risk of relapse once treatment has ended. Psychotherapy involves identification and ranking of stimuli that provoke obsessions, exposure to these stimuli while preventing compulsions, and cognitive restructuring. The family of the OCD patient plays a significant role in treatment. This article includes expanded research on family-focused CBT and treatment of pediatric OCD. The family's accommodation and emotional response to a patient's symptoms may interfere with therapy and perpetuate the disorder. The treatment of pediatric OCD involves the same considerations. However, the form of obsessions and compulsions may differ and therapeutic techniques are modified to make them age appropriate.
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Affiliation(s)
- Barbara Van Noppen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Sean Sassano-Higgins
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Raghu Appasani
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Felicity Sapp
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
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Wang GY, Premkumar P, Lee CQ, Griffiths MD. The Role of Criticism in Expressed Emotion Among Psychoactive Substance Users: an Experimental Vignette Study. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00591-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sepúlveda AR, Moreno-Encinas A, Martínez-Huertas JA, Anastasiadou D, Nova E, Marcos A, Gómez-Martínez S, Villa-Asensi JR, Mollejo E, Graell M. Toward a Biological, Psychological and Familial Approach of Eating Disorders at Onset: Case-Control ANOBAS Study. Front Psychol 2021; 12:714414. [PMID: 34566794 PMCID: PMC8458812 DOI: 10.3389/fpsyg.2021.714414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Eating disorders (ED) are considered as heterogeneous disorders with a complex multifactor etiology that involves biological and environmental interaction. Objective: The aim was to identify specific ED bio-psychological-familial correlates at illness onset. Methods: A case-control (1:1) design was applied, which studied 50 adolescents diagnosed with ED at onset (12-17 years old) and their families, paired by age and parents' socio-educational level with three control samples (40 with an affective disorder, 40 with asthma, and 50 with no pathology) and their respective families. Biological, psychological, and familial correlates were assessed using interviews, standardized questionnaires, and a blood test. Results: After performing conditional logistic regression models for each type of variable, those correlates that showed to be specific for ED were included in a global exploratory model (R 2 = 0.44). The specific correlates identified associated to the onset of an ED were triiodothyronine (T3) as the main specific biological correlate; patients' drive for thinness, perfectionism and anxiety as the main psychological correlates; and fathers' emotional over-involvement and depression, and mothers' anxiety as the main familial correlates. Conclusion: To our knowledge, this is the first study to use three specific control groups assessed through standardized interviews, and to collect a wide variety of data at the illness onset. This study design has allowed to explore which correlates, among those measured, were specific to EDs; finding that perfectionism and family emotional over-involvement, as well as the T3 hormone were relevant to discern ED cases at the illness onset from other adolescents with or without a concurrent pathology.
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Affiliation(s)
- Ana Rosa Sepúlveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Alba Moreno-Encinas
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | | | - Dimitra Anastasiadou
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Esther Nova
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - Ascensión Marcos
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - Sonia Gómez-Martínez
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | | | - Encarna Mollejo
- Psychiatry Service, Hospital Universitario del Sureste, Arganda del Rey, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, Niño Jesús University Children’s Hospital, Madrid, Spain
- CIBERSAM, Madrid, Spain
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Expressed Emotion in Families of Children With and Without Autism Spectrum Disorder, Cerebral Palsy and Down Syndrome: Relations with Parenting Stress and Parenting Behaviors. J Autism Dev Disord 2021; 52:1789-1806. [PMID: 34021833 DOI: 10.1007/s10803-021-05075-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
This study examined the family emotional climate as assessed by Five Minute Speech Samples and the relation with parenting stress and parenting behaviors among parents of children (6-17 years, 64.7% boys) with autism spectrum disorder, cerebral palsy, Down syndrome, and without any known disability (n = 447). The large majority of parents (79%) showed low levels of Expressed Emotion, an indicator of a positive family climate. In all groups, more Emotional Over-involvement, more Criticism and fewer expressions of Warmth were associated with higher levels of parenting stress. Across groups, Emotional Over-involvement was related to more autonomy-supportive parenting, Criticism to more psychologically controlling and overreactive parenting, and Warmth was associated with more responsive and less psychologically controlling and overreactive parenting.
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Matsuda Y, Schwartz TA, Chang Y, Beeber LS. A Refined Model of Stress-Diathesis Relationships in Mothers With Significant Depressive Symptom Severity. J Am Psychiatr Nurses Assoc 2021; 27:240-250. [PMID: 31578899 PMCID: PMC7441645 DOI: 10.1177/1078390319877228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Mothers' depressive symptoms affect their children's growth as well as physical and mental well-being. Moreover, mothers of young children with developmental delay or disability (DD) tend to have higher depressive symptoms. AIMS: The purpose of this study was to examine associations between maternal depressive symptoms and number of children with DD among mothers with significant levels of depressive symptoms, while accounting for maternal diathesis factors and family stress factors. METHODS: This study was a secondary analysis of pooled baseline data collected from 2004 to 2012 in the northeastern and southeastern United States from three intervention studies to reduce depressive symptoms of mothers with young children (n = 364). Multiple regression analyses were conducted to examine associations between maternal depressive symptoms and number of children with DD, followed by the post hoc pairwise comparison. RESULTS: In the model including family stress factors, we found a significant test for linear trend in the mean for maternal depressive symptoms across the number of children with DD (F[1] = 4.3, p = .0388). CONCLUSIONS: Mothers who have multiple children with DD tend to experience higher depressive symptoms; thus, interventions are needed to help prevent these mothers from experiencing higher depressive symptoms or to reduce their current depressive symptoms. Both theory-based and strength-based interventions can target conflict management at the family level, reducing maternal depressive symptoms while improving mothers' self-efficacy, which would help mothers care for their own health, manage family conflict, and seek appropriate support to manage the children's medical and developmental needs.
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Affiliation(s)
- Yui Matsuda
- Yui Matsuda, PhD, APHN-BC, MPH, University of Miami, Coral Gables, FL, USA
| | - Todd A. Schwartz
- Todd A. Schwartz, DrPH, University of North Carolina at Chapel Hill, NC, USA
| | - YunKyung Chang
- YunKyung Chang, PhD, MPH, University of North Carolina at Chapel Hill, NC, USA
| | - Linda S. Beeber
- Linda S. Beeber, PhD, PMHCNS-BC, FAAN, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Negative parental emotional environment increases the association between childhood behavioral problems and impaired recognition of negative facial expressions. Dev Psychopathol 2021; 34:936-945. [PMID: 33926601 DOI: 10.1017/s0954579420002072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Impaired facial emotion recognition is a transdiagnostic risk factor for a range of psychiatric disorders. Childhood behavioral difficulties and parental emotional environment have been independently associated with impaired emotion recognition; however, no study has examined the contribution of these factors in conjunction. We measured recognition of negative (sad, fear, anger), neutral, and happy facial expressions in 135 children aged 5-7 years referred by their teachers for behavioral problems. Parental emotional environment was assessed for parental expressed emotion (EE) - characterized by negative comments, reduced positive comments, low warmth, and negativity towards their child - using the 5-minute speech sample. Child behavioral problems were measured using the teacher-informant Strengths and Difficulties Questionnaire (SDQ). Child behavioral problems and parental EE were independently associated with impaired recognition of negative facial expressions specifically. An interactive effect revealed that the combination of both factors was associated with the greatest risk for impaired recognition of negative faces, and in particular sad facial expressions. No relationships emerged for the identification of happy facial expressions. This study furthers our understanding of multidimensional processes associated with the development of facial emotion recognition and supports the importance of early interventions that target this domain.
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40
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All in the Family: How Parental Criticism Impacts Depressive Symptoms in Youth. Res Child Adolesc Psychopathol 2021; 50:27-35. [PMID: 33743095 DOI: 10.1007/s10802-021-00809-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Despite a strong connection between family environment and mood symptoms in youth, little research to date has examined potential underlying mechanisms. We propose an etiological model investigating how parenting (i.e., expressed emotion, or EE) affects youth depression by shaping their emotion regulation abilities. Forty-six youth and caregivers participated in this cross-sectional study. Family environment was assessed using the Five-Minute Speech Sample (FMSS) and the Levels of Expressed Emotion Scale (LEE). The Difficulties in Emotion Regulation Scale (DERS) and the Children's Depression Rating Scale-Revised (CDRS-R) were used to assess youth emotion regulation and depressive symptoms, respectively. Analyses demonstrated no significant relationships between type of reporter (i.e., independent rater, parent, youth) of parental EE and criticism. Mediation analyses suggested that youth-reported parental EE predicted greater levels of youth depressive symptoms, and that this association was mediated by emotion regulation. This study has direct clinical implications, elucidating the importance of strengthening positive parent-child communication to support the development of emotion regulation skills and psychological well-being for youth.
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41
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Khanjari S, Tehrani FJ, Panahi SS, Saidee A. Translational cultural adaptation and psychometric study of the Persian version of pediatric inventory for parents. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:65. [PMID: 34084812 PMCID: PMC8057186 DOI: 10.4103/jehp.jehp_842_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cancer, as a life-threatening disease in children, poses several challenges for parents. It is necessary to have a tool that can comprehensively examine the stressful events for parents of children with cancer. The aim this present study was done with the aim of study the Persian version of pediatric inventory for parents (PIP). MATERIALS AND METHODS The study was a conducted based on methodological research design. Four hundred and fifteen parents of children with cancer referring to Alia Asghar Children's Hospital and Children's Medical Centre in Tehran answered the Persian version of PIP questionnaire in 2019. a confirmatory factor analysis was carried out using LISREL (software version 8.8) to test the construct validity of PIP. The two tools of parental stress scale and state-trait anxiety inventory (STAI-Y) were used for concurrent validity purposes. RESULTS The results showed that, the overall score of the questionnaire was higher than the average and related to emotional distress. The internal correlation coefficient (Cronbach's alpha) in both parts of the PIP was between 0.808 and 0.957 and acceptable. Concurrent validity analysis indicated positive and significant correlation of this tool in the difficulty section of the scale with both Parental Stress Scale and STAI-Y. The results of confirmatory factor analysis indicated that the factor loads of all items except three items in the frequency section were more than 0.3 and were appropriate. CONCLUSION The Persian version of PIP can be available to health and family experts as a valid and reliable tool to assess stressful events of parents of children with cancer.
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Affiliation(s)
- Sedigheh Khanjari
- Center for Nursing Care Research, School of Nursing and Midwifery, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Javaheri Tehrani
- Center for Nursing Care Research, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Shariat Panahi
- Center for Nursing Care Research, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Saidee
- Department of Statistical Research and Information Technology, Institute for Research and Planning in Higher Education, Tehran, Iran
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Miklowitz DJ, Weintraub MJ, Posta F, Walshaw PD, Frey SJ, Morgan-Fleming GM, Wilkerson CA, Denenny DM, Arevian AA. Development and Open Trial of a Technology-Enhanced Family Intervention for Adolescents at Risk for Mood Disorders. J Affect Disord 2021; 281:438-446. [PMID: 33360365 PMCID: PMC8068558 DOI: 10.1016/j.jad.2020.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 12/22/2022]
Abstract
AIM Integrating psychosocial interventions with mobile apps may increase treatment engagement among adolescents. We examined the user experience, uptake, and clinical effects of a mobile-enhanced family-focused therapy (FFT) among adolescents at risk for mood disorders. METHOD We created a mobile app containing 12 lesson plans corresponding to content of weekly FFT sessions, with modules concerning mood management, family communication and problem-solving. We pilot tested the app in an open trial of FFT (12 sessions in 18 weeks) for adolescents who had active depressive or hypomanic symptoms, a parent with mood disorder, and at least one parent who expressed high levels of criticism. Teens and parents made daily and weekly ratings of youths' moods, amount of parent/offspring criticism, and practice of FFT psychoeducational, communication or problem-solving skills. Independent evaluators interviewed adolescents at baseline and every 9 weeks over 27 weeks to measure symptom trajectories. RESULTS Participants were adolescents (n=22; mean age 15.4 ± 1.8 years; 45.5% female) and their 34 parents. Completion of requested app assessment and skill practices averaged 46%-65% among adolescents and parents over 18 weeks of treatment. Adolescents showed significant improvement in clinician-rated depression scores over 27 weeks (Cohen's d=1.58, 95% CI, 0.83 to 2.32) and reported reductions in the amount of perceived criticism expressed by parents. LIMITATIONS The uncontrolled design limits inferences about whether the mobile app augmented the effects of FFT on moods or family relationships. CONCLUSIONS Mobile applications may enhance users' responses to family therapy and provide clinicians with information regarding clinical status. Clinicaltrials.gov NCT03913013.
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Affiliation(s)
- David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA.
| | - Marc J Weintraub
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | | | - Patricia D Walshaw
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Samantha J Frey
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Georga M Morgan-Fleming
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Catherine A Wilkerson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Danielle M Denenny
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Armen A Arevian
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
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43
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Fahrer J, Brill N, Dobener LM, Asbrand J, Christiansen H. Expressed Emotion in the Family: A Meta-Analytic Review of Expressed Emotion as a Mechanism of the Transgenerational Transmission of Mental Disorders. Front Psychiatry 2021; 12:721796. [PMID: 35177995 PMCID: PMC8846301 DOI: 10.3389/fpsyt.2021.721796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High Expressed Emotion (HEE) has been identified as a risk factor for the exacerbation and course of mental illness. EE has been investigated as a caregiver's response to an offspring's problem behavior and pathology. The present meta-analysis regards EE from a transgenerational perspective and as one mechanism that might explain the transgenerational transmission of mental disorders. METHOD We identified a total of 13 studies relying on 16 independent samples of parent-child dyads of parents with a mental illness and healthy controls; these were included in our analysis. Results were synthesized into one effect size per sample; meta-regression on additional effects of parental diagnostic category, child mental illness, and child age were also applied. RESULTS Parents with a mental illness are classified as HEE significantly more often. Effects were established for high criticism, albeit of small size (OR = 1.45), although they become stronger whenever offspring exhibit mental illness themselves (OR = 2.82). CONCLUSION The current study highlights the dearth of studies on EE in families in which a parent has a mental illness and its effects on their children. Our findings highlight EE as a potential mechanism for attributing the transgenerational transmission of mental disorders, especially for the EE-variable criticism, indicating dysfunctional parent-child interactions. SYSTEMATIC REVIEW REGISTRATION http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019117609, identifier: CRD42019117609.
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Affiliation(s)
- Julia Fahrer
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Philipps University Marburg, Marburg, Germany.,Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Faculty of Psychology and Sports Science, Justus-Liebig-University Gießen, Gießen, Germany
| | - Nathalie Brill
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Philipps University Marburg, Marburg, Germany
| | - Lisa Marie Dobener
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Philipps University Marburg, Marburg, Germany
| | - Julia Asbrand
- Institute of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Philipps University Marburg, Marburg, Germany
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Nestor B, Sutherland S, Kouros CD, Brunwasser SM, Weersing VR, Hollon SD, Gladstone TR, Clarke G, Beardslee W, Brent D, Garber J. Effects of an adolescent depression prevention program on maternal criticisms and positive remarks. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:927-937. [PMID: 32658515 PMCID: PMC8022270 DOI: 10.1037/fam0000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study examined effects of an adolescent depression prevention program on maternal criticisms and positive remarks, whether the extent of adolescents' depression accounted for effects, and whether effects of the program on maternal criticisms and positive remarks differed by adolescents' gender. Participants were 298 adolescent (Mage = 14.79, SD = 1.36; 59% female) offspring of mothers with histories of depression; youth were randomized to either a cognitive-behavioral prevention (CBP) program or usual care (UC). At baseline and 9-month postintervention evaluations, mothers were administered the Five-Minute Speech Sample to measure number of criticisms and positive remarks made during an open-ended description of their child and their relationship. Adolescents' depression from pre- through postintervention was assessed with interviews. A hierarchical generalized linear model showed a significant condition-by-gender interaction, indicating that, controlling for baseline criticism, at postintervention mothers of girls in CBP made significantly more criticisms than did mothers of girls in UC, whereas mothers of boys in CBP made fewer criticisms than did mothers of boys in UC. The extent of adolescents' depression from pre- through postintervention partially mediated the relation between intervention condition and mothers' criticisms, for boys but not for girls. Second, controlling for preintervention positive remarks, at postintervention, mothers of youth in CBP made significantly more positive remarks about their child than did mothers of youth in UC, regardless of gender; this relation was not mediated by adolescent depression from pre- through postintervention. We suggest possible explanations for the observed effects of CBP on mothers' criticisms and positive remarks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Bridget Nestor
- Department of Psychology and Human Development and Department of Psychology, Vanderbilt University
| | - Susanna Sutherland
- Department of Psychology and Human Development and Department of Psychology, Vanderbilt University
| | | | | | - V. Robin Weersing
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego
| | - Steven D. Hollon
- Department of Psychology and Human Development and Department of Psychology, Vanderbilt University
| | | | - Greg Clarke
- Kaiser Permanente Center for Health Research
| | - William Beardslee
- Department of Psychiatry, Children’s Hospital Boston, and Judge Baker Children’s Center
| | - David Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Judy Garber
- Department of Psychology and Human Development and Department of Psychology, Vanderbilt University
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45
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Polygenic Risk for Major Depression Interacts with Parental Criticism in Predicting Adolescent Depressive Symptom Development. J Youth Adolesc 2020; 50:159-176. [PMID: 33230654 PMCID: PMC7815554 DOI: 10.1007/s10964-020-01353-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022]
Abstract
Research has focused more and more on the interplay between genetics and environment in predicting different forms of psychopathology, including depressive symptoms. While the polygenic nature of depressive symptoms is increasingly recognized, only few studies have applied a polygenic approach in gene-by-environment interaction (G × E) studies. Furthermore, longitudinal G × E studies on developmental psychopathological properties of depression are scarce. Therefore, this 6-year longitudinal community study examined the interaction between genetic risk for major depression and a multi-informant longitudinal index of critical parenting in relation to depressive symptom development from early to late adolescence. The sample consisted of 327 Dutch adolescents of European descent (56% boys; Mage T1 = 13.00, SDage T1 = 0.44). Polygenic risk for major depression was based on the Hyde et al. (Nature Genetics, 48, 1031–1036, 2016) meta-analysis and genetic sensitivity analyses were based on the 23andMe discovery dataset. Latent Growth Models suggested that polygenic risk score for major depression was associated with higher depressive symptoms across adolescence (significant main effect), particularly for those experiencing elevated levels of critical parenting (significant G × E). These findings highlight how polygenic risk for major depression in combination with a general environmental factor impacts depressive symptom development from early to late adolescence.
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46
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Sepúlveda AR, Lacruz T, Solano S, Blanco M, Moreno A, Rojo M, Beltrán L, Graell M. Identifying Loss of Control Eating within Childhood Obesity: The Importance of Family Environment and Child Psychological Distress. CHILDREN-BASEL 2020; 7:children7110225. [PMID: 33187289 PMCID: PMC7696176 DOI: 10.3390/children7110225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 01/18/2023]
Abstract
This study aims to examine the differences in family environment, psychological distress, and disordered eating symptomatology between children classified by weight status with or without loss of control (LOC) eating and to test a model of the role of emotional regulation of LOC eating based on a dysfunctional family environment. A cross-sectional study was conducted among 239 families. The assessment measured family expressed emotion, family adaptability and cohesion, child levels of depression and anxiety, body esteem, and disordered eating attitudes. The assessment was carried out in primary care centers and primary schools. Child body mass index (BMI) was associated with higher expressed emotion, psychological distress, and disordered eating symptomatology. Children with obesity and LOC presented higher BMI, poorer body esteem, and more disordered eating attitudes than children without LOC. Children with overweight/obesity, both with or without LOC, exhibited higher psychological distress and emotional overinvolvement than normal-weight children. A partial mediation of depression or anxiety and disordered eating attitudes between expressed emotion and LOC was found. Findings support that children with overweight/obesity show more family and psychological distress. Body esteem issues and disordered eating attitudes could alert the presence of LOC in children with obesity. The function of LOC might be to cope with psychological distress that may appear in a dysfunctional family environment.
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Affiliation(s)
- Ana Rosa Sepúlveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, 28049 Madrid, Spain; (T.L.); (S.S.); (M.B.); (A.M.); (M.R.); (L.B.)
- Correspondence: ; Tel.: +34-914-975-214
| | - Tatiana Lacruz
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, 28049 Madrid, Spain; (T.L.); (S.S.); (M.B.); (A.M.); (M.R.); (L.B.)
| | - Santos Solano
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, 28049 Madrid, Spain; (T.L.); (S.S.); (M.B.); (A.M.); (M.R.); (L.B.)
| | - Miriam Blanco
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, 28049 Madrid, Spain; (T.L.); (S.S.); (M.B.); (A.M.); (M.R.); (L.B.)
| | - Alba Moreno
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, 28049 Madrid, Spain; (T.L.); (S.S.); (M.B.); (A.M.); (M.R.); (L.B.)
| | - Marta Rojo
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, 28049 Madrid, Spain; (T.L.); (S.S.); (M.B.); (A.M.); (M.R.); (L.B.)
| | - Lucía Beltrán
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, 28049 Madrid, Spain; (T.L.); (S.S.); (M.B.); (A.M.); (M.R.); (L.B.)
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, University Hospital Niño Jesús, 28009 Madrid, Spain;
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Haddad C, Darwich MJ, Obeid S, Sacre H, Zakhour M, Kazour F, Nabout R, Hallit S, Tahan FE. Factors associated with anxiety disorders among patients with substance use disorders in Lebanon: Results of a cross-sectional study. Perspect Psychiatr Care 2020; 56:745-752. [PMID: 31793708 DOI: 10.1111/ppc.12462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 11/23/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Estimate the rate of anxiety disorders (AD) and associated factors among patients with substance use disorder (SUD) in Lebanon. METHODS A cross-sectional study, conducted between April and September 2017, enrolled 57 inpatients with SUD. RESULTS The rate of AD in patients with SUD was 61.4%. The university level of education compared to the primary level of education (ORa = 0.221) was significantly associated with lower anxiety among patients with SUD. Being sexually abused and having a family history of depression tended to significance. PRACTICAL IMPLICATIONS AD is widespread in Lebanon and high rates of anxiety in patients with SUD were found, warranting the implementation of strategic interventions and establishing national policies and legislation for mental health services to provide optimal care.
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Affiliation(s)
- Chadia Haddad
- Departments of Research, Psychiatry and Psychology, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | | | - Sahar Obeid
- Departments of Research, Psychiatry and Psychology, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Maha Zakhour
- Faculty of Sciences, Lebanese University, Fanar, Lebanon
| | - Francois Kazour
- Departments of Research, Psychiatry and Psychology, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Sciences, Lebanese University, Fanar, Lebanon.,Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSERM U930, équipe 4 "Troubles affectifs", Université François-Rabelais de Tours, Tours, France.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rita Nabout
- Faculty of Sciences, Lebanese University, Fanar, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Fouad E Tahan
- Departments of Research, Psychiatry and Psychology, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Sciences, Lebanese University, Fanar, Lebanon
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48
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da Silva AHS, de Souza Tressoldi L, de Azevedo-Marques JM, Shuhama R, Del-Ben CM, Galera SAF, da Silva Gherardi-Donato EC, Vedana KGG, Zanetti ACG. Predictors of Expressed Emotion in First Episode Psychosis. Issues Ment Health Nurs 2020; 41:908-915. [PMID: 32568611 DOI: 10.1080/01612840.2020.1749916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article evaluated the predictors of EE and its components, EOI and CC, in relatives of first episode psychosis patients (FEP) in Brazil. Cross-sectional observational study conducted with 82 dyads of FEP patients and their relatives. Data collection instruments: sociodemographic and clinical data questionnaire, Family Questionnaire, Zarit Burden Interview and Morisky Medication Adherence Scale. Logistic and linear regression models were used. Our results indicate that patient's age, relative's sex, daily time spent together, and family burden were predictors of EE and its components. Our findings may be helpful in planning nursing interventions to reduce EE and prevent psychotic relapses.
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Affiliation(s)
- Amanda Heloisa Santana da Silva
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Rosana Shuhama
- Psychiatry Division. Department of Neurosciences and Behavior, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Psychiatry Division. Department of Neurosciences and Behavior, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sueli Aparecida Frari Galera
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Edilaine Cristina da Silva Gherardi-Donato
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Kelly Graziani Giacchero Vedana
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
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Zyto S, Jabben N, Schulte PFJ, Regeer EJ, Goossens PJJ, Kupka RW. A multi-center naturalistic study of a newly designed 12-sessions group psychoeducation program for patients with bipolar disorder and their caregivers. Int J Bipolar Disord 2020; 8:26. [PMID: 32869118 PMCID: PMC7459037 DOI: 10.1186/s40345-020-00190-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/04/2020] [Indexed: 01/14/2023] Open
Abstract
Background Psychoeducation (PE) for bipolar disorder (BD) has a first-line recommendation for the maintenance treatment phase of BD. Formats vary greatly in the number of sessions, whether offered individually or in a group, and with or without caregivers attending. Due to a large variation in formats in the Netherlands, a new program was developed and implemented in 17 outpatient clinics throughout the country. The current study investigated the feasibility of a newly developed 12-sessions PE group program for patients with BD and their caregivers in routine outpatient practice and additionally explored its effectiveness. Methods Participants in the study were 108 patients diagnosed with BD, 88 caregivers and 35 course leaders. Feasibility and acceptance of the program were investigated by measures of attendance, and evaluative questionnaires after session 12. Preliminary treatment effects were investigated by pre- and post-measures on mood symptoms, attitudes towards BD and its treatment, levels of self-management, and levels of expressed emotion. Results There was a high degree of satisfaction with the current program as reported by patients, caregivers, and course leaders. The average attendance was high and 83% of the patients and 75% of the caregivers completed the program. Analyses of treatment effects suggest positive effects on depressive symptoms and self-management in patients, and lower EE as experienced by caregivers. Conclusions This compact 12-sessions psychoeducation group program showed good feasibility and was well accepted by patients, caregivers, and course leaders. Preliminary effects on measures of self-management, expressed emotions, and depressive symptoms were promising. After its introduction it has been widely implemented in mental health institutions throughout the Netherlands.
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Affiliation(s)
- Susan Zyto
- Mental Health Service Organisation North Holland North, Center for Psychosomatic Medicine, Hoorn, The Netherlands. .,Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Nienke Jabben
- Department of Psychiatry, Zuyderland Medical Center, Sittard, The Netherlands
| | - Peter F J Schulte
- Mental Health Service Organisation North Holland North, Alkmaar, The Netherlands
| | - Eline J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Peter J J Goossens
- Dimence Group Mental Health Care Center, Deventer, The Netherlands.,University Center for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ralph W Kupka
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
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Irritability and Perceived Expressed Emotion in Adolescents With Iron Deficiency and Iron Deficiency Anemia: A Case-Control Study. J Pediatr Hematol Oncol 2020; 42:403-409. [PMID: 31725544 DOI: 10.1097/mph.0000000000001663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to assess the difference in irritability and perceived expressed emotion (EE) between adolescents with iron deficiency (ID) or iron deficiency anemia (IDA) and their healthy peers. In addition, we aimed to investigate the relationship between hemogram parameters, irritability, and perceived EE in adolescents with ID and IDA. The sample of this single-center cross-sectional case-control study consisted of 89 adolescents from 12 to 17 years of age. Of the participants, 19 had been diagnosed with ID, 31 had IDA, and 39 were healthy controls. Significant differences in the self-reported and parent-reported irritability scores were observed between the ID group and the control group and between the IDA group and the control group. There was also a significant difference in the subscale of irritability between the ID group and the control group. The difference between the IDA and control groups in the intrusiveness subscale was found to be significant as well. Adolescents with IDA and ID exhibited significantly perceived irritability compared with the control group. In terms of irritability, adolescents with IDA and ID revealed greater irritability than their healthy peers. The results of this study suggest that irritability and perceived EE should be investigated in cases of ID, whether with or without anemia. As chronic diseases may benefit substantially from psychiatric consultation, psychosocial evaluation and intervention should be considered a complementary treatment option in the management of ID and IDA.
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