The Role of Family Routines in the Intergenerational Transmission of Depressive Symptoms between Parents and their Adolescent Children

Belief Updating, Childhood Maltreatment, and Paranoia in Schizophrenia-Spectrum Disorders

BACKGROUND AND HYPOTHESIS

Exposure to childhood maltreatment-a risk factor for psychosis is associated with paranoia-may impact one's beliefs about the world and how beliefs are updated. We hypothesized that increased exposure to childhood maltreatment is related to volatility-related belief updating, specifically higher expectations of volatility, and that these relationships are strongest for threat-related maltreatment. Additionally, we tested whether belief updating mediates the relationship between maltreatment and paranoia.

STUDY DESIGN

Belief updating was measured in 75 patients with schizophrenia-spectrum disorders and 76 nonpsychiatric controls using a 3-option probabilistic reversal learning (3PRL) task. A Hierarchical Gaussian Filter (HGF) was used to estimate computational parameters of belief updating, including prior expectations of volatility (μ03). The Childhood Trauma Questionnaire (CTQ) was used to assess cumulative maltreatment, threat, and deprivation exposure. Paranoia was measured using the Positive and Negative Syndrome Scale (PANSS) and the revised Green et al. Paranoid Thoughts Scale (R-GPTS).

RESULTS

Greater exposure to childhood maltreatment is associated with higher prior expectations of volatility in the whole sample and in individuals with schizophrenia-spectrum disorders. This was specific to threat-related maltreatment, rather than deprivation, in schizophrenia-spectrum disorders. Paranoia was associated with both exposure to childhood maltreatment and volatility priors, but we did not observe a significant indirect effect of volatility priors on the relationship between maltreatment and paranoia.

CONCLUSIONS

Our study suggests that individuals with schizophrenia-spectrum disorders who were exposed to threatening experiences during childhood expect their environment to be more volatile, potentially facilitating aberrant belief updating and conferring risk for paranoia.

Annual Research Review: The power of predictability - patterns of signals in early life shape neurodevelopment and mental health trajectories

The global burden of early life adversity (ELA) is profound. The World Health Organization has estimated that ELA accounts for almost 30% of all psychiatric cases. Yet, our ability to identify which individuals exposed to ELA will develop mental illness remains poor and there is a critical need to identify underlying pathways and mechanisms. This review proposes unpredictability as an understudied aspect of ELA that is tractable and presents a conceptual model that includes biologically plausible mechanistic pathways by which unpredictability impacts the developing brain. The model is supported by a synthesis of published and new data illustrating the significant impacts of patterns of signals on child development. We begin with an overview of the existing unpredictability literature, which has focused primarily on longer patterns of unpredictability (e.g. years, months, and days). We then describe our work testing the impact of patterns of parental signals on a moment-to-moment timescale, providing evidence that patterns of these signals during sensitive windows of development influence neurocircuit formation across species and thus may be an evolutionarily conserved process that shapes the developing brain. Next, attention is drawn to emerging themes which provide a framework for future directions of research including the evaluation of functions, such as effortful control, that may be particularly vulnerable to unpredictability, sensitive periods, sex differences, cross-cultural investigations, addressing causality, and unpredictability as a pathway by which other forms of ELA impact development. Finally, we provide suggestions for prevention and intervention, including the introduction of a screening instrument for the identification of children exposed to unpredictable experiences.

Parent Anxiety, Depression, Protective Responses, and Parenting Stress in the Context of Parent and Child Chronic Pain: A Daily Diary Study of Parent Variability

Parents with (vs without) chronic pain report poorer psychosocial functioning (eg, worse mental health, parenting difficulties), which has been linked to poorer child outcomes (eg, child pain). However, emerging research suggests that individuals vary in their functioning from day-to-day, particularly those with chronic pain. This study used daily diaries to compare parents with (versus without) chronic pain on variability in their anxiety, mood, protective responses, and parenting stress. We also examined parent chronic pain status as a moderator of the associations between parent variability and youth daily pain and interference. Participants were 76 youth with chronic pain (Mage = 14.26; 71.1% female) and one of their parents (89.5% mothers; n = 38 or 50.0% endorsing chronic pain). Parents and youth completed self-report questionnaires and 7 days of diaries. Parent variability was calculated to reflect the frequency and size of day-to-day changes. Multilevel models revealed that parents with (vs without) chronic pain were significantly more variable in their parenting stress, but not in their anxiety, mood, or protective responses. Contrary to hypotheses, parent variability was not significantly related to youth daily pain intensity or interference and parent chronic pain did not moderate any associations. Instead, mean levels of parent anxiety, protective responses, and parenting stress across the week significantly predicted youth daily pain interference. Findings suggest that while variability was observed among parents (with and without chronic pain) of youth with chronic pain, it did not significantly predict youth's daily pain-related functioning. Further research is needed to confirm these initial findings. PERSPECTIVE: Parents with chronic pain have expressed concerns that the variable nature of their pain negatively impacts their children. Our results found that parents (with and without chronic pain) were variable in their anxiety, mood, protective responses, and parenting stress, but this variability did not significantly predict youth's chronic pain-related functioning.

The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children's and Parents' Emotional and Behavioral Problems and Parents' Health-Related Quality of Life

This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3-15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.

Depression Transmission From Parents to Their Adult Children in China: The Mediating Role of Family Violence

Depression can be transmitted from parents to children through the gene-environment interaction. Previous studies have focused on the short-term effects of parental depression on children and adolescents while neglecting the long-term effects. Furthermore, as a major indicator of stressful environment, the mediating role of different types of family violence has rarely been studied. The purpose of this study was to examine the long-term effects of parental depressive symptoms on those of adult children and to explore the potential mediating roles of different types of family violence (physical abuse, witnessing interparental violence, and sibling violence) in China. Data came from the 2014 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS), which consisted of 10,973 participants aged 45 years and older. Logistic regression models were performed. The total effect was decomposed into direct and indirect effects by logistic regression based on the Karlson/Holm/Breen (KHB) method. The results indicated that parental depressive symptoms were related to adult children's depressive symptoms (odds ratio [OR], 1.20; 95% confidence interval [CI] [1.16-1.25]). The KHB method showed that this relationship was mediated by physical abuse (OR, 1.01; 95% CI [1.00-1.01]) and witnessing interparental violence (OR, 1.01; 95% CI [1.01-1.02]). In China, depression can be transmitted from parents to their adult children through family violence. The findings suggest that regular mental health screening across entire lifespan and family violence prevention programs targeting depressed parents may bring long-term benefit to adult children's mental health.

The Transition to Adulthood in Children of Depressed Parents: Long-Term Follow-Up Data from the Family Talk Preventive Intervention Project

Little is known about the effects of parental depression on offspring as they transition to adulthood-a challenging time developmentally, when late adolescents must separate from home, achieve intimate relationships, and develop a sense of identity. We present long-term quantitative and qualitative data from early adolescents with a depressed parent who were randomized to one of two family-based preventive interventions and followed over time, across the transition to young adulthood. Specifically, we present clinical measures of psychopathology and Likert-scale questionnaire data from young adults and their parents regarding the transition to adulthood and perceptions of the interventions. We also report in-depth qualitative interview data from young adults about the effects of parental depression on their transition to adulthood. Findings suggest that leaving home, establishing relationships, and coping with stressors may be challenging for emerging adults. Furthermore, the interviews highlight the importance of siblings, the burden of parental depression, and the development of self-understanding and empathy in young adults who grew up with a depressed parent. Data suggest that clinicians, policy makers, educators, and employers must address the preventive and clinical needs of young people and their families as they transition to young adulthood after growing up with depressed parents.

Shared Activities With Parents During Adolescence Predicts Health Risk Across Multiple Biological Systems 22 Years Later

OBJECTIVE

Although affectively focused dimensions of social relationships are associated with differences in health risk, less research has considered nonaffective features of relationships, such as engaging in shared activities. This study sought to test whether adolescents who engaged in more shared activities with their parents had lower health risk in early midlife across multiple biological markers.

METHODS

Using data from a nationally representative study ( N = 4801), prospective associations between shared activities with parents during adolescence and health risk classifications for measures of inflammation, renal function, glucose homeostasis, and cholesterol 22 years later were examined, along with the potentially confounding roles of childhood socioeconomic status and parent-child relationship satisfaction. Exploratory analyses considered possible indirect effects of cigarette use, alcohol use, and body mass index in adulthood.

RESULTS

Engaging in more shared activities with parents was associated with a reduced likelihood of being classified in a high-risk health category for markers of inflammation ( B = -0.02, standard error [SE] = 0.01, p = .040), renal function ( B = -0.08, SE = 002, p = .001), glucose ( B = -0.06, SE = 0.23, p = .011), and high-density lipoprotein ( B = - 0.03, SE = 0.01, p = .021), and overall allostatic load ( B = - 0.02, SE = 0.02, p = .001), beyond demographic and health covariates. Controlling for parental income and relationship satisfaction largely did not affect observed associations. Exploratory tests of indirect effects imply that health behaviors in adulthood may partially account for observed associations.

CONCLUSIONS

Engaging in more shared activities predicted more optimal health classifications 22 years later, suggesting that the amount of contact between parents and teenagers may have long-lasting beneficial health effects. Furthermore, consideration of nonaffective dimensions of family relationships may provide additional insight into associations between social relationships and health.

Commonality and Specificity in Chinese Parental Emotion Socialization and Adolescents' Psychological Functioning: A Bifactor Approach

Understanding of the conceptual relations among different parental emotion socialization processes (i.e., whether and how they are distinct or share common components) and their developmental implications for adolescents is limited, especially within Asian cultural contexts. Guided by the parental emotion socialization framework, this study aimed to: (1) investigate a conceptual model that delineates general and specific components in parental emotion socialization with both adolescents and parents within a contemporary Asian cultural context-Beijing, China, and (2) examine whether the common and specific processes predicted adolescents' psychological functioning six months later for both informants. Participants included 1486 Chinese adolescents (M_age = 15.11 years; 52.6% males) and their primary caregivers (M_age = 44.93 years; 44.9% males). Both adolescents and parents self-reported on parental emotion socialization and adolescents completed a measure of their psychological functioning at two time-points. We evaluated the fit of one-factor, first-order factor, and bifactor models for both informants separately. Results indicated a good fit of the bifactor model with a proposed general factor of parent meta-emotion philosophy and specific factors of parental reaction and emotional expressivity, with partial factorial invariance of the parental reaction factor across informants. The common and specific factors uniquely predicted adolescents' psychological functioning. Findings inform the parental emotion socialization framework, particularly our conceptual understanding of the different processes with Asian samples, and have practical implications for the design and implementation of comprehensive and culturally relevant parenting interventions in support of adolescent psychological functioning.

Parenting beliefs about attunement and structure are related to observed parenting behaviours

We compared self-reported parenting beliefs about caring for infants with observed parenting behaviours during play interactions between 32 parents and their infants. We measured parenting beliefs about the value of attunement and structure in caring for infants using the Baby Care Questionnaire (BCQ) (Winstanley & Gattis, 2013; Winstanley, Sperotto, Putnick, Cherian, Bornstein & Gattis, 2014). We used a micro-coding approach to distinguish between responsive parenting behaviours (maintaining infant attention) and demanding parenting behaviours (introducing or redirecting infant attention) (Landry, Garner, Swank & Baldwin, 1996). Attunement beliefs were positively related to responsive parenting behaviours and negatively related to demanding parenting behaviours. Structure beliefs were weakly related to demanding parenting behaviours. These results are an important first step toward identifying relations between self-reported parenting beliefs about attunement and structure and observed parenting behaviours.

Inflammation and depression in young people: a systematic review and proposed inflammatory pathways

Depression onset peaks during adolescence and young adulthood. Current treatments are only moderately effective, driving the search for novel pathophysiological mechanisms underlying youth depression. Inflammatory dysregulation has been shown in adults with depression, however, less is known about inflammation in youth depression. This systematic review identified 109 studies examining the association between inflammation and youth depression and showed subtle evidence for inflammatory dysregulation in youth depression. Longitudinal studies support the bidirectional association between inflammation and depression in youth. We hypothesise multiple inflammatory pathways contributing to depression. More research is needed on anti-inflammatory treatments, potentially tailored to individual symptom profiles.

Influence of Childhood Family Routines on Adult Depression: A Cross Sectional Study

In order to explore the influence of childhood family routines on adult depression and the mediating role of tolerance of uncertainty and rumination, the current study tested 818 participants by adopting four questionnaires. The results of structural equation modeling revealed that (1) family routines had a negative effect on depression among Chinese college students; (2) family routines were found to have a positive effect on tolerance of uncertainty, and tolerance of uncertainty was a bridge linking family routines and depression; (3) family routines had a significant effect on depression through rumination; (4) the relationship between family routines and depression was partially mediated by the chain of tolerance of uncertainty and rumination. The result reveals not only the fact that childhood family routines have significant influence on college students' depression but also the mechanism of childhood family routines that affect college students' depression. The limitations and implications of our study were also discussed.

Commentary: Social Immune Processes as Pathways to Psychopathology: a commentary on Robles (2020)

In this Annual Research Review, Robles (2020) discusses and synthesizes a growing literature on immune correlates of social relationships during childhood and adolescence. As he notes, the capacity for our social experiences to shape innate immune processes holds tremendous medical and psychiatric import. Childhood social experiences are associated with peripheral inflammation later in life, with related and possibly intermediate markers (like stimulated cytokine production or the expression of NF-κβ genes), and with circulating inflammatory markers in childhood (at least in high-risk groups), supporting the interpretation that youth social experiences are important contributors to health trajectories across the life span. Somewhat less explored, however, are what such associations mean for psychopathology.

Caregivers' joint depressive symptoms and preschoolers' daily routines in Chinese three-generation families: Does household chaos matter?

The benefits of routines for children have been consistently demonstrated in previous literature. However, factors that may confer risks for child routines have seldom been examined, particularly in families where parents and grandparents co-care the children. This study aimed to investigate the associations of parents' and grandparents' depressive symptoms with preschoolers' daily routines in Chinese three-generation families and to determine whether household chaos mediated or moderated the associations. The participants were from 171 urban three-generation families where mothers, fathers, and grandmothers (97 paternal and 74 maternal) were primary caregivers. Mothers, fathers, and grandmothers reported their depressive symptoms at Wave 1; at Wave 2 (during the COVID-19 pandemic), caregivers reported household chaos and child routines. The results revealed that child routines were negatively predicted by parents' joint depressive symptoms rather than grandmothers' depressive symptoms. In the associations, household chaos acted as a mediator rather than a moderator. Specifically, household chaos marginally mediated the associations between parents' and grandmothers' depressive symptoms and child routines only in maternal three-generation families. These findings suggest that in three-generation families, caregivers with more depressive symptoms may elicit more chaotic family environments, which may in turn compromise their children's daily routines.

The Protective Roles of Exercise and Maintenance of Daily Living Routines for Chinese Adolescents During the COVID-19 Quarantine Period

PURPOSE

Adolescents are particularly vulnerable during the COVID-19 quarantine periods and may be at risk for developing psychological distress symptoms that extend beyond a crisis, including depression. This study examined adolescents' postquarantine depressive symptoms associated with pandemic stressors. The primary aim was to identify potential protective factors that may buffer the association between the presence of COVID-19 cases in adolescents' communities and their postquarantine depressive symptoms.

METHODS

Adolescents from public schools were recruited from Zhengzhou city, Henan, China (N = 1,487, M_age=13.14 years, 50% girls). Adolescents reported the presence of confirmed or suspected COVID-19 cases in their communities, their daily activities and routines during the 2-month quarantine period, and depressive symptoms after the quarantine period.

RESULTS

The presence of cases in adolescents' communities during the quarantine contributed to more depressive symptoms in adolescents after the quarantine. This association was buffered by adolescents' spending more time on physical activities and better maintenance of daily living routines during the quarantine period. The presence of community infection was also more strongly associated with depressive symptoms in older adolescents.

CONCLUSIONS

The presence of COVID-19 cases in communities contributed to adolescents' poorer mental health, and the association was stronger for older adolescents. Spending time on physical activities and maintaining daily living routines during the quarantine appear to be practical strategies that can be used by adolescents to mitigate the association between pandemic stressors and their diminishing mental health.

Depression and inflammation among children and adolescents: A meta-analysis

BACKGROUND

Increasing evidence suggests that youth with Major Depressive Disorder (MDD) exhibit early indicators of cardiovascular disease. A leading hypothesized mechanism of this association is via inflammatory pathways, however, results examining this direct association are mixed. Our objective was to synthesize and quantify observational studies examining the association of depression and inflammation among children and adolescents.

METHODS

Electronic searches were conducted in MEDLINE, Embase, PsycINFO, and Scopus, yielding 2,757 non-duplicate records from 1946 to 2019. The included studies measured depression or depressive symptoms and examined its association with inflammation in participants younger than 18 years. All relevant articles were reviewed and data extracted by two independent coders. Estimates were examined by using random-effects meta-analysis.

RESULTS

Twenty-two studies (20,791 participants) were included. Significant associations were observed between concurrent depression and CRP (n = 7; r = 0.12; 95% confidence interval [CI] = 0.04 to 0.19), and IL-6 (n = 7; r = 0.17; 95% CI= 0.10 to 0.24). Longitudinal analyses revealed that depression is a significant predictor of IL-6 (n = 3; r = 0.29; 95% CI= 0.04 to 0.50) and conversely, that inflammation (measured by CRP or IL-6) predicts future depression (n = 4; r = 0.04; 95% CI= 0.00 to 0.08).

LIMITATIONS

Results are limited by the small number of studies preventing examination of some moderator variables. Findings are correlational, not causal.

CONCLUSION

Depression is positively associated with concurrent and future inflammation among children and adolescents. Results suggest that bidirectional associations may exist between depression and a pro-inflammatory state.

Anger and Sadness Regulation in Refugee Children: The Roles of Pre- and Post-migratory Factors

Pre- and post-migratory factors have been implicated in refugee children's mental health. However, findings regarding their unique and joint roles are inconsistent or nonexistent. We examined the main and interactive relations of pre-migratory life stressors and post-migratory daily hassles and routines to emotion regulation-a key marker of mental health-in 5- to 13-year-old Syrian refugee children (N = 103) resettling in Canada. Mothers and children completed questionnaires assessing pre-migratory life stressors and post-migratory daily hassles. Mothers also reported their children's adherence to family routines and emotion regulation abilities (i.e., anger and sadness regulation) via questionnaire. Overall, children who more frequently engaged in family routines showed better anger regulation. Pre- and post-migratory factors also interacted, such that greater post-migratory daily hassles were associated with worse sadness regulation for children with lower levels of pre-migratory life stressors, but were unassociated with the sadness regulation of children who experienced higher levels of pre-migratory life stressors. Results suggest that pre- and post-migratory factors play unique and joint roles in refugee children's emotion regulation during resettlement.

Measuring novel antecedents of mental illness: the Questionnaire of Unpredictability in Childhood

Increasing evidence indicates that, in addition to poverty, maternal depression, and other well-established factors, unpredictability of maternal and environmental signals early in life influences trajectories of brain development, determining risk for subsequent mental illness. However, whereas most risk factors for later vulnerability to mental illness are readily measured using existing, clinically available tools, there are no similar measures for assessing early-life unpredictability. Here we validate the Questionnaire of Unpredictability in Childhood (QUIC) and examine its associations with mental health in the context of other indicators of childhood adversity (e.g., traumatic life events, socioeconomic status, and parenting quality). The QUIC was initially validated through administration to a cohort of adult females (N = 116) and then further refined in two additional independent cohorts (male Veterans, N = 95, and male and female adolescents, N = 175). The QUIC demonstrated excellent internal (α = 0.89) and test-retest reliability (r = 92). Scores on the QUIC were positively correlated with other prospective indicators of exposures to unpredictable maternal inputs in infancy and childhood (unpredictable maternal mood and sensory signals), and accuracy of recall also was confirmed with prospective data. Importantly, the QUIC predicted symptoms of anxiety, depression, and anhedonia in the three study cohorts, and these effects persisted after adjusting for other previously established risk factors. The QUIC, a reliable and valid self-report assessment of exposure to unpredictability in the social, emotional, and physical domains during early life, is a brief, comprehensive, and promising instrument for predicting risk for mental illness.

Time Spent with Parents Predicts Change in Depressive Symptoms in Adolescents with Major Depressive Disorder

Research with community samples suggests that non-affective features of families, such as the amount of time parents and adolescents spend together, affect depressive symptoms in adolescents. It is possible, however, that spending time with parents not only protects against the onset of depressive symptoms, but also reduces symptoms in adolescents who are already depressed. The current study was designed to test this formulation while also examining whether affective dimensions of family functioning - specifically parental warmth - accounted for or moderated observed associations. Finally, we tested the reverse direction of the associations, examining whether greater severity of depression in adolescents results in parents spending less time with them. Forty-one adolescents (ages 14 to 17 years) who met criteria for a current major depressive episode participated in the present study with one parent. Once each month for six time points, dyads completed reports of depressive symptoms and the amount of time parents and adolescents spent with each other. Participants also completed measures of parental warmth. Results of lagged multilevel modeling indicated that spending more time with a parent predicted fewer depressive symptoms in adolescents at the following assessment relative to their mean; in contrast, greater severity of depressive symptoms did not predict spending less time with a parent at the following assessment. In contrast, parental warmth did not account for or moderate the association between time together and depressive symptoms. These results suggest that non-affective dimensions of family life, specifically spending more time with parents, have beneficial effects on depressive symptoms in adolescents diagnosed with depression.

The Profundity of the Everyday: Family Routines in Adolescence Predict Development in Young Adulthood

PURPOSE

The current study was designed to investigate the unique, long-term effects of family routines during adolescence on multiple developmental domains in young adulthood for rural African-Americans.

METHODS

Prospective data were collected annually for 6 years from 504 rural African-American youth and their parents, beginning when the youth were 16 years of age.

RESULTS

Results indicated that youth whose primary caregivers reported more family routines during adolescence (e.g., regularly eating together as a family, consistent bedtime) reported less alcohol use, greater emotional self-regulation, lower epinephrine levels, and higher rates of college/university enrollment in young adulthood. These effects were evident for all outcomes controlling for socioeconomic risk, sex, and available baseline (age 16 years) measures; for a subset of outcomes, the effects of family routines persisted even after taking into account levels of supportive parenting, harsh parenting, and household chaos.

CONCLUSIONS

Findings substantiate the benefits of consistent, predictable family environments for healthy development and suggest that family routines constitute an important, yet understudied, factor for adolescents' long-term development.

Beyond positive or negative: variability in daily parent-adolescent interaction quality is associated with adolescent emotion dysregulation

Previous work on the contribution of family environments to adolescent emotion dysregulation has tended to focus on broad parenting characteristics (such as warmth); however, it is possible that day-to-day variability in parenting may also relate to emotion dysregulation. The current study sought to test whether inconsistency in the quality of daily parent-youth interactions related to multiple indices of emotion dysregulation in adolescents. Two-hundred-twenty-two adolescents (ages 13-16; 53% female) participated with one parent. Adolescents completed 14-days of diary reporting on the quality of interactions with their parent (negative/neutral/positive) and their emotion dysregulation experiences for each day. Analyses reveal that, beyond the effects of average interaction quality, adolescents with greater variability in the quality of their interactions with their parent reported greater average emotion dysregulation across the days of diary recording and demonstrated greater variability in their ratings of daily emotion dysregulation. Findings were not accounted for by parental warmth or hostility, parent-reported trait-level emotion regulation, or day-level associations between study variables. In these ways, greater variability - and not merely greater negativity - during interactions between parents and adolescents was related to adolescent emotion dysregulation, suggesting that consistency in parent-adolescent relationships may be an important dimension of psychosocial risk to consider within families.

Adapting to the changing needs of adolescents: parenting practices and challenges to sensitive attunement

Changes in adolescents' motivations and capabilities pose unique challenges to parents who play a continuing role in ensuring the youth's safety and well-being. We describe sensitively attuned parenting as an optimal response to this challenge and summarize practices of positive engagement, supervision/guidance and open communication that support sensitive attunement and facilitate the continuing development of the adolescent's self-confidence, autonomous decision-making, and communication skills. We then consider factors that require parents to adapt their practices to the particular needs and developmental level of the adolescent. Individual differences that may challenge parent's effectiveness in implementing these practices include: biological vulnerabilities, differential sensitivity to parenting, relationship history and temperament. Clinical interventions that seek to improve parenting offer an opportunity to test sensitive attunement as a mechanism for reducing adolescents' symptoms and problem behaviors.

Household water insecurity, missed schooling, and the mediating role of caregiver depression in rural Uganda

BACKGROUND

School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children's water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.

METHOD

We conducted a population-based, cross-sectional study of female household heads (N = 257) and their children ages 5-17 (N = 551) in the rural regions surrounding the town of Mbarara, in southwestern Uganda. We used multivariable linear regressions to estimate the association between water insecurity and missed schooling. We then assessed the extent to which the association was mediated by caregiver depression.

RESULTS

Among children, water insecurity had a statistically significant association with the number of missed school days (a standard deviation increase in water insecurity resulted in 0.30 more missed school days in the last week). The estimated association was partially mediated by caregiver depression. When stratified by sex, this mediating pathway remained significant for boys, but not among girls.

CONCLUSIONS

Water insecurity is a risk factor for missed schooling among children in rural Uganda. Caregiver depression partially mediated this relationship. Also addressing caregiver mental health in water insecure families may more fully address the needs of sub-Saharan African families and promote educational participation among youth.