The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up

Family Functioning Styles and Exercise Addiction: Disengaged, Enmeshed, and Rigid Family Patterns Are Associated with Exercise Addiction

Physical exercise is a widely recommended practice for promoting health, but for some individuals, this activity can result in pathological and morbid behaviour. Therefore, the study of the factors contributing to the onset, development, and progression of exercise addiction is particularly relevant. Within this framework, the present study assessed the effect of family functioning, body image concerns, age, and gender on exercise addiction. A sample of 300 regular exercisers (Mage = 30.3 years, SD = 11.6; 69.7% females, 30.3% males) participated in the study and completed the Family Adaptability and Cohesion Evaluation Scales-IV, Body Image Concern Inventory, and Exercise Addiction Inventory. Data were analysed by implementing a series of moderated moderated-mediations. Results showed that three significant models were relevant. First, positive associations of disengaged (p < 0.05), enmeshed (p < 0.05), and rigid (p < 0.01) family functioning with exercise addiction were found. Furthermore, body image concerns mediated all these relationships, and the interaction between gender and age significantly moderated the effects of body image concerns on exercise addiction (p < 0.05). Such data may be useful for a deeper understanding of the variables associated with the development of exercise addiction, suggesting key elements on which it might be useful to focus in clinical and/or preventive activity.

The cost-utility of an intervention for children and adolescents with a parent having a mental illness in the framework of the German health and social care system: a health economic evaluation of a randomized controlled trial

BACKGROUND

Children of families with a parent with a mental illness have an increased risk of developing social and mental health problems resulting in decreased quality of life. Therefore, children and adolescents living in families with a parent with mental illness are regarded as a target group for preventive interventions. To date, only a few economic evaluation studies for interventions directed at preventing the intergenerational transmission of mental health problems exist. In this investigation we estimated the cost utility of an intervention for the support of children and adolescents with a parent having a mental illness from the perspective of the German health and social care system.

METHODS

We randomly assigned a total of 214 families with 337 children and adolescents to the intervention (INT) group (108/170) or the control (TAU) group (106/167). Families in the intervention group received on average eight intervention sessions (50-90 min) over 6 months. We estimated total cost of illness by means of the Children and Adolescent Mental Health Service Receipt Inventory (CAMHSRI) over 24 months. For the estimation of Quality-Adjusted Live Years (QALYs) we applied the KIDSCREEN-10. For estimating the incremental cost-utility of the intervention compared to treatment as usual we used the net-benefit approach.

RESULTS

We estimated the annual cost of illness amounting to € 3784.59 (SD € 8581.11) in the TAU group and € 3264.44 (SD € 9431.89) in the INT group. The annual cost difference between INT and TAU was € - 516.14 (SE 1124.95) which was not significant (p ≤ 0.05). We estimated the average QALY to be 0.759 (SD 0.073) in the TAU group and 0.763 (SD 0.072). The QALY difference between INT and TAU was 0.0037 (SE 0.0092) which was not significant (p ≤ 0.05). The incremental cost utility ratio (ICUR) indicated that the gain of one additional year in full health by means of the intervention was associated with the saving of € 139.49. However, the stochastic insecurity of the ICUR did not allow a unique decision about the cost-utility of the intervention.

CONCLUSIONS

More information on the economic value of the intervention for families with a parent with mental illness in comparison to treatment as usual in Germany is needed.

TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.

The relationship between social media addiction, fear of missing out and family functioning: a structural equation mediation model

BACKGROUND

The use of social media became a daily activity for many individuals, with recreational, informational, and social purposes, to name a few. However, for some subjects, the use of these platforms may become problematic and generate functioning impairments in many life areas. Given this, the present research aimed at investigating the factor that may contribute to Social Media Addiction, by focusing on Fear of Missing Out and Family Functioning Patterns.

METHODS

A sample of 303 social media users (Mage = 35.29; SD = 14.87; 65% females, 35% males) completed a survey including the Bergen Social Media Addiction Scale, Family Adaptability and Cohesion Evaluation Scales-IV, and Fear of Missing Out Scale. Data were analysed by implementing Pearson correlation and testing a mediation with the Structural Equation Model approach.

RESULTS

Cohesion, flexibility, and disengagement family functioning patterns were significantly associated with the levels of social media addiction. These dimensions were inserted in the structural equation model, where the full mediation of fear of missing out in their relationship with social media addiction was shown.

CONCLUSIONS

The data showed the protective effect of flexible and cohesive family functioning patterns, as well as the role of disengagement and, sequentially, fear of missing out as risk factors. These findings may provide useful indications to elaborate tailored and effective therapeutic and preventive activity.

Family functioning and problematic internet pornography use among adolescents: a moderated mediation model

Background

In recent years, the issue of problematic Internet pornography use (PIPU) among adolescents has become increasingly prominent, attracting widespread attention from society. Family functioning has been recognized as a protective factor for PIPU, but the underlying mediating and moderating mechanisms remain unclear. The purpose of this study is (a) to investigate the mediating role of self-esteem in the relationship between family functioning and PIPU, and (b) to examine the moderating role of the need to belong in this mediating pathway.

Methods

A total of 771 high school students (Mage = 16.19, SD = 0.90) were surveyed using the Problematic Internet Pornography Use Scale, Family Assessment Device, Rosenberg Self-Esteem Scale, and the Need to Belong Scale.

Results

Correlation analysis showed a significant negative correlation between family functioning and PIPU (r = -0.25, p < 0.001), a significant positive correlation between self-esteem and family functioning (r = 0.38, p < 0.001), a significant negative correlation between self-esteem and PIPU (r = -0.24, p < 0.001), and a significant positive correlation between need to belong and PIPU (r = 0.16, p < 0.01). Mediation analysis showed that self-esteem partially mediated the relationship between family functioning and PIPU, with a mediation effect of -0.06. Further moderated mediation analysis showed that for adolescents with higher need to belong, the mediating effect of self-esteem was stronger.

Conclusions

For adolescents with high belonging needs who are at high risk for PIPU, good family functioning may have a protective effect by boosting self-esteem.

A comprehensive review on emerging trends in the dynamic evolution of digital addiction and depression

Introduction

Using digital addiction as an umbrella term to cover any type of addictions to digital technologies such as the internet, smartphones, social media, or video games, the current study aimed to reveal the intellectual structure and evolution of research addressing digital addiction-depression relationship.

Methods

The study combined bibliometric and science mapping analysis methods for this purpose. Data for the study was gathered from Web of Science Core Collection after a comprehensive process of data search/extraction, and 241 articles were included in the final data set. A period-based, comparative science mapping analysis was performed using the SciMAT software.

Results

The analysis of data over three periods, Period 1 (1983-2016), Period 2 (2017-2019), and Period 3 (2020-2022) showed that internet addiction was the most significant theme across all three periods, which was followed by social media addiction. Depression, which emerged as a significant theme during Period 1, was later covered under anxiety disorder theme. Research interest was mostly on factors related to both addiction and depression such as cognitive distortion, insomnia, loneliness, self-esteem, social support, alexithymia, as well as cybervictimization or academic performance.

Discussion

The results suggested that much research is warranted on the digital addiction-depression relationship in different age cohorts, especially children and elderly. Similarly, the current analysis showed that this line of research particularly focused on internet, gaming and social media addiction, and evidence with regard to other types of digital addiction or related compulsive behaviors was almost absent. In addition, research was mostly inclined to understanding cause-effect relationships, which is significant, but preventive strategies seemed to be barely addressed. Likewise, the smartphone addiction-depression relationship arguably garnered less research interest, so future research would contribute to the field in this respect.

Prevalence and determinants of Internet Addiction among medical students and its association with depression

BACKGROUND

Internet addiction has been a topic of discussion in the academic literature for many years. As of April 2020, about 60 % of the world's population (nearly 4.6 billion people) were active internet user in their early adulthood. The prevalence among adolescent and college students ranged from 0.9 % to 33 %. The current study aimed to explore internet addiction's prevalence and correlates among undergraduate medical students at an Egyptian university. Also, to assess the relationship between internet addiction, depression symptoms, and socioeconomic status.

METHODS

A cross-sectional study of 321 undergraduate medical students at Assiut University using the Internet Addiction Scale, Patient Health Questionnaire, and Family Affluence Scale.

RESULTS

About 9 % of the study participants screened positive for internet addiction. The most important determinants among medical students were sex, mother's employment status, family affluence, depressive symptoms, and unmonitored internet access.

LIMITATIONS

We did not investigate another psychiatric disease, daily time of internet usage, most frequent time of usage, type of internet usage, and cost of use.

CONCLUSIONS

Internet Addiction is an important psychological problem affecting about 9 % of Assiut university medical students during their undergraduate stage, which may interfere with their lives and studies. Students with lower Internet addiction rates were female students whose mothers were employed, lived in a low affluence family, had fewer depressive symptoms, and had unmonitored internet privacy.

Sigara Kullanma Durumunun Aile Içi Fonksiyonlara Etkisi

Aim: Family is the most natural environment where people can meet their needs of love, compassion, affection and care for mental and physical health. In this study, we aim to investigate the relation between smoking and family functions. Material and Method: Ninety seven patients between 18-60 years age who were admitted to the Ankara Training and Research Hospital, live with at least one family member and agreed to participate in the study were included in this study. Cross-sectional, observational and analytic methods were applied. The recorded data of the participants were as follows: age, sex, occupation, marital status, education level, the family members whom living with, the status of smoking at home, chronic diseases and current medication. McMaster Model of Family Functioning (MMFF) and Fagerström Test for Nicotine Dependence (FTND) were used. Results: Statistically significant differences between MMFF scores of smoking patients in the subscales of “Roles” and “Affective Involvement” were found (p=0.004, p= 0.002, respectively). We have seen in the subscale of “Problem Solving” that single members were negatively affected (p=0.033). The negative effects of smoking were found to be decreasing by age in the “Communication” subscale (p=0.002). The “Roles” subscale was observed to be negatively disturbed in the group of smokers with chronic diseases(p=0,050). We also found that being single and having a chronic disease negatively affected “Affective Responsiveness” subscale (p=0.050, p=0.020, respectively). Conclusion: Smoking affects the family functions negatively. Thus, the fight against smoking might be thought to make a favorable effect on the family functions.

Quality of life in pediatric patients with obsessive-compulsive disorder during and 3 years after stepped-care treatment

The present study aimed to investigate the long-term quality of life (QoL) in a large sample of pediatric obsessive-compulsive disorder (OCD) patients. The study included 220 pediatric OCD patients from the Nordic Long-term OCD Treatment Study (NordLOTS) who were evaluated at seven time points before, during, and after stepped-care treatment over a 3-year follow-up period. Data from three symptom severity trajectory classes formed the basis of the QoL evaluation: acute (n = 127, N = 147), slow (n = 46, N = 63), and limited responders (n = 47, N = 59). Patients' QoL was assessed using parent and child ratings of the revised Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). QoL was analyzed by trajectory class using a random mixed effects model. The association between pre-treatment factors and long-term QoL was investigated across classes in a multivariate model. Three years after treatment, the acute responder class had reached QoL levels from a general population, whereas the limited responder class had not. The slow responder class reached norm levels for the child-rated QoL only. Higher levels of co-occurring externalizing symptoms before treatment were associated with lower parent-rated QoL during follow-up, while adolescence and higher levels of co-occurring internalizing symptoms were associated with lower child-rated QoL during follow-up. For some patients, residual OCD symptoms in the years after treatment, even at levels below assumed clinical significance, are associated with compromised QoL. Co-occurring symptoms could be part of the explanation. Assessing QoL after OCD treatment, beyond the clinician-rated symptom severity, could detect patients in need of further treatment and/or assessment. Trial registry: Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com ; ISRCTN66385119.

Alexithymia, Dissociation, and Family Functioning in a Sample of Online Gamblers: A Moderated Mediation Study

The diffusion of the internet and technological progress have made gambling on online platforms possible, also making it more anonymous, convenient, and available, increasing the risk of pathological outcomes for vulnerable individuals. Given this context, the present study explores the role of some protective and risk factors for problematic gambling in online gamblers by focusing on the interaction between alexithymia, dissociation, and family functioning. A sample of 193 online gamblers (Mage = 28.8 years, SD = 10.59; 17% females, 83% males) completed the South Oaks Gambling Screen, Twenty-Items Toronto Alexithymia Scale, Dissociative Experience Scale-II, and Family Adaptability and Cohesion Evaluation Scales-IV through an online survey. MANOVA, ANOVA and moderated mediation analyses were carried out to analyse the data. Significant differences in cohesive family functioning, alexithymia and dissociation have been found between online gamblers with problematic, at-risk or absent levels of gambling disease. Furthermore, the results showed a significant and positive association between alexithymia and problematic online gambling, partially mediated by dissociation, with the moderation of cohesive family functioning. Such data may have relevant clinical implications, highlighting the interaction of some core personal and environmental variables that may be involved in the etiology of online pathological gambling and could be kept in mind to tailor preventive interventions.

The role of mental health symptomology and quality of life in predicting referrals to special child and adolescent mental health services

BACKGROUND

Children and adolescents' mental health problems have been largely assessed with conventional symptom scales, for example, Strengths and Difficulties Questionnaire (SDQ) given that it is one of the mostly widely used measures in specialist Child and Adolescent Mental Health Services (CAMHS). However, this emphasis on symptom scales might have missed some important features of the mental health challenges that children and young people experience including day to day functioning and life satisfaction aspect (i.e. qualify of life).

METHOD

The study examined longitudinal association between a young person's self-perceptions of quality of life and mental health difficulties and referral to specialist CAMHS service using a population cohort study (Targeted Mental Health in Schools service data) nested within a large-scale linkage between school (National Pupil Data base) and child mental health service administrative data (South London and Maudsley NHS Foundation Trust children and adolescent mental health services health records). Cox proportional hazard regression to estimate crude and adjusted hazard ratios (HRs) for the association between participant psychopathology, and incidence of CAMHS referral.

RESULTS

Pupils experiencing more behavioural difficulties, had an increased incidence of CAMHS referral (adjusted hazard ratio 1.1, 95% confidence interval 1.0-1.2). However, pupils who reported higher health related quality of life had a lower incidence of CAMHS referral over the follow-up period (adjusted hazard hario 0.94, 95% confidence interval 0.9-0.98).

CONCLUSION

Children and young people's perception of their quality of life should be considered at the stages of a clinical needs assessment.

Trajectories of health-related quality of life in children of parents with mental health problems: results of the BELLA study

PURPOSE

Children of parents with mental health problems (CPM) have an increased risk for impaired health-related quality of life (HRQoL). This study aims at investigating the age- and gender-specific course of HRQoL and at exploring predictors of HRQoL in CPM based on longitudinal data (baseline, 1-year and 2-year follow-up) of a German population-based sample.

METHODS

Longitudinal data from the German BELLA study was analyzed (n = 1429; aged 11 to 17 years at baseline). The SCL-S-9 in combination with the cutoff for the General Severity Index (GSI) from the longer SCL-90-R served to identify CPM (n = 312). At first, we compared domain-specific HRQoL according to the KIDSCREEN-27 in CPM versus Non-CPM. Focusing on CPM, we used individual growth modeling to investigate the age and gender-specific course, and to explore effects of risk and (personal, familial and social) resource factors on self-reported HRQoL in CPM.

RESULTS

Self-reported HRQoL was reduced in CPM compared to Non-CPM in all domains, but in social support & peers. However, a minimal important difference was only reached in girls for the domain autonomy & parent relation. Internalizing and externalizing mental health problems were associated with impaired HRQoL in CPM. Self-efficacy, social support and family climate were identified as significant resources, but parental mental health problems over time were not associated with any investigated domain of HRQoL in CPM.

CONCLUSIONS

Adolescent female CPM may be especially at risk for reduced HRQoL. When developing support programs for CPM, self-efficacy, social support and family climate should be considered, HRQoL and mental health problems in CPM should be addressed.

Evaluation of a Family-Based Intervention Program for Children of Mentally Ill Parents: Study Protocol for a Randomized Controlled Multicenter Trial

Background: Children of mentally ill parents have a three to seven times higher risk of developing mental disorders compared to the general population. For this high-risk group, specialized prevention and intervention programs have already been developed. However, there has been insufficient sytematic evaluation to date. Moreover, effectiveness and the cost-effectiveness data of the respective programs until today is very scarce and at the same time constitutes the pre-condition for the program's implementation into regular health care. Methods: The study consists of a two-group randomized controlled multicenter trial conducted at seven study sites throughout Germany and Switzerland. Participants are families with mentally ill parents and their children aged from 3 to 19 years. The intervention comprises 6 to 8 semi-structured sessions over a period of about 6 months. Topics discussed in the intervention include parental mental illness, coping, family relations and social support. Families in the control condition will receive treatment as usual. The children's mental health, assessed using the K-SADS-PL by blinded external raters will constitute the primary efficacy outcome. Further outcomes will be assessed from the parents' as well as from the children's perspectives. Participants are investigated at baseline, 6, 12, and 18 months after baseline assessment. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed. Discussion: This paper describes the evaluation of a family-based intervention program for children of mentally ill parents (CHIMPs) in the regular health care system in Germany and Switzerland. A methodically sophisticated study design has been developed to reflect the complexity of the actual health care situation. This trial will contribute to the regular health care for the high-risk group of children of mentally ill parents. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.

Associations Among Internet Addiction, Genetic Polymorphisms, Family Functioning, and Psychopathological Risk: Cross-Sectional Exploratory Study

BACKGROUND

International research has emphasized that youths are at higher risk for the onset of internet addiction (IA), but studies investigating biological, psychological, and social factors associated with this condition are limited.

OBJECTIVE

This study aims to investigate the possible association between IA and genetic polymorphisms in monoamine oxidase A (MAO-A), serotonin-transporter (5-HTTPR), dopamine receptor (DRD4), and dopamine transporter (DAT1) genes by considering the role played by the perception of young adults in their family functioning and their depression, anxiety, and avoidant personality problems.

METHODS

In a sample of 104 male and female young adults aged between 19 and 23 years (mean age 21.87, SD 2.29 years) recruited from universities in the central southern part of Italy, we addressed the presence of IA using the Young criteria of the IA test. Moreover, the perception of young adults of their family functioning and their psychopathological symptoms were assessed through the Family Assessment Device (FAD) and the Adult Self-Report, respectively.

RESULTS

We found no significant association between IA and any genetic polymorphisms, neither among males or females. Young adults with IA reported significantly higher scores in the subscale of FAD affective responsiveness (AR; P=.01) and in depressive problems (P=.02), anxiety problems (P=.009), and avoidant personality problems (P=.003) than those in the control group. Results of mediation analyses showed a mediation role played by depressive symptoms (B=0.99; 95% CI 0.22 to 1.97) and avoidant personality problems (B=1.09; 95% CI 0.32 to 2.05) of young adults on the relationship between the FAD, AR, and IA. Finally, this relationship was moderated by the genotype of the 5-HTTLPR (P<.001), DAT1 (P<.001), and MAO-A (P<.001) genes in young adults.

CONCLUSIONS

This exploratory study supports the recent evidence on the mutual relationship among biological, individual, and social risk factors associated with IA in young adulthood. Our findings may have important clinical implications for the development of prevention and treatment programs.

Internet Addiction among Young Adult University Students: The Complex Interplay between Family Functioning, Impulsivity, Depression, and Anxiety

International research has underlined that both interpersonal, self-regulation, and comorbid variables can lead to a higher risk of developing internet addiction (IA) among young adults. To date, no studies have explored the interplay between young adults’ family functioning, impulsivity, and psychopathological difficulties. In a community sample of 244 young adult university students, this study aims to assess the relationship between young adults’ IA and young adults’ gender, the perception of their family functioning, impulsivity level, and depressive and anxiety symptoms, considering the possible interplay between these variables. The presence and the severity of IA were addressed through the Internet Addiction Test (IAT). Moreover, young adults filled out self-reporting questionnaires, assessing their perception of family functioning and their impulsivity levels and psychopathological symptoms. Results showed no significant association between the youth’s gender and IA. However, moderately addicted young adults were more likely to report poorer quality of family affective involvement and higher attentional impulsivity and depressive problems than other groups. Moreover, young adults’ attentional impulsivity mediated the relationship between family affective involvement and IA. This study provides new evidence on the complex interaction between individuals and interpersonal risk factors involved in IA among young adults, with important implications for the planning of intervention treatments.

Predictors of Quality of Life in Children and Adolescents with Psychiatric Disorders

This study aimed to identify factors that predict quality of life (QoL), over and above potential improvements in QoL related to a decrease in psychopathology, in children and adolescents with psychiatric problems. Two hundred and thirty one referred children and adolescents, aged 7-19 years, were followed up across a 1-year period. QoL and psychopathology were assessed, as were a broad range of child, parent, and family/social network factors. Time 1 QoL scores and change in level of psychopathology from Time 1 to Time 2 were important predictors of Time 2 QoL scores. Lower than expected Time 2 QoL was also predicted by the presence at Time 1 of a chronic physical disease, low self-esteem, poor social skills, and stressful life events. Findings can be useful to identify children who are at risk for lower than expected levels of QoL, even after receiving help from mental health agencies.

"What matters to you?": A randomized controlled effectiveness trial, Using Systematic Idiographic Assessment as an intervention to Increase Adolescents' perceived control of their mental health

INTRODUCTION

Over the last decades, many Western countries have seen an increase in mental health difficulties in the adolescent population. Among Norwegian adolescents, internalizing symptoms are most prevalent, and 10%-38% of adolescents seek out primary health care services for mental health problems. This study examined whether an idiographic measure designed for adolescents called Assert, which uses variables individually selected by the adolescents, could improve user involvement, locus of control, mental health, and quality of life.

METHODS

This study conducted a randomized controlled effectiveness trial using Assert in primary healthcare. A community sample of 150 Norwegian adolescents aged 12-23 years (M = 16.2; SD = 2.2) were randomized to the Assert or control group. Of the participants 27 (18%) were male. The adolescents and 52 counsellors from primary healthcare services responded to online questionnaires. Of the counselors, 92.8% were female and trained in the use of systematic idiographic assessment.

RESULTS

Adolescents who used Assert scored significantly lower on external LoC, attributing less of their mental health improvement to chance, fate, or luck. However, the intervention showed no effect on the symptoms of mental health, QoL, or user involvement.

CONCLUSIONS

Using Assert in primary healthcare may enhance adolescents' sense of being able to influence their life circumstances and mental health by allowing them more control of their treatment. However, this approach might not be successful in reducing symptoms.