Systematic review of the link between maternal anxiety and overprotection

Aligning categories of mental health conditions with intervention types in high-performance sports: A narrative cornerstone review and classification framework

Epidemiological studies suggest that psychiatric disorders are as prevalent amongst high-performance athletes as in general populations, challenging the myth of invulnerability. Despite efforts of sport organisations to highlight the significance of athletes' mental health, it is still many times tough to combine the sport performance ethos with a discourse on mental health. This narrative cornerstone review examines challenges related to definitions and classifications of athlete mental health in high-performance sports and how these influence assessments and the implementation of interventions. We discuss challenges with concept creep and psychiatrisation and outline their consequences for sport healthcare professionals. Based on this, we present a framework that aligns different categories of athlete mental health conditions (from the reduction of wellbeing to psychiatric disorders) with intervention types (from the provision of supporting environments to pharmacotherapy). We conclude that researchers and sport practitioners need to carefully consider conceptual creep and the risk of pathologising normal and healthy, albeit emotionally aversive, reactions to athlete lifeworld events when assessing athlete mental health. A clear separation of terminology denoting the athlete's resources to handle the lifeworld (including salutogenic factors) and terms describing psychiatric conditions and their management is necessary to avoid misguidance in intervention planning.

Partners with a Highly Favorable Attitude Toward Breastfeeding Contribute to Promoting Initiation and Length of Breastfeeding for More than 5 Months in a Population-Based Canadian Study

Introduction: Promoting maternal breastfeeding for at least 6 months is important to improve children physical health during infancy and neurodevelopmental outcomes in childhood. For this guideline to be followed, it is paramount to identify what factors best support the initiation and length of breastfeeding. This study estimates the contribution of various child- and parent-level factors, as well as the sociodemographic context in predicting maternal breastfeeding initiation and duration. Methods: This study draws on data from the Quebec Longitudinal Study of Child Development. Mothers who never breastfed when the infant was 5 months old (n = 630, 28.3%) were compared to mothers who breastfed for less than 5 months (n = 844, 38.0%) and mothers breastfeeding for more than 5 months (n = 749, 33.7%), using multivariable multinomial regression models. Results: Mothers with a partner showing a positive attitude toward breastfeeding were up to 13 times more likely to breastfeed their infant for more than 5 months. The positive attitude of partners toward breastfeeding was the strongest predictor of breastfeeding duration, followed by the maternal educational attainment and timing she returns to work. Most prenatal and perinatal child-level factors and the sociodemographic context predicted breastfeeding duration, but to a lesser extent. Discussion: This finding underscores the role of the partner's attitude in promoting initiation and length of breastfeeding. As such, educational campaigns and health practitioners could target both the mother and their partner in promoting breastfeeding.

Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences

Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.

Inadequate care and excessive overprotection during childhood are associated with the presence of diabetes mellitus in adulthood in a general Japanese population: a cross-sectional analysis from the Hisayama Study

OBJECTIVE

To investigate associations between parenting styles during childhood and diabetes in adulthood in a Japanese community.

METHODS

In 2011, 710 community-dwelling Japanese residents aged ≥ 40 years were assessed for the presence of diabetes and for their perceptions of the parenting style of their parents, as measured using the "care" and "overprotection" scales of the Parental Bonding Instrument. Care and overprotection scores for each parent were dichotomized by age-specific median values. Diabetes mellitus was defined as a fasting plasma glucose level of ≥ 7.0 mmol/L, a 2-h post-loaded glucose level of ≥ 11.1 mmol/L, HbA1c ≥ 6.5%, and/or the current use of insulin or oral glucose-lowering agents. The odds ratios (ORs) for prevalent diabetes were calculated using a logistic regression model.

RESULTS

The prevalence of diabetes was 14.9%. Subjects with a high paternal overprotection score had a significantly greater likelihood of prevalent diabetes than those with a low paternal overprotection score after adjusting for confounders (OR 1.71, 95% confidence interval [CI] 1.06-2.77), while there was no significant association between paternal care and diabetes. Additionally, the multivariable-adjusted ORs for the presence of diabetes were significantly higher in subjects with a low maternal care score (OR 1.61, 95%CI 1.00-2.60) or in subjects with a high maternal overprotection score (OR 1.73, 95%CI 1.08-2.80). Moreover, the subjects with a low care score and high overprotection score for both their father and mother had a significantly higher multivariable-adjusted OR of diabetes than those with a high care score and low overprotection score for both parents (OR 2,12, 95%CI 1.14-3.95).

CONCLUSIONS

This study suggests that inadequate care and excessive overprotection during childhood may contribute to the development of diabetes in adulthood.

Family caregiver's concerns and anxiety about unaccompanied out-of-home activities of persons with cognitive impairment

BACKGROUND

Although people with cognitive impairment highly value social participation in out-of-home activities, their families typically perceive concerns and experience anxiety over such activities. This study aimed to elucidate the underlying concerns and factors associated with family caregivers' anxiety over the individual's unaccompanied out-of-home activities.

METHODS

In December 2021, we conducted a cross-sectional e-survey of family caregivers of individuals with early-stage cognitive impairment. Caregivers' concerns about ten common risks related to out-of-home activities were cross-tabulated by specific anxiety levels to examine trend associations. With the variables of caregivers and their individuals across the five domains, we ran logistic regression analyses to determine explanatory models for anxiety.

RESULTS

The study participants were 1,322 family caregivers of people whose cognitive function varied from intact to possible mild dementia according to the Dementia Assessment Sheet for Community-based Integrated Care System 8-item. Significant associations were found between the prevalence of concerns and the degree of anxiety, even without actual experience with the issues of concern. Among the five domains, individual dementia characteristics and social behaviors were the predominant factors attributed to caregiver anxiety. Caregivers' no anxiety state was significantly associated with: younger age (OR 4.43, 95% CI 1.81-10.81), no detectable cognitive decline (OR 3.34, 95% CI 1.97-5.64), free from long-term care (LTC) (OR 3.52, 95% CI 1.72-7.21), no manifestation of behavioral and psychological symptoms of dementia (BPSD) (OR 13.22, 95% CI 3.06-57.01), and not engaging in unaccompanied out-of-home activities (OR 3.15, 95% CI 1.87-5.31). Their severe anxiety was positively associated with being on LTC (OR 3.39, 95% CI 2.43-4.72) and minor BPSD (OR 1.43, 95% CI 1.05-1.95), and negatively associated with engagement in unaccompanied out-of-home activities (OR 0.31, 95% CI 0.23-0.43).

CONCLUSIONS

The study found that family caregivers' anxiety was associated with concerns about behavioral issues, regardless of actual experiences. There were two significant associations in opposite directions between caregivers' anxiety and the individual's engagement in out-of-home activities. In the early phase of cognitive impairment, caregivers may intuitively interpret the individual's behavior and feel anxious. Educational support may provide reassurance and enable caregivers to facilitate out-of-home activities.

Bidirectional Associations Between Friend Overprotection and Psychosocial Adjustment During Adolescence

As friends increase in closeness and influence during adolescence, some friends may become overprotective, or excessively and intrusively protective. Engaging in overprotective behavior, and being the recipient of such behavior, may have positive and negative adjustment trade-offs. The current study examines, for the first time, bidirectional associations between friend overprotection and several adjustment trade-offs, including internalizing problems (i.e., depressive and anxiety symptoms), peer difficulties (i.e., rejection and physical and relational victimization), and positive friendship quality (i.e., closeness, help, and security) during early adolescence. Participants were 269 young adolescents (140 boys; M_age = 11.46, SD = 0.41) who completed self-report and peer nomination measures in their schools at two time points 4 months apart (Fall and Spring of the school year). Structural equation models revealed that being overprotected by a friend predicted decreases in friendship quality and was predicted by peer difficulties and internalizing problems (negatively). Being overprotective of friends predicted increases in internalizing symptoms and was predicted by peer difficulties. Findings are novel as they suggest that friend overprotection may be risky (and not beneficial) for both the overprotector and the overprotectee, setting the stage for future inquiry in this new area of peer relations research.

Preventing anxiety in the children of anxious parents - feasibility of a brief, online, group intervention for parents of one- to three-year-olds

BACKGROUND

The evidence suggests an increased risk of developing anxiety problems in children of anxious parents. The current study explored the feasibility and acceptability of an intervention with anxious parents of young children, to inform the possibility of further trials.

METHODS

Participants were recruited through primary and secondary care psychological services and social media. Participants who had a current or recent anxiety disorder and a child aged 12-47 months were included. Assessments of parental and child outcomes occurred at baseline, after the intervention (week-2) and follow-up (week-8). The intervention was delivered in a small group format, in two sessions, one week apart, using videoconferencing.

RESULTS

Out of 32 participants, 30 (94%) attended the full intervention. All found the intervention acceptable and reported it as useful and relevant. There was a reduction in parental depression (MD = 2.63, 95%CI 1.01-4.26), anxiety (MD = 3.93, 95%CI 2.49-5.37) and stress (MD = 4.60, 95% CI 3.02-6.18) and increases in parenting confidence.

CONCLUSIONS

The online group intervention was feasible and acceptable. There were moderate to large effects on parental mental health and no adverse effects on children (decline on outcome measures). This indicates that intervening early in parenting with anxious parents is possible and warrants further investigation to establish prevention efficacy with a larger, controlled trial.

Assessing bidirectional relations between infant temperamental negative affect, maternal anxiety symptoms and infant affect-biased attention across the first 24-months of life

Developmental theories suggest affect-biased attention, preferential attention to emotionally salient stimuli, emerges during infancy through coordinating individual differences. Here we examined bidirectional relations between infant affect-biased attention, temperamental negative affect, and maternal anxiety symptoms using a Random Intercepts Cross-Lagged Panel model (RI-CLPM). Infant-mother pairs from Central Pennsylvania and Northern New Jersey (N = 342; 52% White; 50% reported as assigned female at birth) participated when infants were 4, 8, 12, 18 and 24 months of age. Infants completed the overlap task while eye-tracking data were collected. Mothers reported their infant's negative affect and their own anxiety symptoms. In an RI-CLPM, after accounting for between-person variance (random intercepts representing the latent average of a construct), it is possible to assess within-person variance (individual deviations from the latent average of a construct). Positive relations represent stability in constructs (smaller within-person deviations). Negative relations represent fluctuation in constructs (larger within-person deviations). At the between-person level (random intercepts), mothers with greater anxiety symptoms had infants with greater affect-biased attention. However, at the within-person level (deviations), greater fluctuation in maternal anxiety symptoms at 12- and 18 months prospectively related to greater stability in attention to angry facial configurations. Additionally, greater fluctuation in maternal anxiety symptoms at 18 months prospectively related to greater stability in attention to happy facial configurations. Finally, greater fluctuation in maternal anxiety symptoms at 4- and 12 months prospectively related to greater stability in infant negative affect. These results suggest that environmental uncertainty, linked to fluctuating maternal anxiety, may shape early socioemotional development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6-9 years) to adolescence (10-14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times-when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients' quality of life was increased and internalizing problems were decreased-proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions.

Maternal symptoms of depression and anxiety during the postpartum period moderate infants' neural response to emotional faces of their mother and of female strangers

Affective exchanges between mothers and infants are key to the intergenerational transmission of depression and anxiety, possibly via adaptations in neural systems that support infants' attention to facial affect. The current study examined associations between postnatal maternal symptoms of depression, panic and social anxiety, maternal parenting behaviours, and infants' neural responses to emotional facial expressions portrayed by their mother and by female strangers. The Negative Central (Nc), an event-related potential component that indexes attention to salient stimuli and is sensitive to emotional expression, was recorded from 30 infants. Maternal sensitivity, intrusiveness, and warmth, as well as infant's positive engagement with their mothers, were coded from unstructured interactions. Mothers reporting higher levels of postnatal depression symptoms were rated by coders as less sensitive and warm, and their infants exhibited decreased positive engagement with the mothers. In contrast, postnatal maternal symptoms of panic and social anxiety were not significantly associated with experimenter-rated parenting behaviours. Additionally, infants of mothers reporting greater postnatal depression symptoms showed a smaller Nc to their own mother's facial expressions, whereas infants of mothers endorsing greater postnatal symptoms of panic demonstrated a larger Nc to fearful facial expressions posed by both their mother and female strangers. Together, these results suggest that maternal symptoms of depression and anxiety during the postpartum period have distinct effects on infants' neural responses to parent and stranger displays of emotion.

Childhood inhibition predicts adolescent social anxiety: Findings from a longitudinal twin study

An enduring issue in the study of mental health is identifying developmental processes that explain how childhood characteristics progress to maladaptive forms. We examine the role that behavioral inhibition (BI) has on social anxiety (SA) during adolescence in 868 families of twins assessed at ages 8, 13, and 15 years. Multimodal assessments of BI and SA were completed at each phase, with additional measures (e.g., parenting stress) for parents and twins. Analyses were conducted in several steps: first, we used a cross-lagged panel model to demonstrate bidirectional paths between BI and SA; second a biometric Cholesky decomposition showed that both genetic and environmental influences on childhood BI also affect adolescent SA; next, multilevel phenotypic models tested moderation effects between BI and SA. We tested seven potential moderators of the BI to SA prediction in individual models and included only those that emerged as significant in a final conditional model examining predictors of SA. Though several main effects emerged as significant, only parenting stress had a significant interaction with BI to predict SA, highlighting the importance of environmental moderators in models examining temperamental effects on later psychological symptoms. This comprehensive assessment continues to build the prototype for such developmental psychopathology models.

The impact of treating parental anxiety on children's mental health: An empty systematic review

Children of anxious parents are at heightened risk of developing an anxiety disorder of their own, but promising research indicates that targeting parenting behaviours can reduce the risk of intergenerational transmission of anxiety. Given there is extensive evidence for the efficacy of treatments for adult anxiety, the current review sought to identify whether interventions solely addressing parental symptoms had any effect on the mental health and wellbeing of their children. Randomised Controlled Trials of psychological interventions targeting adults with a probable anxiety disorder and which included a child mental health or wellbeing outcome were eligible for inclusion. Scopus, Web of Science, PubMed, PsychINFO, and PsychArticles were searched, and 2137 articles were systematically reviewed. However, no articles were identified that met the review criteria. Research into interventions targeting adult anxiety is failing to consider the potential benefit treatment may have on dependent children. This is a missed opportunity to evaluate a potential means of support for children who are known to be at risk of anxiety. Evaluation of psychological interventions for adult anxiety should consider including both adult and child mental health outcomes to determine potential preventative effects.

Overprotection and overcontrol in childhood: An evaluation on reliability and validity of 33-item expanded Childhood Trauma Questionnaire (CTQ-33), Chinese version

Overprotection and overcontrol from parents or other family members, which are not rare in the Chinese culture, have been suggested to be traumatic experiences for some children. However, research on overprotection/overcontrol is much rarer in China compared with other childhood trauma subtypes. One of the possible reasons for this is the lack of easy and feasible screening tools. In this study, we therefore translated and validated a Chinese version of the 33-item Childhood Trauma Questionnaire (CTQ-33), which was expanded from the widely-used 28-item CTQ with an additional overprotection/overcontrol subscale. A total of 248 young healthy participants were recruited and completed the Chinese version of CTQ-33, and 50 of them were retested after an interval of two weeks. At baseline, all participants also completed the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale to assess their depression and anxiety, respectively. Our main findings include that: (1) the Chinese version of CTQ-33 showed a good internal consistency (Cronbach's α coefficient = 0.733) and an excellent test-retest reliability over a two-week period (ICC = 0.861); (2) the previously reported significant associations between the overprotection/overcontrol and other subtypes of childhood trauma (abuse and neglect), as well as psychopathological conditions such as depression can all be replicated using the Chinese version of CTQ-33. These results suggest that the Chinese version of CTQ-33 would be a promising tool for assessing various subtypes of childhood adversities, especially the overprotection/overcontrol experiences in Chinese populations.