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Kowalec K, Harder A, Dolovich C, Fitzgerald KC, Salter A, Lu Y, Bernstein CN, Bolton JM, Cutter G, Fisk JD, Gelernter J, Graff LA, Hägg S, Hitchon CA, Levey DF, Lublin FD, McKay KA, Patten S, Patki A, Stein MB, Tiwari HK, Wolinsky JS, Marrie RA. Polygenic liability for anxiety in association with comorbid anxiety in multiple sclerosis. Ann Clin Transl Neurol 2024; 11:1393-1404. [PMID: 38715244 PMCID: PMC11187942 DOI: 10.1002/acn3.52025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/03/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Comorbid anxiety occurs often in MS and is associated with disability progression. Polygenic scores offer a possible means of anxiety risk prediction but often have not been validated outside the original discovery population. We aimed to investigate the association between the Generalized Anxiety Disorder 2-item scale polygenic score with anxiety in MS. METHODS Using a case-control design, participants from Canadian, UK Biobank, and United States cohorts were grouped into cases (MS/comorbid anxiety) or controls (MS/no anxiety, anxiety/no immune disease or healthy). We used multiple anxiety measures: current symptoms, lifetime interview-diagnosed, and lifetime self-report physician-diagnosed. The polygenic score was computed for current anxiety symptoms using summary statistics from a previous genome-wide association study and was tested using regression. RESULTS A total of 71,343 individuals of European genetic ancestry were used: Canada (n = 334; 212 MS), UK Biobank (n = 70,431; 1,390 MS), and the USA (n = 578 MS). Meta-analyses identified that in MS, each 1-SD increase in the polygenic score was associated with ~50% increased odds of comorbid moderate anxious symptoms compared to those with less than moderate anxious symptoms (OR: 1.47, 95% CI: 1.09-1.99). We found a similar direction of effects in the other measures. MS had a similar anxiety genetic burden compared to people with anxiety as the index disease. INTERPRETATION Higher genetic burden for anxiety was associated with significantly increased odds of moderate anxious symptoms in MS of European genetic ancestry which did not differ from those with anxiety and no comorbid immune disease. This study suggests a genetic basis for anxiety in MS.
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Affiliation(s)
- Kaarina Kowalec
- Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Arvid Harder
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Casandra Dolovich
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | | | - Amber Salter
- Department of NeurologyUT SouthwesternDallasTexasUSA
| | - Yi Lu
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Charles N. Bernstein
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - James M. Bolton
- Department of PsychiatryMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Gary Cutter
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - John D. Fisk
- Nova Scotia Health and Departments of Psychiatry, Psychology & Neuroscience, and MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Joel Gelernter
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryVA Connecticut Healthcare SystemNew HavenConnecticutUSA
| | - Lesley A. Graff
- Department of Clinical Health PsychologyMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Sara Hägg
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Carol A. Hitchon
- Department of RheumatologyMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Daniel F. Levey
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryVA Connecticut Healthcare SystemNew HavenConnecticutUSA
| | - Fred D. Lublin
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kyla A. McKay
- Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
| | - Scott Patten
- Department of Community Health SciencesCumming School of Medicine, University of CalgaryCalgaryCanada
| | - Amit Patki
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Murray B. Stein
- Department of PsychiatryMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Hemant K. Tiwari
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jerry S. Wolinsky
- Department of NeurologyMcGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Ruth A. Marrie
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
- Department of Community Health SciencesMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
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Susman ES, Patino EO, Tiab SS, Dong L, Gumport NB, Sarfan LD, Hinshaw SP, Harvey AG. Transdiagnostic Sleep and Circadian Intervention in Youth: Long-term Follow-up of a Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00240-5. [PMID: 38729603 DOI: 10.1016/j.jaac.2024.05.001] [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: 09/14/2023] [Revised: 03/25/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This preregistered study compared the effects of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) with psychoeducation (PE) about sleep, health, yoga, meditation, and outdoor appreciation activities on sleep and circadian functioning, health risk, and sleep health behaviors at long-term follow-up (LTFU), an average of 8 years following treatment. We also examined if more sleep health behaviors at LTFU were associated with better sleep and circadian functioning at LTFU and if better sleep and circadian functioning were associated with lower health risk at LTFU. METHOD At baseline, we randomly assigned adolescents with an eveningness chronotype to TranS-C (n = 89) or PE (n = 87). Of this sample, we assessed 106 young adults (mean age at follow-up = 22.5 years; n = 55 from TranS-C; n = 51 from PE) an average of 8 years following treatment. RESULTS Despite TranS-C (vs PE) sustaining improvement in circadian functioning through 12-month follow-up, at LTFU, there were no significant differences between the conditions on any outcome, including sleep and circadian functioning, risks in 5 health domains indexed by self-report and ecological momentary assessment, sleep health behaviors, and physical measurements. Across both conditions, measures indicating poorer sleep and circadian functioning were associated with higher health risk across multiple domains, and more sleep health behaviors were associated with lower levels of eveningness at LTFU. CONCLUSION These results provide an important window into the influence of development on long-term outcomes for youth and raise the possibility that interventions for youth could be enhanced with a focus on habit formation. CLINICAL TRIAL REGISTRATION INFORMATION Maintaining Behavior Change: A 6-Year Follow-up of Adolescent 'Night-owls'; https://www. CLINICALTRIALS gov/; NCT05098782. STUDY PREREGISTRATION INFORMATION Long-term Follow-up of Young Adults Who Received TranS-C to Modify Eveningness Chronotype in Adolescence; https://osf.io/; d5a4g. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. One or more of the authors of this paper received support from a program designed to increase minority representation in science.
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Affiliation(s)
| | | | | | - Lu Dong
- RAND, Santa Monica, California
| | | | | | - Stephen P Hinshaw
- University of California, Berkeley, California; University of California San Francisco, San Francisco, California
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Chen RJ, Nabila A, Gal Toth J, Stuhlmann H, Toth M. The chemokine XCL1 functions as a pregnancy hormone to program offspring innate anxiety. Brain Behav Immun 2024; 118:178-189. [PMID: 38428650 PMCID: PMC11044916 DOI: 10.1016/j.bbi.2024.02.032] [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: 07/28/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
Elevated levels of cytokines in maternal circulation increase the offspring's risk for neuropsychiatric disease. Because of their low homeostatic levels, circulating maternal cytokines during normal pregnancies have not been considered to play a role in fetal brain development and offspring behavior. Here we report that the T/NK cell chemotactic cytokine XCL1, a local paracrine immune signal, can function as a pregnancy hormone and is required for the proper development of placenta and male offspring approach-avoidance behavior. We found that circulating XCL1 levels were at a low pregestational level throughout pregnancy except for a midgestational rise and fall. Blunted elevation in maternal plasma XCL1 in dams with a genetic 5HT1A receptor deficit or following neutralization by anti-XCL1 antibodies increased the expression of tissue damage associated factors in WT fetal placenta and led to increased innate anxiety and stress reactivity in the WT male offspring. Therefore, chemokines like XCL1 may act as pregnancy hormones to regulate placenta development and offspring emotional behavior.
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Affiliation(s)
- Rosa J Chen
- Department of Pharmacology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Anika Nabila
- Department of Pharmacology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Judit Gal Toth
- Department of Pharmacology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Heidi Stuhlmann
- Cell and Developmental Biology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Miklos Toth
- Department of Pharmacology, Weill Cornell Medicine, New York, NY 10065, USA.
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Moltrecht B, Lange AMC, Merrick H, Radley J. Whole-family programmes for families living with parental mental illness: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02380-3. [PMID: 38393370 DOI: 10.1007/s00787-024-02380-3] [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: 08/15/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024]
Abstract
Several interventions have been developed to support families living with parental mental illness (PMI). Recent evidence suggests that programmes with whole-family components may have greater positive effects for families, thereby also reducing costs to health and social care systems. This review aimed to identify whole-family interventions, their common characteristics, effectiveness and acceptability. A systematic review was conducted according to PRISMA 2020 guidelines. A literature search was conducted in ASSIA, CINAHL, Embase, Medline, and PsycINFO in January 2021 and updated in August 2022. We double screened 3914 abstracts and 212 papers according to pre-set inclusion and exclusion criteria. The Mixed Methods Appraisal Tool was used for quality assessment. Quantitative and qualitative data were extracted and synthesised. Randomised-control trial data on child and parent mental health outcomes were analysed separately in random-effects meta-analyses. The protocol, extracted data, and meta-data are accessible via the Open Science Framework ( https://osf.io/9uxgp/ ). Data from 66 reports-based on 41 independent studies and referring to 30 different interventions-were included. Findings indicated small intervention effects for all outcomes including children's and parents' mental health (dc = -0.017, -027; dp = -0.14, -0.16) and family outcomes. Qualitative evidence suggested that most families experienced whole-family interventions as positive, highlighting specific components as helpful, including whole-family components, speaking about mental illness, and the benefits of group settings. Our findings highlight the lack of high-quality studies. The present review fills an important gap in the literature by summarising the evidence for whole-family interventions. There is a lack of robust evidence coupled with a great need in families affected by PMI which could be addressed by whole-family interventions. We recommend the involvement of families in the further development of these interventions and their evaluation.
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Affiliation(s)
- B Moltrecht
- Evidence-Based Practice Unit, Anna Freud Centre, University College London, London, UK.
- Centre for Longitudinal Studies, University College London, London, UK.
| | - Aurelie M C Lange
- Centre for Applied Research on Social Sciences and Law, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - H Merrick
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - J Radley
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Zhang N, Smith IC, Ginsburg G. Do Self-Processes and Parenting Mediate the Effects of Anxious Parents' Psychopathology on Youth Depression and Suicidality? Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01657-z. [PMID: 38206536 DOI: 10.1007/s10578-023-01657-z] [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] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
To understand how anxious parents' global psychopathology increases children's risks for depression and suicidality, we tested mediational pathways through which parent global psychopathology was associated with youth depression and suicidality over a six-year period. Parents (n = 136) who had an anxiety disorder at baseline reported global psychopathology and youth internalizing problems. Youth did not have any psychiatric disorder at baseline and they reported self-esteem, perceived control, and perceived parental warmth and rejection at baseline and 1-year follow-up. At 6-year follow-up, youth depression and suicidality were assessed via multiple reporters including the self, parent, and/or an independent evaluator. Results showed that parental psychopathology had an indirect but not direct effect on youth depression and suicidality via perceived control. No associations were found for the other hypothesized mediators. Perceived control might be a transdiagnostic intervention target in depression and suicide prevention programs for youth exposed to parental anxiety.
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Affiliation(s)
- Na Zhang
- Department of Human Development and Family Sciences, University of Connecticut, 1 University Place, Stamford, CT, 06901, USA.
| | - Isaac C Smith
- Hartford Hospital, Institute of Living, Hartford, CT, USA
- University of Vermont Medical Center, Burlington, VT, USA
| | - Golda Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Bobbitt S, Kawamura A, Saunders N, Monga S, Penner M, Andrews D. Anxiety in children and youth: Part 2-The management of anxiety disorders. Paediatr Child Health 2023; 28:52-66. [PMID: 36865757 PMCID: PMC9971334 DOI: 10.1093/pch/pxac104] [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: 04/01/2021] [Accepted: 04/12/2022] [Indexed: 03/04/2023] Open
Abstract
Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 2, which focuses on management, are to: (1) review the evidence and context for a range of clinical approaches that combine behavioural and pharmacological interventions to effectively address impairment, (2) describe the roles of education and psychotherapy in the prevention and treatment of anxiety disorders, and (3) outline the use of pharmacotherapy, with side effects and risks. Recommendations for managing anxiety are based on current guidelines, review of the literature, and expert consensus. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family.
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Affiliation(s)
- Susan Bobbitt
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Anne Kawamura
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Natasha Saunders
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Suneeta Monga
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Melanie Penner
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Debra Andrews
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
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Developing a Brief Parent Training Intervention to Prevent Anxiety in Offspring. Scand J Child Adolesc Psychiatr Psychol 2022; 10:123-133. [PMID: 36514489 PMCID: PMC9716892 DOI: 10.2478/sjcapp-2022-0013] [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] [Indexed: 11/30/2022] Open
Abstract
Offspring of parents with anxiety disorders have an increased risk of developing anxiety themselves. Very few studies have evaluated interventions aiming to prevent anxiety in offspring of anxious parents. This study was a small (N=40) randomized pilot study with three arms evaluating the feasibility of a novel parent support group for anxious parents, the Supporting Anxious Parents Program (SAPP). The primary objective was to evaluate the acceptability of the SAPP. In addition, we also evaluated preliminary effects on child anxiety, parent risk factors, and quality of life, and feasibility of the study design. Excessive parental worry and anxiety and having a child not meeting criteria for an anxiety disorder (6-12 years old), served as inclusion criteria. Thirteen parents were randomly allocated to a group-based intervention, 14 to an individual Internet-based version of the intervention, and 13 to a waitlist control condition. The intervention was developed to target three risk factors involved in the parent-child transmission of anxiety; criticism/low warmth, overprotective behaviors, and modeling of anxiety. The results showed that parents were generally very satisfied with the intervention. We did not find any significant decreases in child anxiety in the intervention conditions. However, for the parents, we found preliminary support for reduced overprotective behaviors, reduced worry, and increased quality of life. The study design was found to be feasible. According to the results, a revision of the intervention is recommended before a full randomized controlled trial could be conducted.
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Slade EP, Ginsburg GS, Riddle MA. Cost-benefit Analysis of the Coping and Promoting Strength Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:1096-1107. [PMID: 34647197 DOI: 10.1007/s11121-021-01309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/24/2022]
Abstract
This study sought to estimate the net benefits and return on investment (ROI, %) of the Coping and Promoting Strength (CAPS) program to families and insurers, respectively, using data from a multi-year follow up of 136 US families who had participated in a randomized efficacy trial of CAPS. CAPS is a brief parent-focused psychosocial intervention that was compared to information monitoring in the trial. Of the 136 original participants, 113 (83%) completed follow-up interviews 7.1 years, on average, after the CAPS study baseline (mean follow-up age: 15.8 years; range: 13.1 to 20.8 years). Parent-reported willingness-to-pay values and estimates of behavioral healthcare cost savings from delayed onset of anxiety were used to simulate the average net benefits of CAPS to families and insurance plans, respectively, assuming patients pay 20% coinsurance. Psychologists in private offices were expected to charge an average of approximately $195 per CAPS session or $1417 in total in 2020 dollars. The estimated family share of the total CAPS session cost was $283 per youth, while the insurer share was $1134 per youth. Given these costs, the CAPS intervention was estimated to result in average overall net benefits of $1033 per youth (95% CI: -$546 to $2611). Families gained $344 (95% CI: $232 to $455 per family) for an ROI of 121%. Insurance plans on average gained a net savings of $689 per youth (95% CI: -$778 to $2156 per youth) for an average ROI of 61%. In this multiyear follow-up of offspring of anxious parents, exposure to the CAPS pediatric anxiety prevention program was found to be more economically efficient than was waiting for an anxiety disorder to be diagnosed. ClinicalTrials.gov Identifier: NCT00847561.
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Affiliation(s)
- Eric P Slade
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Golda S Ginsburg
- School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lannes A, Bui E, Arnaud C, Raynaud JP, Revet A. Preventive interventions in offspring of parents with mental illness: a systematic review and meta-analysis of randomized controlled trials. Psychol Med 2021; 51:2321-2336. [PMID: 34435556 DOI: 10.1017/s0033291721003366] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Children with parents suffering from a psychiatric disorder are at higher risk for developing a mental disorder themselves. This systematic review and meta-analysis of randomized controlled trials aims to evaluate the efficacy of psychosocial interventions to prevent negative mental health outcomes in the offspring of parents with mental illness. Eight electronic databases, grey literature and a journal hand-search identified 14 095 randomized controlled trials with no backward limit to June 2021. Outcomes in children included incidence of mental disorders (same or different from parental ones) and internalizing and externalizing symptoms at post-test, short-term and long-term follow-up. Relative risks and standardized mean differences (SMD) for symptom severity were generated using random-effect meta-analyses. Twenty trials were selected (pooled n = 2689 children). The main therapeutic approaches found were cognitive-behavioural therapy and psychoeducation. A significant effect of interventions on the incidence of mental disorders in children was found with a risk reduction of almost 50% [combined relative risk = 0.53, 95% confidence interval (CI) 0.34-0.84]. Interventions also had a small but significant effect on internalizing symptoms at post-test (SMD = -0.25, 95% CI -0.37 to -0.14) and short-term follow-up (-0.20, 95% CI -0.37 to -0.03). For externalizing symptoms, a decreasing slope was observed at post-test follow-up, without reaching the significance level (-0.11, 95% CI -0.27 to 0.04). Preventive interventions targeting the offspring of parents with mental disorders showed not only a significant reduction of the incidence of mental illness in children, but also a diminution of internalizing symptoms in the year following the intervention.
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Affiliation(s)
- Alice Lannes
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- University of Caen Normandy & Caen University Hospital, Caen, France
| | - Catherine Arnaud
- CERPOP, UMR 1295, Inserm, University Paul Sabatier Toulouse, Toulouse, France
- Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
| | - Jean-Philippe Raynaud
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, UMR 1295, Inserm, University Paul Sabatier Toulouse, Toulouse, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, UMR 1295, Inserm, University Paul Sabatier Toulouse, Toulouse, France
- CIC 1436, Team PEPSS, « Pharmacologie En Population cohorteS et biobanqueS », Toulouse University Hospital, Toulouse, France
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Harvey AG, Callaway CA, Zieve GG, Gumport NB, Armstrong CC. Applying the Science of Habit Formation to Evidence-Based Psychological Treatments for Mental Illness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:572-589. [PMID: 34495781 DOI: 10.1177/1745691621995752] [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: 01/08/2023]
Abstract
Habits affect nearly every aspect of our physical and mental health. Although the science of habit formation has long been of interest to psychological scientists across disciplines, we propose that applications to clinical psychological science have been insufficiently explored. In particular, evidence-based psychological treatments (EBPTs) are interventions targeting psychological processes that cause and/or maintain mental illness and that have been developed and evaluated scientifically. An implicit goal of EBPTs is to disrupt unwanted habits and develop desired habits. However, there has been insufficient attention given to habit-formation principles, theories, and measures in the development and delivery of EBTPs. Herein we consider whether outcomes following an EBPT would greatly improve if the basic science of habit formation were more fully leveraged. We distill six ingredients that are central to habit formation and demonstrate how these ingredients are relevant to EBPTs. We highlight practice points and an agenda for future research. We propose that there is an urgent need for research to guide the application of the science of habit formation and disruption to the complex "real-life" habits that are the essence of EBPTs.
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Affiliation(s)
| | | | - Garret G Zieve
- Department of Psychology, University of California, Berkeley
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Ginsburg GS, Yun-Tein J, Riddle MA. Preventing the Onset of Anxiety Disorders in Offspring of Anxious Parents: A Six-Year Follow-up. Child Psychiatry Hum Dev 2021; 52:751-760. [PMID: 33070244 PMCID: PMC8285043 DOI: 10.1007/s10578-020-01080-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/01/2022]
Abstract
This study examined the effects of a family-based intervention Coping and Promoting Strength (CAPS) relative to a control condition, information-monitoring (IM), to prevent the onset of anxiety disorders in offspring of anxious parents six years after their initial assessment. One hundred thirty six families participated in the original randomized trial; 113 (83%) completed the one time follow-up assessment. Presence of anxiety disorders and severity of symptoms in offspring were assessed by masked evaluators using the Anxiety Disorders Interview Schedule; parents and offspring also completed questionnaires assessing offspring anxiety. Using the intention to treat sample from the original trial, Cox regression models showed significant intervention main effects in the rate of onset of anxiety disorders from baseline to follow-up (anxiety disorder: hazard ratio (HR) = 2.55, 95% CI: 1.54, 4.21) but growth curves suggest effects occurred within the first year after program completion. No group differences were found in the cumulative incidence of anxiety disorders at the six-year follow-up. Additional intervention appears needed to maintain the initial positive effects long-term to reduce the risk for downstream disability.Clinical Trials Registration: NCT00847561.
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A Systematic Review Focusing on Psychotherapeutic Interventions that Impact Parental Psychopathology, Child Psychopathology and Parenting Behavior. Clin Child Fam Psychol Rev 2021; 24:579-598. [PMID: 34254219 DOI: 10.1007/s10567-021-00355-3] [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] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
Given the high rates of co-occurrence of psychopathology within families, it is important to identify and characterize interventions that simultaneously reduce both parent and child symptoms, and improve parenting quality. This is needed as intervention development is increasingly moving toward integrated interventions that target some combination of parent and child mental health, and parenting behavior. Even so, much remains unknown regarding which treatment components provide maximum benefit for parent symptoms, child symptoms, and parenting behavior. This systematic review identified and characterized psychotherapeutic interventions that report improvements in each of three outcomes: parent symptoms, child symptoms and parenting behavior. Fifty-six unique interventions were eligible for review, of which 25 reported improvements in all three outcomes. All 25 of these interventions directly intervened on parenting behavior, often as the sole target of the intervention. Few interventions improved all three outcomes in samples in which parents, children or both met clinical-level thresholds of psychopathology. Additional research is needed to better understand the bi-directional and transactional influences of treatment on family members, and to better inform the development of interventions for dually disordered parent-child dyads across a range of diagnostic profiles.
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Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis. Harv Rev Psychiatry 2021; 29:196-215. [PMID: 33979106 DOI: 10.1097/hrp.0000000000000294] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention). METHODS We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number. RESULTS 295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features. CONCLUSION Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.
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Visagie L, Loxton H, Swartz L, Stallard P. Cognitive behaviour therapy-based early intervention and prevention programme for anxiety in South African children with visual impairments. Afr J Disabil 2021; 10:796. [PMID: 33604268 PMCID: PMC7876962 DOI: 10.4102/ajod.v10i0.796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Anxiety is the most common psychological difficulty reported by youth worldwide and may also be a significant problem for children with visual impairments. Cognitive behaviour therapy (CBT) interventions have proven to be successful in treating childhood anxiety; however, mostly these are not suitable for children with visual impairments, as the materials used are not sufficiently accessible to this population. Objectives The present study was motivated by the dearth of research on this topic and aimed to examine the effects of a specifically tailored, group-based, universally delivered, CBT intervention for anxiety in children with visual impairments and to examine the influence of three predictor variables (i.e. age, gender and level of visual impairment) on prevention effects. Method A randomised wait-list control group design with pre-, post- and follow-up intervention measures was employed. The final sample of 52 children (aged 9–14) with varying degrees of visual impairment received the anxiety intervention. Participants were followed over a course of 10 months during which their anxiety symptoms were assessed quantitatively at four time points (T1–T4). Results The results indicated that the anxiety intervention did not significantly decrease symptoms of anxiety within the intervention groups. However, the intervention appeared beneficial for girls, younger children and legally blind participants. Conclusion This study demonstrated how CBT interventions can be adapted for use in children with visual impairments. Results obtained provide a foundation upon which future updated anxiety intervention programmes can be built, meeting the need for further research in this area.
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Affiliation(s)
- Lisa Visagie
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Helene Loxton
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Paul Stallard
- Department for Health, Faculty of Humanities and Social Sciences, University of Bath, Claverton Down, Bath, United Kingdom
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Havinga PJ, Maciejewski DF, Hartman CA, Hillegers MHJ, Schoevers RA, Penninx BWJH. Prevention programmes for children of parents with a mood/anxiety disorder: Systematic review of existing programmes and meta-analysis of their efficacy. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:212-251. [PMID: 33410149 PMCID: PMC8248072 DOI: 10.1111/bjc.12277] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Objectives To systematically describe the characteristics and techniques of prevention programmes for children of parents with mood/anxiety disorders. In addition, recruitment approaches and difficulties were identified and a meta‐analysis was conducted to examine the efficacy of these prevention programmes. Methods Randomized controlled trials assessing the efficacy of a prevention programme for children (6–25 years) of parents with mood and/or anxiety disorders were included. A systematic literature search was conducted in PubMed, PsychINFO, and CENTRAL from the earliest record to March 2019. In addition, programme manuals of identified prevention programmes were requested for a content analysis. Results Twenty‐two articles containing eight unique prevention programmes involving 1,325 subjects were identified. Programmes varied in the number and types of techniques, but all provided psychoeducation. Results suggested that recruitment via clinicians was more successful than recruitment via health maintenance organization databases. In a meta‐analysis, a significant risk difference was found in favour of prevention programmes on the risk of developing a depressive/anxiety disorder in offspring at short‐term (9–18 months follow‐up; RR = 0.37, 95% CI [0.21; 0.66]) and long‐term follow‐up (24 months or longer follow‐up; RR = 0.71, 95% CI [0.57; 0.87] and on symptom levels in offspring at post‐intervention (SMD = −0.19, 95% CI [−0.36; −0.02]) and at 12‐months follow‐up (SMD = −0.31, 95% CI [−0.57; −0.06]). Conclusions The prevention programmes combined psychoeducational elements with skills training and/or cognitive‐behavioural therapy elements. The recruitment process and the content of these programmes are sometimes insufficiently described. Nevertheless, they appear to be effective, indicating a need to further examine how these programmes exactly work and for whom. Practitioner points Preventive interventions for children of parents with mood/anxiety disorders appear to be effective in preventing these disorders in offspring. Available preventive intervention programmes focus mostly on psychoeducation, cognitive‐behavioural therapy, and family processes. More effort should be made into describing preventive interventions so that they can be easily implemented by practitioners. Studies should further examine why and for whom preventive interventions for children of parents with mood/anxiety disorders are effective.
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Affiliation(s)
- Petra J Havinga
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Dominique F Maciejewski
- Department of Developmental Psychopathology, Behavioural Science Institute, Nijmegen, The Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychology and Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Stoll RD, Pina AA, Schleider J. Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:435-459. [PMID: 32285692 PMCID: PMC7473445 DOI: 10.1080/15374416.2020.1738237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In 1998, Ost published [One-session treatment of specific phobias-a rapid and effective method] [in Swedish] giving rise to the idea that brief, intensive, and concentrated psychosocial interventions could exhibit public health impact. At this juncture, and per criteria of the Society for Clinical Child and Adolescent Psychology, there are data supporting that brief, non-pharmacological intervention [prescriptions] for pediatric anxiety can be considered well-established or probably efficacious. In addition, data from 76 randomized controlled trials (N = 17,203 youth) yield an overall mean effect size of 0.19 on pediatric anxiety outcomes (pre-post). Note, however, that effect sizes vary significantly. These data point to the capacity for clinical change coming from in-vivo exposures for specific phobias (~3 h, one session), CBT with social skills training (~3 h, six sessions for indicated prevention and early intervention), and CBT-based parent training (~6 h, eight digital modules with clinician support). Given such evidence, we recommend efforts be made to establish ways to position such treatment innovations for rapid deployment facilitated by high-quality training, monitoring, technical assistance, and ongoing disclosures.
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Affiliation(s)
- Ryan D Stoll
- Department of Psychology, Arizona State University
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Schwartz C, Barican JL, Yung D, Zheng Y, Waddell C. Six decades of preventing and treating childhood anxiety disorders: a systematic review and meta-analysis to inform policy and practice. EVIDENCE-BASED MENTAL HEALTH 2019; 22:103-110. [PMID: 31315926 PMCID: PMC6663062 DOI: 10.1136/ebmental-2019-300096] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/25/2022]
Abstract
Question Anxiety disorders are the most prevalent childhood mental disorders. They also start early and persist, causing high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders? Methods We sought randomised controlled trials (RCTs) evaluating interventions addressing anxiety problems in young people. We identified RCTs by searching CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science. Thirty-three RCTs met inclusion criteria—evaluating 8 prevention programmes, 12 psychosocial treatments and 7 pharmacological treatments. We then conducted meta-analyses by intervention type. Findings For prevention, the cognitive-behavioural therapy (CBT) programme Coping and Promoting Strength stood out for reducing anxiety diagnoses. For psychosocial treatment, 9 CBT interventions also reduced diagnoses: Cool Kids; Cool Little Kids Plus Social Skills; Coping Cat; Coping Koala; One-Session Treatment; Parent Education Program; Skills for Academic and Social Success; Strongest Families and Timid to Tiger. Successful CBT interventions were used with children ranging from pre-schoolers to teens in homes, communities/schools and clinics. For pharmacological treatment, selective-serotonergic-reuptake-inhibitors (SSRIs) significantly improved symptoms. Fluoxetine stood out for also reducing post-test diagnoses, but caused adverse events. Meta-analyses indicated strongest effects for CBT (Log OR=0.95; 95% CI, 0.69 to 1.21) and SSRI treatments (1.57; 1.09 to 2.06). Conclusions CBT is effective for preventing and treating childhood anxiety—across a range of ages and formats. Fluoxetine is also an effective treatment but side effects must be managed. CBT prevention and treatment interventions should be made widely available, adding fluoxetine in severe cases.
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Affiliation(s)
- Christine Schwartz
- Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Jenny Lou Barican
- Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Donna Yung
- Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Yufei Zheng
- Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Charlotte Waddell
- Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Ballal D, Navaneetham J, Chandra PS. Children of Parents with Mental Illness: The Need for Family Focussed Interventions in India. Indian J Psychol Med 2019; 41:228-234. [PMID: 31142923 PMCID: PMC6532370 DOI: 10.4103/ijpsym.ijpsym_430_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/11/2019] [Indexed: 01/21/2023] Open
Abstract
Family interventions have been an integral part of mental healthcare in India for several decades. This paper highlights the need for an emerging change in the nature of family interventions in India-from generic interventions for heterogeneous caregiver groups to interventions addressing particular needs based on family stages and structures. It makes a case for recognizing the experiences and needs of one such group, that is, families affected by parental mental illness with children in their care and summarizes the current status of research on this topic in the Indian and global context. It presents implications for future research in India and discusses preliminary ideas for professionals working in adult mental health settings to address the needs of children and families affected by parental mental illness.
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Affiliation(s)
- Divya Ballal
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | | | - Prabha S. Chandra
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
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My Child's thoughts frighten me: Maladaptive effects associated with parents' interpretation and management of children's intrusive thoughts. J Behav Ther Exp Psychiatry 2018; 61:87-96. [PMID: 29990683 DOI: 10.1016/j.jbtep.2018.06.007] [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: 10/15/2017] [Revised: 04/18/2018] [Accepted: 06/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Environmental factors explain substantial variance in youth's obsessive-compulsive symptoms (OCS) and much of this research has focused upon overt parenting behaviors (e.g., accommodation). No work, however, has examined how parents' internal processes (e.g., perception of children's intrusions) influence youth's OCS. Based upon the cognitive theory of obsessions, we propose that parents' misappraisal of children's intrusions as threatening will be positively associated with (a) the number of maladaptive intrusion management strategies recommended by the parent, as well as (b) children's obsessive beliefs, (c) interpretation biases, and (d) OCS severity. METHODS Twenty-seven children (M = 12.81; SD = 3.43) and the parent most involved in childcare completed diagnostic interviews and self-report questionnaires. In the laboratory, we induced obsessional anxiety in youth through a standardized in vivo paradigm (e.g., think about a personalized harm-related negative event occurring). Parents rated how they interpreted their children's unwanted thought and the intrusion management strategies they would recommend. RESULTS Parents who interpreted their children's intrusions as threatening recommended more maladaptive intrusion management strategies and their misappraisal positively and significantly correlated with the severity of children's obsessive beliefs, interpretation biases, and OCS, even after controlling for co-occurring internalizing symptoms. LIMITATIONS Small sample and cross-sectional design precludes causal conclusions. CONCLUSIONS Parents' misinterpretation of children's intrusions may operate as a mechanism by which OCS are generationally transmitted. Results can inform OC prevention programs that target parents' cognitive biases in their own psychotherapy.
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Spence SH. Assessing anxiety disorders in children and adolescents. Child Adolesc Ment Health 2018; 23:266-282. [PMID: 32677290 DOI: 10.1111/camh.12251] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Given the relatively high prevalence of anxiety problems among young people and their adverse consequences if left untreated, it is important that clinicians and researchers have access to reliable and valid assessment tools to facilitate early detection, case formulation, treatment design and evaluation of outcomes. METHOD This paper presents the findings of a pragmatic review of the literature regarding the assessment of anxiety in young people in multiple contexts, including mental health services, school-based screening and research trials. RESULTS Commonly used diagnostic interviews, questionnaire measures and alternative assessment methods are described, along with psychometric properties and practical issues. The review indicates the complexities of assessing anxiety problems given the high level of comorbidity between anxiety disorders and with depression. It also highlights the different approaches required for assessment across different age groups, the need for multiple informants and issues relating to the lack of agreement between reporters. There is a strong evidence-base for several diagnostic instruments and anxiety scales, although the accuracy of youth and parent report scales in forming clinical diagnoses is not sufficiently strong to justify their use in isolation for diagnostic purposes. CONCLUSIONS The assessment of youth anxiety should ideally include a multiinformant, multimethod approach, with measures tailored to the age of the child, and the purpose of the evaluation. There is now a sufficiently strong research base to enable clinicians and researchers to ensure that they select evidence-based instruments.
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Affiliation(s)
- Susan H Spence
- Australian Institute for Suicide Research and Prevention and School of Applied Psychology, Griffith University, Mt Gravatt, Australia
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21
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Suicidal thoughts and attempts in First Nations communities: links to parental Indian residential school attendance across development. J Dev Orig Health Dis 2018; 10:123-131. [PMID: 29923477 DOI: 10.1017/s2040174418000405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The Indian residential school (IRS) system in Canada ran for over a century until the last school closed in 1996. Conditions in the IRSs resulted in generations of Indigenous children being exposed to chronic childhood adversity. The current investigation used data from the 2008-2010 First Nations Regional Health Survey to explore whether parental IRS attendance was associated with suicidal thoughts and attempts in childhood, adolescence and in adulthood among a representative sample of First Nations peoples living on-reserve across Canada. Analyses of the adult sample in Study 1 (unweighted n=7716; weighted n=186,830) revealed that having a parent who attended IRS was linked with increased risk for suicidal thoughts and attempts in adolescence and adulthood. Although females were negatively affected by having a parent who attended IRS, the link with suicidal ideation in adulthood was greater for males. Analyses of the youth sample in Study 2 (unweighted n=2883; weighted n=30,190) confirmed that parental IRS attendance was associated with an increased risk for suicidal ideation and attempts. In contrast to the adult sample, parental IRS attendance had a significantly greater relation with suicidal ideation among female youth. A significant interaction also emerged between parental IRS attendance and age in the youth sample, with the influence of parental attendance being particularly strong among youth ages 12-14, compared with those 15-17 years. These results underscore the need for culturally relevant early interventions for the large proportions of Indigenous children and youth intergenerationally affected by IRSs and other collective traumas.
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Urao Y, Yoshida M, Koshiba T, Sato Y, Ishikawa SI, Shimizu E. Effectiveness of a cognitive behavioural therapy-based anxiety prevention programme at an elementary school in Japan: a quasi-experimental study. Child Adolesc Psychiatry Ment Health 2018; 12:33. [PMID: 29946354 PMCID: PMC6007075 DOI: 10.1186/s13034-018-0240-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/06/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The efficacy of cognitive behavioural therapy (CBT) for anxiety related problems in children is empirically supported. In addition, universal anxiety prevention programmes based on CBT have been demonstrated in recent years. The purpose of this study was to verify the effectiveness of a CBT based original programme 'Journey of the Brave,' aiming to prevent anxiety disorders and anxiety-related problems for Japanese children aged 10-12 years old. METHODS Intervention groups from two classes of 5th grade elementary students (n = 41) received ten 45-min programme sessions. The control group was drawn from one class of 5th grade children (n = 31) from a nearby school. All participants completed the Spence Children's Anxiety Scale (SCAS) at pre, post, and 3 months follow-up. Mixed-effects model for repeated measures analysis was conducted. RESULTS The mean anxiety score on the SCAS for the intervention group was significantly reduced at both post intervention and 3 months follow-up compared with the control group. The group differences on the SCAS from baseline to post-test were - 5.321 (95% CI - 10.12 to - 0.523, p = 0.030), and at the 3-month follow-up were - 7.104 (95% CI - 11.90 to - 2.306, p = 0.004). CONCLUSIONS The effectiveness of the anxiety prevention programme 'Journey of the Brave' was verified though this study using a quasi-experimental design on a small sample.Trial registration: UMIN000009021.
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Affiliation(s)
- Yuko Urao
- Research Centre for Child Mental Development, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Michiko Yoshida
- Department of Cognitive Behavioural Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Takako Koshiba
- Department of International Communication, Kanda University of International Studies, 1-4-1 Wakaba Mihama-ku, Chiba, 261-0014 Japan
| | - Yasunori Sato
- Department of Global Clinical Research, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Shin-ichi Ishikawa
- Department of Psychology, Doshisha University, 1-3 Tatara Miyakodani, Kyotanabe, Kyoto 610-0394 Japan
| | - Eiji Shimizu
- Research Centre for Child Mental Development, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
- Department of Cognitive Behavioural Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
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Ginsburg GS, Schleider J, Tein JY, Drake KL. Family and Parent Predictors of Anxiety Disorder Onset in Offspring of Anxious Parents. CHILD & YOUTH CARE FORUM 2018; 47:363-376. [PMID: 30034206 PMCID: PMC6051714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Offspring of anxious parents are at increased risk for developing anxiety disorders. There is a need to identify which youth are at greatest risk for disorder onset in this population. OBJECTIVE This study prospectively examined several theory-based family and parent characteristics (e. g., family conflict, parental over-control, parental psychopathology) as predictors of anxiety disorder onset in children whose parents were clinically anxious. METHODS Families were enrolled in a randomized controlled trial evaluating a familybased preventative intervention, relative to an information monitoring control condition, for offspring of anxious parents (N= 136; child mean age 8.69 years; 55% female; 85% Caucasian). Family and parent measures were collected using multiple informants and an observational task at baseline, post-intervention, and at a six and 12 month followup. Child anxiety disorder diagnosis was determined by independent evaluators using the Anxiety Disorders Interview Schedule for Children. RESULTS Results indicated that none of the baseline family or parent variables examined predicted the onset of an anxiety disorder in children over the one year follow-up period. CONCLUSIONS Findings raise questions about the short-term risk associated with family and parent factors in anxiety disorder development in this high risk population.
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Affiliation(s)
- Golda S. Ginsburg
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT
| | | | - Jenn Yun Tein
- Arizona State University, Department of Psychology, Tempe, AZ
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Cardamone-Breen MC, Jorm AF, Lawrence KA, Rapee RM, Mackinnon AJ, Yap MBH. A Single-Session, Web-Based Parenting Intervention to Prevent Adolescent Depression and Anxiety Disorders: Randomized Controlled Trial. J Med Internet Res 2018; 20:e148. [PMID: 29699964 PMCID: PMC5945988 DOI: 10.2196/jmir.9499] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Depression and anxiety disorders are significant contributors to burden of disease in young people, highlighting the need to focus preventive efforts early in life. Despite substantial evidence for the role of parents in the prevention of adolescent depression and anxiety disorders, there remains a need for translation of this evidence into preventive parenting interventions. To address this gap, we developed a single-session, Web-based, tailored psychoeducation intervention that aims to improve parenting practices known to influence the development of adolescent depression and anxiety disorders. OBJECTIVE The aim of this study was to evaluate the short-term effects of the intervention on parenting risk and protective factors and symptoms of depression and anxiety in adolescent participants. METHODS We conducted a single-blind, parallel group, superiority randomized controlled trial comparing the intervention with a 3-month waitlist control. The intervention is fully automated and consists of two components: (1) completion of an online self-assessment of current parenting practices against evidence-based parenting recommendations for the prevention of adolescent depression and anxiety disorders and (2) an individually tailored feedback report highlighting each parent’s strengths and areas for improvement based on responses to the self-assessment. A community sample of 349 parents, together with 327 adolescents (aged 12-15 years), were randomized to either the intervention or waitlist control condition. Parents and adolescents completed online self-reported assessments of parenting and adolescent symptoms of depression and anxiety at baseline, 1-month (parent-report of parenting only), and 3-month follow-up. RESULTS Compared with controls, intervention group parents showed significantly greater improvement in parenting risk and protective factors from baseline to 1-month and 3-month follow-up (F2,331.22=16.36, P<.001), with a small to medium effect size at 3-month follow-up (d=0.33). There were no significant effects of the intervention on adolescent-report of parenting or symptoms of depression or anxiety in the adolescents (all P>.05). CONCLUSIONS Findings suggest that a single-session, individually tailored, Web-based parenting intervention can improve parenting factors that are known to influence the development of depression and anxiety in adolescents. However, our results do not support the effectiveness of the intervention in improving adolescent depression or anxiety symptoms in the short-term. Long-term studies are required to adequately assess the relationship between improving parenting factors and adolescent depression and anxiety outcomes. Nonetheless, this is a promising avenue for the translation of research into a low-cost, sustainable, universal prevention approach. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12615000247572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000247572 (Archived by WebCite at http://www.webcitation.org/6v1ha19XG)
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Affiliation(s)
- Mairead C Cardamone-Breen
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Katherine A Lawrence
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | | | - Marie Bee Hui Yap
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Parental Responses to Children’s Avoidance in Fear-Provoking Situations: Relation to Child Anxiety and Mediators of Intervention Response. CHILD & YOUTH CARE FORUM 2018. [DOI: 10.1007/s10566-018-9440-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Hale AE, Ginsburg GS, Chan G, Kendall PC, McCracken J, Sakolsky D, Birmaher B, Compton S, Marie Albano A, Walkup J. Mediators of Treatment Outcomes for Anxious Children and Adolescents: The Role of Somatic Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:94-104. [PMID: 28278599 PMCID: PMC6129169 DOI: 10.1080/15374416.2017.1280804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors are effective treatments for pediatric anxiety disorders. However, the mechanisms of these treatments are unknown. Previous research indicated that somatic symptoms are reduced following treatment, but it is unclear if their reductions are merely a consequence of treatment gains. This study examined reductions in somatic symptoms as a potential mediator of the relationship between treatment and anxiety outcomes. Participants were 488 anxious youth ages 7-17 (M = 10.7), 50.4% male, 78.9% Caucasian, enrolled in Child/Adolescent Anxiety Multimodal Study, a large randomized control trial comparing 12-week treatments of CBT, sertraline, a combination of CBT and sertraline, and a pill placebo. Causal mediation models were tested in R using data from baseline, 8-, and 12-week evaluations. Somatic symptoms were assessed using the Panic/Somatic subscale from the Screen for Child Anxiety Related Emotional Disorders. Youth outcomes were assessed using the Pediatric Anxiety Rating Scale and Children's Global Assessment Scale. Reductions in somatic symptoms mediated improvement in anxiety symptoms and global functioning for those in the sertraline-only condition based on parent report. Conditions involving CBT and data based on child reported somatic symptoms did not show a mediation effect. Findings indicate that reductions in somatic symptoms may be a mediator of improvements for treatments including pharmacotherapy and not CBT. Although the overall efficacy of sertraline and CBT for anxiety may be similar, the treatments appear to function via different mechanisms.
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Affiliation(s)
- Amy E. Hale
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | - Golda S. Ginsburg
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | - Grace Chan
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | | | - James McCracken
- UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA
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Kuckertz JM, Mitchell C, Wiggins JL. Parenting mediates the impact of maternal depression on child internalizing symptoms. Depress Anxiety 2018; 35:89-97. [PMID: 28962070 PMCID: PMC5760303 DOI: 10.1002/da.22688] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/19/2017] [Accepted: 08/29/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To examine the potential mediating role of parenting behaviors in the longitudinal, bidirectional relationships between maternal depression and child internalizing symptoms (i.e. depression and anxiety). METHODS We analyzed data from 4,581 mother-child dyads from the Fragile Families and Child Wellbeing Study, assessed when the child was 3, 5, and 9 years old. Data included maternal depression diagnosis, child internalizing symptoms, and parenting behaviors (i.e. psychological aggression, nonviolent discipline, and physical assault). Data were analyzed using cross-lagged panel models. RESULTS Results indicated bidirectional relationships between maternal depression and child internalizing symptoms over childhood. Mediation analyses suggested that maternal depression led to subsequent increased psychological aggression toward their child, which in turn led to increased child internalizing symptoms. Nonviolent discipline and physical assault did not mediate this relationship. However, greater use of nonviolent discipline at age 5 among all parents predicted higher child internalizing symptoms at age 9. No parenting behaviors were both predicted by earlier child internalizing symptoms and predictive of subsequent maternal depression. CONCLUSIONS Our results suggest a bidirectional relationship between child and maternal internalizing psychopathology that is partially explained by depressed mothers' greater use of psychological aggression toward their children. It is important to note that the size of these effects were small, suggesting that the relationship between parent and child psychopathology is likely additionally explained by factors not assessed in the current study. Nonetheless, these results have implications for prevention and intervention strategies targeting child anxiety and depression.
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Affiliation(s)
- Jennie M. Kuckertz
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego San Diego, CA
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Jillian Lee Wiggins
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego San Diego, CA
- Psychology Department, San Diego State University, San Diego, CA
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28
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Family and Parent Predictors of Anxiety Disorder Onset in Offspring of Anxious Parents. CHILD & YOUTH CARE FORUM 2017. [DOI: 10.1007/s10566-017-9432-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Fréchette-Simard C, Plante I, Bluteau J. Strategies included in cognitive behavioral therapy programs to treat internalized disorders: a systematic review. Cogn Behav Ther 2017; 47:263-285. [PMID: 29103355 DOI: 10.1080/16506073.2017.1388275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review aimed to identify the strategies used in programs based on cognitive behavioral therapy (CBT) to prevent and treat symptoms of anxiety, depression, and internalized behaviors of children and adolescents. Based on an online search (ERIC, PsycInfo, Virtuose UQAM, and Google Scholar), 61 studies describing different cognitive behavioral programs were selected. Results showed that 40 strategies were implemented in at least one program. However, none of the strategies were systematically present in all programs, and only few were reported in more than 50% of the studies. Cognitive restructuring and problem-solving were the most popular strategies to treat depressive symptoms, whereas anxiety programs also generally included relaxation and exposure. Furthermore, six strategies were identified in a single anxiety program, whereas nine strategies were implemented in only one depression program. These results suggest that in anxiety and depression programs designed for children and adolescents, the label "CBT" encompasses a wide variety of programs with only few similar strategies. Such findings highlight the need to define a common basis for CBT programs, in order to better reflect CBT theory and to identify the effectiveness of the strategies included in these programs.
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Affiliation(s)
- Catherine Fréchette-Simard
- a Department of Special Education , Universite du Quebec a Montreal , Montreal , Quebec H3C 3P8 , Canada
| | - Isabelle Plante
- a Department of Special Education , Universite du Quebec a Montreal , Montreal , Quebec H3C 3P8 , Canada
| | - Jonathan Bluteau
- a Department of Special Education , Universite du Quebec a Montreal , Montreal , Quebec H3C 3P8 , Canada
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30
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Moreno-Peral P, Conejo-Cerón S, Rubio-Valera M, Fernández A, Navas-Campaña D, Rodríguez-Morejón A, Motrico E, Rigabert A, Luna JDD, Martín-Pérez C, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Luciano JV, Bellón JÁ. Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Psychiatry 2017; 74:1021-1029. [PMID: 28877316 PMCID: PMC5710546 DOI: 10.1001/jamapsychiatry.2017.2509] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/29/2017] [Indexed: 12/31/2022]
Abstract
Importance To our knowledge, no systematic reviews or meta-analyses have been conducted to assess the effectiveness of preventive psychological and/or educational interventions for anxiety in varied populations. Objective To evaluate the effectiveness of preventive psychological and/or educational interventions for anxiety in varied population types. Data Sources A systematic review and meta-analysis was conducted based on literature searches of MEDLINE, PsycINFO, Web of Science, EMBASE, OpenGrey, Cochrane Central Register of Controlled Trials, and other sources from inception to March 7, 2017. Study Selection A search was performed of randomized clinical trials assessing the effectiveness of preventive psychological and/or educational interventions for anxiety in varying populations free of anxiety at baseline as measured using validated instruments. There was no setting or language restriction. Eligibility criteria assessment was conducted by 2 of us. Data Extraction and Synthesis Data extraction and assessment of risk of bias (Cochrane Collaboration's tool) were performed by 2 of us. Pooled standardized mean differences (SMDs) were calculated using random-effect models. Heterogeneity was explored by random-effects meta-regression. Main Outcomes and Measures Incidence of new cases of anxiety disorders or reduction of anxiety symptoms as measured by validated instruments. Results Of the 3273 abstracts reviewed, 131 were selected for full-text review, and 29 met the inclusion criteria, representing 10 430 patients from 11 countries on 4 continents. Meta-analysis calculations were based on 36 comparisons. The pooled SMD was -0.31 (95% CI, -0.40 to -0.21; P < .001) and heterogeneity was substantial (I2 = 61.1%; 95% CI, 44% to 73%). There was evidence of publication bias, but the effect size barely varied after adjustment (SMD, -0.27; 95% CI, -0.37 to -0.17; P < .001). Sensitivity analyses confirmed the robustness of effect size results. A meta-regression including 5 variables explained 99.6% of between-study variability, revealing an association between higher SMD, waiting list (comparator) (β = -0.33 [95% CI, -0.55 to -0.11]; P = .005) and a lower sample size (lg) (β = 0.15 [95% CI, 0.06 to 0.23]; P = .001). No association was observed with risk of bias, family physician providing intervention, and use of standardized interviews as outcomes. Conclusions and Relevance Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.
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Affiliation(s)
- Patricia Moreno-Peral
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Sonia Conejo-Cerón
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Maria Rubio-Valera
- Sant Joan de Déu Research Foundation, Barcelona, Spain
- Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain
- School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Anna Fernández
- Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain
- Service of Community Health, Public Health Agency of Barcelona, Barcelona, Spain
| | - Desirée Navas-Campaña
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Alberto Rodríguez-Morejón
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
- Department of Personality, Evaluation, and Psychological Treatment, Universidad de Málaga, Málaga, Spain
| | - Emma Motrico
- Prevention and Health Promotion Research Network, Málaga, Spain
- Department of Psychology, University Loyola Andalucía, Seville, Spain
| | - Alina Rigabert
- Department of Psychology, University Loyola Andalucía, Seville, Spain
| | - Juan de Dios Luna
- Prevention and Health Promotion Research Network, Málaga, Spain
- Department of Biostatistics, University of Granada, Granada, Spain
| | - Carlos Martín-Pérez
- Prevention and Health Promotion Research Network, Málaga, Spain
- Primary Care Center of Marquesado, Área Nordeste de Granada, Granada, Spain
| | - Antonina Rodríguez-Bayón
- Prevention and Health Promotion Research Network, Málaga, Spain
- Primary Care Center of San José, Linares, Jaén, Spain
| | | | - Juan Vicente Luciano
- Prevention and Health Promotion Research Network, Málaga, Spain
- Sant Joan de Déu Research Foundation, Barcelona, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St Boi de Llobregat, Spain
| | - Juan Ángel Bellón
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
- Primary Care Center of El Palo, Málaga, Spain
- Department of Preventive Medicine, Public Health and Psychiatry, University of Málaga, Málaga, Spain
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31
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Lawrence PJ, Rooke SM, Creswell C. Review: Prevention of anxiety among at-risk children and adolescents - a systematic review and meta-analysis. Child Adolesc Ment Health 2017; 22:118-130. [PMID: 32680383 DOI: 10.1111/camh.12226] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anxiety disorders are common, often start in childhood and run a chronic course. As such there is a need for effective prevention. METHODS We conducted a systematic review and meta-analyses of randomized, controlled trials to prevent the onset of anxiety disorders in 'at risk' young people. Diagnostic and symptom outcomes were examined. Putative moderators were tested as was publication bias. RESULTS We included 16 trials (2545 young people). Two trials reported diagnostic outcomes, and significant effects were found for these at end-of-programme (RR = .09, 95%CI = .02 to .16), 6- (RR = .17, 95%CI = .06 to .27) and 12-month (RR = .31, 95%CI .17 to .45) follow-ups. Based on 16 trials, improved anxiety symptoms were significant compared to nonattention controls only, with small effect sizes reported by young people at the end-of-programmes, 6- and 12-month follow-ups; and by parents at the end of the programmes and 12-, but not 6-, month follow-ups. There was no evidence of significant moderation or publication bias. CONCLUSIONS Fourteen studies included children and young people who presented with elevated anxiety symptoms, but anxiety disorder was not ruled out in the participants in these studies. Hence, these studies might be reporting results of mixed prevention/early intervention programmes. Prevention programmes that target developmental risk factors, not only disorder maintaining factors, appear most promising. The clinically meaningful impact of anxiety disorder prevention programmes remains unknown.
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Affiliation(s)
- Peter J Lawrence
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | - Sally M Rooke
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
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32
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Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. Curr Opin Psychiatry 2017; 30:283-299. [PMID: 28505032 DOI: 10.1097/yco.0000000000000342] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The transgenerational transmission of mental disorders is one of the most significant causes of psychiatric morbidity. Several risk factors for children of parents with mental illness (COPMI) have been identified in numerous studies and meta-analyses. RECENT FINDINGS Many interventions have been developed for this high-risk group, but data about their efficacy are heterogeneous. SUMMARY The current meta-analysis reports on 96 articles including 50 independent samples from randomized controlled trials quantifying effects of preventive interventions for COPMI. Random effect models resulted in small, though significant Effect Sizes (ES) for programs enhancing the mother-infant interaction (ES = 0.26) as well as mothers' (ES = 0.33) and children's (ES = 0.31) behavior that proved to be stable over the 12-month follow-up, except for infants' behavior. Interventions for children/adolescents resulted in significant small effects for global psychopathology (ES = 0.13), as well as internalizing symptoms (ES = 0.17), and increased significantly over time, with externalizing symptoms reaching significance in the follow-up assessments as well (ES = 0.17). Interventions addressing parents and children jointly produced overall larger effects. Higher study quality was associated with smaller effects. There is a dearth of high quality studies that effectively reduce the high risk of COPMI for the development of mental disorders.
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33
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Pella J, Drake K, Tein JY, Ginsburg G. Child Anxiety Prevention Study: Impact on Functional Outcomes. Child Psychiatry Hum Dev 2017; 48:400-410. [PMID: 27392728 PMCID: PMC5219954 DOI: 10.1007/s10578-016-0667-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the impact of a selective anxiety prevention program for offspring of clinically anxious parents on three domains of child functioning: (1) social, (2) familial, and (3) emotional/behavioral. Dyads were randomized into either the Coping and Promoting Strength program (CAPS; n = 70) or Information Monitoring (IM; n = 66) comparison group. Multi-informant assessments were conducted at baseline, post intervention, and 6 and 12 months follow-ups. Random effects mixed models under the linear growth modeling (LGM) framework was used to assess the impact of CAPS on growth trajectories. Over time, children in the CAPS group had significantly lower anxiety, anxious/depressed symptoms, and lower total behavior problems (parent report), compared to children in IM group. The intervention did not impact other domains assessed (e.g., social functioning), which may be due to "floor effects" on these measures. Longitudinal follow-up data is needed to provide valuable information about this high risk population.
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Affiliation(s)
- Jeffrey Pella
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
| | - Kelly Drake
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jenn-Yun Tein
- Prevention Research Center, Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Golda Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
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34
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Wu MS, Selles RR, Novoa JC, Zepeda R, Guttfreund D, McBride NM, Storch EA. Examination of the Phenomenology and Clinical Correlates of Emetophobia in a Sample of Salvadorian Youths. Child Psychiatry Hum Dev 2017; 48:509-516. [PMID: 27514691 DOI: 10.1007/s10578-016-0677-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Emetophobia is an under-researched disorder characterized by a specific fear of vomiting. There is a paucity of research on this impairing condition, with extant examinations being largely limited to adult samples and online communities. The present study examined the incidence, phenomenology, and correlates of emetophobia in 305 Salvadorian youths. Caregivers completed a battery of questionnaires regarding the youth's symptoms of emetophobia, internalizing/externalizing symptoms, health anxiety, and obsessive-compulsive symptoms. Approximately 7.5 % of the sample was elevated on emetophobia symptoms, and higher levels of emetophobia symptoms were correlated with higher levels of internalizing, externalizing, health anxiety, and obsessive-compulsive symptoms, and lower levels of adaptive functioning. Youths meeting the cutoff for elevated emetophobia symptoms versus those who did not demonstrated significantly higher levels of externalizing behaviors, as well as general obsessive-compulsive symptoms, especially doubting/checking and neutralizing behaviors. These findings are hoped to help improve the conceptualization and treatment of this poorly understood disorder.
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Affiliation(s)
- Monica S Wu
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL, 33701, USA. .,Department of Psychology, University of South Florida, Tampa, FL, USA.
| | - Robert R Selles
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL, 33701, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | | | - Raquel Zepeda
- Universidad de Jose Matias Delgado, Antiguo Cuscatlan, El Salvador
| | | | - Nicole M McBride
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL, 33701, USA
| | - Eric A Storch
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL, 33701, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Health Management and Policy, University of South Florida, Tampa, FL, USA.,Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA.,All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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35
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Wahl P, Bruland D, Bauer U, Okan O, Lenz A. What are the family needs when a parent has mental health problems? Evidence from a systematic literature review. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 30:54-66. [DOI: 10.1111/jcap.12171] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Patricia Wahl
- Institute for Health Research and Social Psychiatry; Catholic University of Applied Sciences North Rhine-Westphalia; Paderborn Germany
| | - Dirk Bruland
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Ullrich Bauer
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Orkan Okan
- Centre for Prevention and Intervention in Childhood and Adolescence; Bielefeld University; Bielefeld Germany
| | - Albert Lenz
- Institute for Health Research and Social Psychiatry; Catholic University of Applied Sciences North Rhine-Westphalia; Paderborn Germany
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36
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37
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Abstract
Anxiety disorders (separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalised anxiety disorder) are common and disabling conditions that mostly begin during childhood, adolescence, and early adulthood. They differ from developmentally normative or stress-induced transient anxiety by being marked (ie, out of proportion to the actual threat present) and persistent, and by impairing daily functioning. Most anxiety disorders affect almost twice as many women as men. They often co-occur with major depression, alcohol and other substance-use disorders, and personality disorders. Differential diagnosis from physical conditions-including thyroid, cardiac, and respiratory disorders, and substance intoxication and withdrawal-is imperative. If untreated, anxiety disorders tend to recur chronically. Psychological treatments, particularly cognitive behavioural therapy, and pharmacological treatments, particularly selective serotonin-reuptake inhibitors and serotonin-noradrenaline-reuptake inhibitors, are effective, and their combination could be more effective than is treatment with either individually. More research is needed to increase access to and to develop personalised treatments.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
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38
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Yap MBH, Morgan AJ, Cairns K, Jorm AF, Hetrick SE, Merry S. Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18. Clin Psychol Rev 2016; 50:138-158. [PMID: 27969003 DOI: 10.1016/j.cpr.2016.10.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE OF THE RESEARCH Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term. PRINCIPAL RESULTS Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6months up to 15years for internalizing measures, 5.5years for depressive measures, and 11years for anxiety measures. MAJOR CONCLUSIONS Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people.
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Affiliation(s)
- Marie B H Yap
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Amy J Morgan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kathryn Cairns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Centre of Excellence in Youth Mental Health, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sally Merry
- School of Medicine, University of Auckland, New Zealand
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39
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Hill A, MacNamara Á, Collins D, Rodgers S. Examining the Role of Mental Health and Clinical Issues within Talent Development. Front Psychol 2016; 6:2042. [PMID: 26793153 PMCID: PMC4707871 DOI: 10.3389/fpsyg.2015.02042] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/22/2015] [Indexed: 11/13/2022] Open
Abstract
Although significant research supports the association between physical activity and mental wellbeing, current literature acknowledges that athletes are no less susceptible to mental illness than the general population. Despite welcomed initiatives aimed at improving mental health within elite sport, these programs often fail to target young athletes; an important concern given that the genesis of many mental illnesses are recognized to occur during this critical period. Given the importance of early intervention and effective treatment, and the potentially devastating consequences of clinical issues going undiagnosed, the implications for talent identification and development (TID) become obvious. With this in mind, this study sought to examine the range of mental health issues that may impact upon developing athletes and potential consequences for the development process, specific risk and protective factors associated with talent development, along with an examination of current practices concerning the identification of mental health issues in such environments. Qualitative interviews were conducted with purposively sampled clinicians (n = 8) experienced in working with adolescents and/or young athletes. Inductive content analysis was undertaken, identifying four main themes: key behavioral indicators; associated risk factors; associated protective factors; and issues around identification and diagnosis. Key behavioral indicators included behavioral change, along with behaviors associated with eating disorders, anxiety and depression. Risk factors centered on family background, the performance environment, and issues surrounding adolescence. Protective factors were primarily social in nature. Finally, a lack of awareness and understanding of clinical issues, multiple causes of symptoms, non-disclosure and the need for triangulation of assessment were identified. The need for improved identification and intervention strategies was apparent, with coaches identified as well placed to detect general “warning signs” such as behavioral change. Short of integrating trained clinicians into talent development environments, as part of a triangulation process, ecologically validated assessment tools—coupled with appropriate training and signposting—could offer a practical way of flagging potential issues in developing athletes. The need for the development of such an instrument is therefore apparent. Finally, education around the influential role of family is also recommended in order to promote the protective elements and mitigate risk factors.
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Affiliation(s)
- Andy Hill
- Institute of Coaching and Performance, University of Central Lancashire Preston, UK
| | - Áine MacNamara
- Institute of Coaching and Performance, University of Central Lancashire Preston, UK
| | - Dave Collins
- Institute of Coaching and Performance, University of Central Lancashire Preston, UK
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Weems CF, Scott BG, Graham RA, Banks DM, Russell JD, Taylor LK, Cannon MF, Varela RE, Scheeringa MA, Perry AM, Marino RC. Fitting anxious emotion-focused intervention into the ecology of schools: results from a test anxiety program evaluation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:200-10. [PMID: 24810999 DOI: 10.1007/s11121-014-0491-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Emotion-focused prevention and intervention efforts in schools have been promoted as a significant developmental and public health priority. This paper reports the results of a longitudinal study testing central premises of a school-based prevention model aimed at promoting positive emotional development through targeting test anxiety. Test anxiety interventions may be a practical strategy for conducting emotion-focused prevention and intervention efforts because of a natural fit within the ecology of the school setting. At-risk youth (n = 1,048) from urban public schools were screened and 325 with elevated test anxiety were offered the intervention in one of two waves (immediate intervention vs. waitlist). The intervention was associated with decreases in test anxiety, anxiety disorder, and depression symptoms. Critically, results suggest high participant satisfaction and growth curve analysis of follow-up assessments (end of the year, the next school year, and a subsequent school year) demonstrated positive developmental trajectories consistent with predictions (e.g., initial change in test anxiety predicted change in other symptoms). Findings provide evidence for the ecological validity of targeting test anxiety in school-based, emotion-focused prevention efforts.
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Affiliation(s)
- Carl F Weems
- Department of Psychology, University of New Orleans, New Orleans, LA, 70148, USA,
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Ginsburg GS, Drake KL, Tein JY, Teetsel R, Riddle MA. Preventing Onset of Anxiety Disorders in Offspring of Anxious Parents: A Randomized Controlled Trial of a Family-Based Intervention. Am J Psychiatry 2015; 172:1207-14. [PMID: 26404420 PMCID: PMC6013063 DOI: 10.1176/appi.ajp.2015.14091178] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the efficacy of a family-based intervention to prevent the onset of anxiety disorders in offspring of anxious parents. METHOD Participants were 136 families with a parent meeting DSM-IV criteria for an anxiety disorder and one child 6-13 years of age without an anxiety disorder. Families were randomly assigned to the family-based intervention (N=70) or to an information-monitoring control condition (N=66). All families were expected to complete assessments, administered by blind interviewers, at baseline, at the end of the intervention (or 8 weeks after randomization) and at 6- and 12-month follow-ups. Onset of any anxiety disorder and anxiety symptom severity (assessed using the Anxiety Disorders Interview Schedule for Children) at 12 months were the primary and secondary outcome measures, respectively. RESULTS The incidence of child anxiety disorders was 31% in the control group and 5% in the intervention group (odds ratio=8.54, 95% CI=2.27, 32.06). At the 1-year follow-up, youths in the control group also had higher anxiety symptoms ratings than those in the intervention group. Effect sizes were medium to large (0.81 at 6 months and 0.57 at 12 months for anxiety symptoms), and the number needed to treat was 3.9 at 12 months. Significant moderators included baseline levels of child anxiety; significant mediators were parental distress and modeling of anxiety. Child maladaptive cognitions and parental anxiety did not mediate outcomes. CONCLUSIONS A brief psychosocial prevention program holds promise for reducing the 1-year incidence of anxiety disorders among offspring of anxious parents.
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Cowan CSM, Callaghan BL, Kan JM, Richardson R. The lasting impact of early-life adversity on individuals and their descendants: potential mechanisms and hope for intervention. GENES BRAIN AND BEHAVIOR 2015; 15:155-68. [PMID: 26482536 DOI: 10.1111/gbb.12263] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 01/15/2023]
Abstract
The adverse effects of early-life stress are pervasive, with well-established mental and physical health consequences for exposed individuals. The impact of early adverse experiences is also highly persistent, with documented increases in risk for mental illness across the life span that are accompanied by stable alterations in neural function and hormonal responses to stress. Here, we review some of these 'stress phenotypes', with a focus on intermediary factors that may signal risk for long-term mental health outcomes, such as altered development of the fear regulation system. Intriguingly, recent research suggests that such stress phenotypes may persist even beyond the life span of the individuals, with consequences for their offspring and grand-offspring. Phenotypic characteristics may be transmitted to future generations via either the matriline or the patriline, a phenomenon that has been demonstrated in both human and animal studies. In this review, we highlight behavioral and epigenetic factors that may contribute to this multigenerational transmission and discuss the potential of various treatment approaches that may halt the cycle of stress phenotypes.
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Affiliation(s)
- C S M Cowan
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - B L Callaghan
- Psychology Department, Columbia University, New York, NY, USA
| | - J M Kan
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - R Richardson
- School of Psychology, The University of New South Wales, Sydney, Australia
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Keeton CP, Teetsel RN, Dull NMS, Ginsburg GS. Parent Psychopathology and Children's Psychological Health: Moderation by Sibling Relationship Dimensions. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 43:1333-42. [PMID: 25896728 PMCID: PMC6013740 DOI: 10.1007/s10802-015-0013-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Offspring of anxious adults are at heightened risk for psychological maladjustment; however factors that protect youth in the context of this risk have been rarely explored. Supported by literature showing the meaningful role of sibling relationships for children's psychological outcomes, this study examined the protective role of the sibling relationship for children in the context of risk for psychological maladjustment due to having a parent with a clinical anxiety disorder. Participants were 81 children ages 7 to 12 years (58% female; 82 % Caucasian), and their parents. Parents met DSM-IV-TR diagnostic criteria for a primary anxiety disorder, and youth did not meet diagnostic criteria for any psychiatric disorder. Parents completed questionnaires on their own psychological distress and use of parenting behaviors, and on their children's psychological adjustment. Children self-reported on the quality of their sibling relationship based on their closest-age sibling. Parenting behaviors were also coded based on a parent-child interaction task. Results of hierarchical regression models demonstrated that sibling relationship quality moderated the relation between parental psychological distress and child adjustment. Post-hoc simple slopes analyses showed that parental distress was significantly positively associated with greater child psychological problems only for children reporting low sibling companionship or high sibling conflict. Aspects of the sibling relationship did not moderate the association between self-rated or observer-rated parenting behaviors and child anxiety symptoms. Findings are consistent with developmental models and empirical literature emphasizing the protective role of sibling relationships for youth's psychological outcomes. Sibling relationships may be a salient target for youth psychological preventive or treatment interventions.
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Affiliation(s)
- Courtney P Keeton
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA,
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Yap MBH, Fowler M, Reavley N, Jorm AF. Parenting strategies for reducing the risk of childhood depression and anxiety disorders: A Delphi consensus study. J Affect Disord 2015; 183:330-8. [PMID: 26047961 DOI: 10.1016/j.jad.2015.05.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Substantial evidence that some modifiable parental factors are associated with childhood depression and anxiety indicates that parents can play a crucial role in the prevention of these disorders in their children. However, more effective translation of research evidence is required. METHODS This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing depression or anxiety disorders in children aged 5-11 years. A literature search identified 289 recommendations for parents. These were presented to a panel of 44 international experts over three survey rounds, who rated their preventive importance. RESULTS 171 strategies were endorsed as important or essential for preventing childhood depression or anxiety disorders by ≥90% of the panel. These were written into a parenting guidelines document, with 11 subheadings: Establish and maintain a good relationship with your child, Be involved and support increasing autonomy, Encourage supportive relationships, Establish family rules and consequences, Encourage good health habits, Minimise conflict in the home, Help your child to manage emotions, Help your child to set goals and solve problems, Support your child when something is bothering them, Help your child to manage anxiety, and Encourage professional help seeking when needed. LIMITATIONS This study relied on experts from Western countries; hence the strategies identified may not be relevant for all ethnic groups. CONCLUSIONS This study produced new parenting guidelines that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their children from depression and anxiety disorders.
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Affiliation(s)
- Marie Bee Hui Yap
- School of Psychological Sciences, Monash University, Bld 17, 18 Innovation Walk, Clayton, Victoria 3800, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Michelle Fowler
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Nicola Reavley
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Anthony Francis Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Australia
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Drake KL, Stewart CE, Muggeo MA, Ginsburg GS. Enhancing the Capacity of School Nurses to Reduce Excessive Anxiety in Children: Development of the CALM Intervention. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2015; 28:121-30. [PMID: 26171792 PMCID: PMC6013739 DOI: 10.1111/jcap.12115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PROBLEM Excessive anxiety is among the most common psychiatric problems facing youth. Because anxious youth tend to have somatic complaints, many seek help from the school nurse. Thus, school nurses are in an ideal position to provide early intervention. This study addresses this problem and describes the plans to develop and test a new intervention (Child Anxiety Learning Modules; CALM), delivered by school nurses, to reduce child anxiety and improve academic functioning. METHODS An iterative development process including consultation with an expert panel, two open trials, and a pilot randomized controlled study comparing CALM to usual care is proposed. Feedback will be solicited from all participants during each phase and data on outcome measures will be provided by children, parents, teachers, and independent evaluators. FINDINGS Data will be collected on intervention satisfaction and feasibility. Primary outcomes that include child anxiety symptoms, classroom behavior, and school performance (e.g., attendance, grades, standardized test scores) will be collected at pre- and post-interventions and at a 3-month follow-up evaluation. CONCLUSIONS Pediatric anxiety is a common problem that school nurses frequently encounter. Consequently, they are well positioned to play a key role in enhancing access to behavioral health interventions to reduce anxiety and may therefore make a significant positive public health impact.
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Affiliation(s)
- Kelly L Drake
- The Johns Hopkins University School of Medicine, c/o Anxiety Treatment Center of Maryland, Ellicott City, MD, USA
| | | | - Michela A Muggeo
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
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García-Campayo J, del Hoyo YL, Valero MS, Yus MCP, Esteban EA, Guedea MP, Botaya RM. Primary prevention of anxiety disorders in primary care: A systematic review. Prev Med 2015; 76 Suppl:S12-5. [PMID: 25456801 DOI: 10.1016/j.ypmed.2014.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/27/2014] [Accepted: 10/09/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Anxiety disorders are the most prevalent psychiatric disorders in primary care and have significant social, economic, and interpersonal costs. Primary care is an ideal setting to prevent the appearance of anxiety disorders. The aim of this study was to evaluate the efficacy and cost-effectiveness of primary prevention interventions in anxiety disorders in the adult population receiving primary health care. METHODS A literature search was carried out in four databases-PubMed, PsycInfo, Cochrane, and Web of Science-from January 1980 to November 2013. Clinical trials and systematic reviews published in English and non-English languages and that evaluated the efficacy and/or cost-effectiveness of interventions of primary prevention for anxiety in primary care in the general adult population were included. Risk of bias was assessed by the Cochrane Risk Bias Tool and Overview Quality Assessment Questionnaire. RESULTS No high-quality research was identified that studied primary prevention of anxiety disorders in the adult population in the primary care setting. The few studies that exist focus on the child-adolescent population or on other types of interventions, usually as secondary prevention. CONCLUSION This study emphasizes the need for the development of high-quality clinical trials on the prevention of anxiety disorders in primary care.
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Affiliation(s)
- Javier García-Campayo
- Department of Psychiatry, Miguel Servet University Hospital, University of Zaragoza, REDIAPP, Isabel la Catolica, 1-3, 50009 Zaragoza, Spain.
| | - Yolanda López del Hoyo
- Department of Psychology & Sociology, University of Zaragoza, REDIAPP, Violante de Hungría, 23, 50009 Zaragoza, Spain
| | | | - Maria Cruz Pérez Yus
- Aragon Health Sciences Institute, REDIAPP, CS. Arrabal, Andador Aragues Puerto, 2-4, 50015 Zaragoza, Spain
| | - Eva Andrés Esteban
- 12 de Octubre Research Institute, Avda. de Córdoba, s/n, 28041 Madrid, Spain
| | | | - Rosa Magallón Botaya
- Health Aragon, REDIAPP, CS, Arrabal, Andador Aragues Puerto, 2-4, 50015 Zaragoza, Spain
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Yap MBH, Jorm AF. Parental factors associated with childhood anxiety, depression, and internalizing problems: a systematic review and meta-analysis. J Affect Disord 2015; 175:424-40. [PMID: 25679197 DOI: 10.1016/j.jad.2015.01.050] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in children. However, there is hitherto no systematic review of this complex literature with a focus on the 5-11 years age range, when there is a steep increase in onset of these disorders. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required. METHODS Employing the PRISMA method, we conducted a systematic review of parental factors associated with anxiety, depression, and internalizing problems in children which parents can potentially modify. RESULTS We identified 141 articles altogether, with 53 examining anxiety, 50 examining depression, and 70 examining internalizing outcomes. Stouffer׳s method of combining p-values was used to determine whether associations between variables were reliable, and meta-analyses were conducted with a subset of eligible studies to estimate the mean effect sizes of associations between each parental factor and outcome. LIMITATIONS Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, the lack of generalizability across cultures, and the inability to conduct a meta-analysis on all included studies. CONCLUSIONS Parental factors with a sound evidence base indicating increased risk for both depression and internalizing problems include more inter-parental conflict and aversiveness; and for internalizing outcomes additionally, they include less warmth and more abusive parenting and over-involvement. No sound evidence linking any parental factor with anxiety outcomes was found.
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Affiliation(s)
- Marie Bee Hui Yap
- School of Psychological Sciences, Monash University, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Anthony Francis Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Australia
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Affiliation(s)
- Melinda Goodyear
- Department of Rural and Indigenous Health, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moe, Victoria, Australia
- The Bouverie Centre, Faculty of Health Science, La Trobe University, Brunswick, Victoria, Australia
| | - Rose Cuff
- The Bouverie Centre, Faculty of Health Science, La Trobe University, Brunswick, Victoria, Australia
| | - Darryl Maybery
- Department of Rural and Indigenous Health, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moe, Victoria, Australia
| | - Andrea Reupert
- Department of Rural and Indigenous Health, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moe, Victoria, Australia
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The prevention of anxiety in preschool-aged children: Development of a new program and preliminary findings. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mhp.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kuhn ES, Laird RD. Family support programs and adolescent mental health: review of evidence. Adolesc Health Med Ther 2014; 5:127-42. [PMID: 25177156 PMCID: PMC4096456 DOI: 10.2147/ahmt.s48057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Family support programs aim to improve parent wellbeing and parenting as well as adolescent mental and behavioral health by addressing the needs of parents of adolescents experiencing or at risk for mental health problems. Family support programs can be part of the treatment for adolescents diagnosed with mental or behavioral health problems, or family support programs can be delivered as prevention programs designed to prevent the onset or escalation of mental or behavioral health problems. This review discusses the rationale for family support programs and describes the range of services provided by family support programs. The primary focus of the review is on evaluating the effectiveness of family support programs as treatments or prevention efforts delivered by clinicians or peers. Two main themes emerged from the review. First, family support programs that included more forms of support evidenced higher levels of effectiveness than family support programs that provided fewer forms of support. Discussion of this theme focuses on individual differences in client needs and program adaptions that may facilitate meeting diverse needs. Second, family support prevention programs appear to be most effective when serving individuals more in need of mental and behavioral health services. Discussion of this theme focuses on the intensity versus breadth of the services provided in prevention programs. More rigorous evaluations of family support programs are needed, especially for peer-delivered family support treatments.
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Affiliation(s)
- Emily S Kuhn
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
| | - Robert D Laird
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
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