Pathways maintaining physical health problems from childhood to young adulthood: The role of stress and mood

Impact of Hospitalizations due to Chronic Health Conditions on Early Child Development

OBJECTIVE

To assess the impact of hospitalization for chronic health conditions on early child development and wellbeing at school start.

METHODS

We conducted a longitudinal cohort study of children starting school using population-based record linkage of routinely collected admitted hospital data and standardized assessment of early childhood development (Australian Early Developmental Census: AEDC). Developmental vulnerability (DV) was defined as children scoring <10th centile in any one of five developmental domains. Children scoring <10th centile on two or more domains were considered developmentally high-risk (DHR). Children hospitalized with chronic health conditions were compared to children without hospitalizations prior to school start.

RESULTS

Among 152,851 children with an AEDC record, 22,271 (14·6%) were hospitalized with a chronic condition. Children hospitalized with chronic health conditions were more likely to be DHR (adjusted odds ratio 1.25, 95% CI: 1.18-1.31) compared to children without hospitalizations. Children hospitalized more frequently (>7 times) or with longer duration (>2 weeks) had a 40% increased risk of being DHR (1.40, 95% CI: 1.05-1.88 and 1.40, 95% CI: 1.13-1.74, respectively). Children hospitalized with mental health/behavioral/developmental conditions had the highest risk of DHR (2.23, 95% CI: 1.72-2.90). Developmental vulnerability was increased for physical health (1.37, 95% CI: 1.30-1.45), language (1.28, 95% CI: 1.19-1.38), social competence (1.22, 95% CI: 1.16-1.29), communication (1.17, 95% CI: 1.10-1.23), and emotional maturity (1.16, 95% CI: 1.09-1.23).

CONCLUSIONS

Frequent and longer duration hospitalizations for chronic health conditions can impact early childhood development. Research and interventions are required to support future development and well-being of children with chronic health conditions who are hospitalized.

To Make and Keep Friends: The Role of Health Status in Adolescent Network Tie Formation and Persistence

Health status may shape network structure through network dynamics (tie formation and persistence) and direction (sent and received ties), net of typical network processes. We apply Separable Temporal Exponential Random Graph Models (STERGMs) to National Longitudinal Study of Adolescent to Adult Health survey data (n = 1,779) to differentiate how health status shapes network sent and received tie formation and persistence. Results indicate that networks are shaped by withdrawal of adolescents experiencing poor health, highlighting the importance of separating distinct and directed processes of friendship formation and persistence when considering how health relates to adolescent social life.

Evaluation of a Health Education Intervention to Improve Parental Knowledge and Attitudes About Chronic Stress and Depression Among Head Start Families

Background. Chronic stress and depression disproportionately affect families experiencing poverty, and likely contribute to disparities in early childhood developmental outcomes. Developing strategies to address chronic stress and depression may help mitigate these disparities. Early Head Start (EHS) and Head Start (HS) programs provide an important platform to address the disproportionate burden of stress and mental health issues experienced by EHS/HS families. However, few low-literacy, broad, scalable interventions improve parents' knowledge and attitudes around these topics. Objectives. We examined parents' knowledge and attitudes regarding stress and depression before and after a train-the-trainer (TTT) intervention delivered to 28 EHS/HS agencies across the United States. Methods. Following a TTT workshop, 18 agencies chose to deliver the stress training to 1,089 parents and 5 chose to deliver the depression training to 670 parents. Participating parents completed paper assessments at baseline and 3 months following the training. Paired T-tests and chi-square analyses tested whether responses significantly improved over time. Results. At baseline, 37.2% of parents reported feeling stressed most of the time and 13.4% reported feeling depressed most of the time. Following the trainings and reinforcement activities, parents' knowledge, attitudes and self-reported behaviors significantly improved, including willingness to seek help for depression, avoidance of negative health-risk behaviors and utilization of healthy stress management practices. At follow up, 18.6% of parents reported feeling stressed most of the time and 11% reported feeling depressed. Conclusion. Findings suggest this low-literacy TTT approach is potentially a promising health promotion intervention with broad dissemination potential.

The Long-Term Impact of Childhood Disability on Mental Health Trajectories in Mid- to Late-Life

OBJECTIVES

We draw from the life course and stress process frameworks to examine how experiencing disability in early life influences mental health in adulthood.

METHODS

Data come from the Health and Retirement Study Cross-Wave Childhood Health and Family Aggregated Data file (2008-2018, n = 15,289). Childhood disability status is a retrospective self-report of whether respondents were disabled for six months or more because of a health problem before the age of 16 (n = 581). We used age-based growth curve models to construct trajectories of depressive symptoms by childhood disability status.

RESULTS

Respondents who experienced childhood disability exhibit more depressive symptoms at age 50 compared to those who did not experience this stressor. However, there is no difference in the growth of depressive symptoms with age between these groups, suggesting maintained inequality over the late adulthood life course.

DISCUSSION

Findings suggest that childhood disability has long-term implications for life course mental health.

Love in the Time of COVID-19: A Multi-Wave Study Examining the Salience of Sexual and Relationship Health During the COVID-19 Pandemic

The current study used Family Systems Theory as a framework to clarify the impact of the COVID-19 pandemic on sexual, romantic, and individual functioning. Specifically, sexual and romantic functioning were modeled as key mechanisms linking COVID-19 related stressors (as predictors) to aspects of individual functioning over time (as outcomes). A sample of 1,241 sexually active adults in relationships (47% married/engaged) was recruited from March 5 to May 5, 2020: 82% White, 66% women, M = 34 years old, 58% heterosexual. All participants completed a baseline survey and 642 participants completed at least one of the six, monthly, follow-up surveys. Multilevel SEM models evaluated the model both at the level of stable between-person differences (i.e., level 2) and at the level of within-person change across time (i.e., level 1). The findings suggested that COVID-19 related stress was predictive of lower sexual, romantic, and individual functioning in both levels of the model. Significant indirect paths supported the proposed mediation at the level of within-person change across time: elevations in COVID-19 stress within specific months predicted corresponding drops in sexual functioning, which in turn predicted corresponding drops in romantic functioning, which in turn predicted corresponding drops in individual well-being (highlighting points of intervention). In contrast, at the level of between-person differences, stable levels of sexual and relationship satisfaction across the 6 months of the study were not associated with stable levels of COVID-19 stressors (representing sources of resilience that promoted well-being) and stable levels of stress from social isolation predicted stably higher amounts of communicating affection to one's loved ones (suggesting a need for affiliation in the face of chronic stress) whereas stable difficulties with orgasms were linked to stable irritability toward partners and depressive symptoms. Multigroup analyses suggested that the findings generalized across gender, age, race/ethnicity, sexual orientation, relationship stage, and cohabitation groups. Spillover effects within a Family Systems Theory framework clarify how upheaval of the COVID-19 pandemic could have impacted sexual, romantic, and individual functioning in a process-oriented framework, highlighting sources of resilience (sexual satisfaction, communicating affection) and risk (orgasm difficulties).

Clinical Measures of Allostatic Load in Children and Adolescents with Food Allergy, Depression, or Anxiety

PURPOSE

Sustained high stress exposure results in chronic activation of the stress response system, dysregulated stress responses, high allostatic load, and poor later-life health. Children and adolescents with chronic health conditions face stressors related to their condition in addition to those typical of childhood and adolescence, placing them at risk of high allostatic load. The purpose of this secondary analysis was to examine whether youth with chronic health conditions differ from controls on clinical measures of allostatic load.

DESIGN AND METHODS

A secondary analysis of two datasets, the electronic health record of a tertiary children's hospital and data from the Survey of the Health of Wisconsin, compared youth with chronic health conditions to controls on clinical measures of allostatic load. Additional analyses explored whether parental stress and mental health influenced these relationships.

RESULTS

Analyses identified differences in BMI, blood pressure, and waist circumference between youth with food allergy, anxiety, or depression, and controls. These relationships differed for males and females and for those with comorbid mental and physical conditions, and were influenced by parent stress and mental health.

CONCLUSIONS

Results support future studies exploring whether high stress in youth with chronic health conditions leads to increased allostatic load. Incorporating biomarkers as well as genetic and epigenetic factors will provide critical insights.

PRACTICE IMPLICATIONS

Youth with mental and physical CHCs may be at increased risk of high allostatic load, reflected in clinical measures of metabolism, and should have regular assessments of their metabolic health.

Psychosocial Functioning After One Year of Interdisciplinary Pediatric Weight Management

Youth with obesity are more likely than normal-weight peers to experience psychosocial problems. Empirically-based recommendations for addressing pediatric obesity include intensive interdisciplinary weight management comprising medical, behavioral health, nutrition, and exercise components. The present study examined changes in psychosocial functioning associated with frequency of participation in an interdisciplinary pediatric weight management program. Participants were 86 patients (55.8% females; median age = 11.5 years; 67.4% Non-Hispanic Black; median BMI percentile = 99.5) enrolled in an interdisciplinary pediatric weight management program for at least one year. Psychosocial functioning was measured with the Pediatric Symptom Checklist (PSC-17), a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention difficulties as well as global functioning. The PSC-17 was completed at the initial clinic visit (baseline) and repeated one-year later (annual). The Wilcoxon Signed Rank test indicated that annual PSC-17 scores were significantly lower than baseline scores across all domains. Spearman correlation coefficients revealed no significant association between total number of clinic visits and PSC-17 global or subscale scores. However, the number of visits for exercise-only sessions was significantly correlated with caregiver-reported improvement in internalizing behaviors. Findings suggest that participation in interdisciplinary pediatric weight management may improve psychosocial functioning in youth with obesity and that attending supervised exercise sessions may be especially beneficial for improving internalizing behavior symptoms.