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Yoon Y, Cederbaum JA, Duan L, Lee JO. Intergenerational Continuity of Childhood Adversity and Its Underlying Mechanisms Among Teen Mothers and Their Offspring. CHILD MALTREATMENT 2024; 29:557-573. [PMID: 37669686 DOI: 10.1177/10775595231200145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The present study investigates how parenting stress mediates the intergenerational continuity of childhood adversity in teenage mothers. Childhood adversity experiences of caregivers significantly affect their offspring's exposure to childhood adversity. However, little is known about the mechanisms linking childhood adversity across generations. The study measures how parental distress and parent-child dysfunctional interaction mediate the association between teen mothers' childhood adversity and their offspring's adversity, measuring when the offspring reached 11.5 years of age. The results revealed that parental distress, but not parent-child dysfunctional interaction, mediated the association between teen mothers' child abuse and their offspring's household dysfunction. This suggests that parental distress may be a crucial intervention target to prevent the intergenerational continuity of childhood adversity. The findings imply that efforts to prevent the intergenerational continuity of childhood adversity may be more successful if the public and professionals have a broader understanding of the associations between early adversity and parenting contexts. In conclusion, the study shed light on the potential mechanisms underlying the intergenerational continuity of childhood adversity and highlights the importance of targeting parenting stress, specifically parental distress, as an intervention strategy to prevent the perpetuation of childhood adversity across generations.
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Affiliation(s)
- Yoewon Yoon
- Department of Social Welfare, Dongguk University, Seoul, South Korea
| | - Julie A Cederbaum
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Lei Duan
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jungeun Olivia Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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2
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Okine L, Cederbaum JA, Duan L, Lee JO. Maternal childhood adversity and adolescent marijuana use at age 17 years: The role of parental mental health and parenting behaviors. J Adolesc 2023; 95:1617-1627. [PMID: 37545353 PMCID: PMC10841321 DOI: 10.1002/jad.12230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Children's risk for marijuana use may be linked to their parents' history of childhood adversity, yet little is known about the mechanisms underlying this link. This study examined whether maternal parenting behavior and mental health serve as mechanisms linking maternal childhood adversity to their children's marijuana use at age 17 years, by gender. METHODS Data were from the Young Women and Child Development Study (59% male), a longitudinal panel study, which began in 1988 and followed mother-child dyads for 17 years (n = 240). Participants were recruited from health and social services agencies located in a metropolitan region of Washington State. Hypotheses were tested using Structural Equation Modeling in Mplus. Multiple-group analysis was conducted to evaluate potential gender differences. RESULTS Results showed that maternal childhood adversity was associated with their mental health outcomes (β = .32, p < .001), which in turn was predictive of mothers' harsh parenting (β = .27, p < .01). Maternal harsh parenting behavior was then associated with their children's marijuana use at age 17 years (β = .34, p < .001). Multiple group analyses revealed that the path from harsh parenting to adolescent marijuana use differed across genders being only significant for boys (β = .42, p < .001). CONCLUSIONS The intergenerational impact of childhood adversity highlights the need for interventions that target both parents and children. This would support teen mothers with a history of childhood adversity to acquire skills and knowledge to help mitigate its impact on their parenting behaviors and offset risks for their children.
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Affiliation(s)
- Lucinda Okine
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Julie A. Cederbaum
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Lei Duan
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Jungeun Olivia Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
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3
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Allen B, Brown MP. Attachment security as an outcome and predictor of response to trauma-focused cognitive-behavioral therapy among maltreated children with posttraumatic stress: A pilot study. Clin Child Psychol Psychiatry 2022:13591045221144588. [PMID: 36472223 DOI: 10.1177/13591045221144588] [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] [Indexed: 12/12/2022]
Abstract
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a frontline intervention for posttraumatic stress disorder (PTSD) symptoms among maltreated children. Research suggests that active caregiver participation predicts positive treatment outcomes, but these studies are often based on the perception of the caregiver. Youth perceptions of the caregiver as a source of support who might help confront distressing memories (i.e., attachment security) and how they relate to TF-CBT treatment are unexplored. This paper uses data from a small randomized controlled feasibility trial of TF-CBT to conduct a pilot examination of whether (a) attachment security may improve through the course of TF-CBT, and (b) pre-treatment attachment security predicts response to TF-CBT for the amelioration of posttraumatic stress. Results favored the conclusion that those beginning treatment with attachment insecurity may demonstrate improvement for this outcome by the end of treatment (n = 8; t = 3.3, p = .013, Cohen's d = 1.17). However, although significant improvements were found over the course of treatment for PTSD, there was no evidence that pre-treatment attachment security predicted PTSD outcome (n = 29; ∆R2 < .01, ∆F(1,26) = .001, p = .969). The limitations of the current pilot study are discussed, as well as directions for future research.
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Affiliation(s)
- Brian Allen
- Department of Pediatrics, 12310Penn State College of Medicine, Hershey, PA, USA.,Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA.,Center for the Protection of Children, 12310Penn State Children's Hospital, Hershey, PA, USA
| | - Michelle P Brown
- Department of Psychology, 2629University of South Carolina, Columbia, SC, USA
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Peters W, Rice S, Alvarez‐Jimenez M, Hetrick SE, Halpin E, Kamitsis I, Santesteban‐Echarri O, Bendall S. Relative efficacy of psychological interventions following interpersonal trauma on anxiety, depression, substance use, and PTSD symptoms in young people: A meta-analysis. Early Interv Psychiatry 2022; 16:1175-1184. [PMID: 35106931 PMCID: PMC9786735 DOI: 10.1111/eip.13265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/21/2021] [Accepted: 01/18/2022] [Indexed: 12/30/2022]
Abstract
AIM Interpersonal trauma exposures are associated with anxiety, depression, and substance use in youth populations (aged 12-25 years). This meta-analysis reports on the efficacy of psychological interventions on these symptom domains in addition to post-traumatic stress. METHODS Following PRISMA guidelines, a search of electronic databases was performed for randomized controlled trials (RCTs) assessing interventions for young people following interpersonal trauma exposure. Risk of bias was assessed using the Cochrane Risk of Bias tool. Data were analysed using random-effects meta-analyses. RESULTS Of the 4832 records screened, 78 studies were reviewed, and 10 RCTs, involving 679 participants (mean age 15.6 years), were analysed. There was a large pooled effect size for post-traumatic stress (7 studies, g = 1.43, 95% CI [0.37, 2.15], p = .002) and substance use (2 studies, g = 0.70, 95% CI [-0.11, 1.22], p < .001) and small effect sizes for anxiety (4 studies, g = 0.30, 95% CI [0.10, 0.49], p = .003), and trend-level effect for depression (10 studies, g = 0.27, 95% CI [0.00, 0.54], p = .052). Heterogeneity was significant for post-traumatic stress and moderate for depression. CONCLUSIONS High-quality RCTs of psychological interventions for anxiety, depression, substance use, and post-traumatic stress symptoms in young people exposed to interpersonal trauma are scarce. While available studies show either statistically significant or trend-level efficacy for psychological interventions in reducing these symptoms, wide confidence intervals, heterogeneity and small sample size mean that results need to be interpreted with caution.
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Affiliation(s)
- Wilma Peters
- Department of Research and TranslationOrygenParkvilleVictoriaAustralia
- Centre for Youth Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
| | - Simon Rice
- Department of Research and TranslationOrygenParkvilleVictoriaAustralia
- Centre for Youth Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
| | - Mario Alvarez‐Jimenez
- Department of Research and TranslationOrygenParkvilleVictoriaAustralia
- Centre for Youth Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
| | - Sarah E. Hetrick
- Department of Psychological Medicine, Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
- Centre for Youth Mental HealthUniversity of AucklandAucklandNew Zealand
| | - Emma Halpin
- Department of Research and TranslationOrygenParkvilleVictoriaAustralia
- Centre for Youth Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
| | - Ilias Kamitsis
- Department of Research and TranslationOrygenParkvilleVictoriaAustralia
- Centre for Youth Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
| | | | - Sarah Bendall
- Department of Research and TranslationOrygenParkvilleVictoriaAustralia
- Centre for Youth Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
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Lange BCL, Nelson A, Lang JM, Stirman SW. Adaptations of evidence-based trauma-focused interventions for children and adolescents: a systematic review. Implement Sci Commun 2022; 3:108. [PMID: 36209138 PMCID: PMC9548160 DOI: 10.1186/s43058-022-00348-5] [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] [Received: 03/29/2022] [Accepted: 09/16/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rates of potentially traumatic events (PTEs) and other forms of adversity among children are high globally, resulting in the development of a number of evidence-based interventions (EBIs) to address the adverse outcomes stemming from these experiences. Though EBIs are intended to be delivered according to set parameters, these EBIs are frequently adapted. However, little is known about existing adaptations of EBIs for children who experienced PTEs or other adversities. As such, this review aimed to determine: (1) why existing EBIs designed to address PTEs and other adversities experienced by children are adapted, (2) what processes are used to determine what elements should be adapted, and (3) what components of the intervention are adapted. METHODS Nine academic databases and publicly available search engines were used to identify academic and grey literature. Initial screening, full-text review, data extraction, and quality determinations were completed by two members of the research team. Data were synthesized narratively for each adapted EBI by research question. RESULTS Forty-two studies examining the adaptations of nine different EBIs were located, with Trauma-Focused Cognitive Behavioral Therapy and Cognitive Behavioral Intervention for Trauma in Schools being the most commonly adapted EBIs. Most frequently, EBIs were adapted to improve fit with a new population and to address cultural factors. Most commonly, researchers in combination with others made decisions about adapting interventions, though frequently who was involved in these decisions was not described. Common content adaptations included the addition of intervention elements and the tailoring/tweaking/refining of intervention materials. Common contextual adaptations included changes to the intended population, changes to the channel of treatment delivery, and changes to who administered the intervention. CONCLUSIONS Most published studies of EBI adaptions have been developed to improve fit and address cultural factors, but little research is available about adaptations made by clinicians in day-to-day practice. Efforts should be made to evaluate the various types of adaptations and especially whether adaptations improve access to services or improve child outcomes in order to ensure that all children exposed to trauma can access effective treatment. TRIAL REGISTRATION The protocol for this systematic review was published with PROSPERO (CRD42020149536).
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Affiliation(s)
- Brittany C. L. Lange
- grid.475976.eChild Health and Development Institute of Connecticut, Inc., Farmington, USA
| | - Ashley Nelson
- grid.475976.eChild Health and Development Institute of Connecticut, Inc., Farmington, USA
| | - Jason M. Lang
- grid.475976.eChild Health and Development Institute of Connecticut, Inc., Farmington, USA ,grid.208078.50000000419370394Department of Psychiatry, UCONN Health, Farmington, USA ,grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, USA
| | - Shannon Wiltsey Stirman
- grid.429666.90000 0004 0374 5948National Center for PTSD, Washington, D.C., USA ,grid.168010.e0000000419368956Stanford University, Stanford, USA
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Reid C, McKenzie JE, Brennan SE, Bennetts SK, Clark Y, Mensah F, Hokke S, Ralph N, Brown SJ, Gee G, Nicholson JM, Chamberlain C. Interventions during pregnancy or up to two years after birth for parents who are experiencing complex trauma or have experienced maltreatment in their childhood (or both) to improve parenting capacity or socio-emotional well-being. Hippokratia 2021. [DOI: 10.1002/14651858.cd014874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Reid
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Shannon K Bennetts
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Murdoch Children's Research Institute; Parkville Australia
| | - Yvonne Clark
- South Australian Health and Medical Research Institute; Adelaide Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
| | - Stacey Hokke
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Naomi Ralph
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Central Queensland University; Townsville Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
- South Australian Health and Medical Research Council; Adelaide Australia
| | - Graham Gee
- Murdoch Children's Research Institute; Parkville Australia
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Australia
| | - Jan M Nicholson
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Catherine Chamberlain
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity; Murdoch University; Perth Australia
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Vogel A, Rosner R. Lost in Transition? Evidence-Based Treatments for Adolescents and Young Adults with Posttraumatic Stress Disorder and Results of an Uncontrolled Feasibility Trial Evaluating Cognitive Processing Therapy. Clin Child Fam Psychol Rev 2021; 23:122-152. [PMID: 31620891 DOI: 10.1007/s10567-019-00305-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is not uncommon among adolescents and young adults (AYAs). Left untreated, transition to adulthood might be especially challenging and/or prolonged for AYAs. However, it is unclear whether AYAs are adequately represented in current PTSD treatment research and whether they benefit to the same degree as younger or older individuals. In the first part of the paper, we reflect on developmental considerations in the treatment of AYAs and give an overview of current age-specific results in PTSD treatment research. Furthermore, we review individual trauma-focused evidence-based treatments that were examined in AYAs over the last 10 years. In the second part, we present data from an uncontrolled feasibility trial evaluating cognitive processing therapy (CPT) with some age-adapted modifications and an exposure component (written accounts). We treated 17 AYAs (aged 14 to 21) suffering from posttraumatic stress symptoms (PTSS). At posttreatment, participants had improved significantly with respect to clinician-rated PTSS severity (d = 1.32). Treatment gains were maintained throughout the 6-week and 6-month follow-ups. Results indicated that CPT, with only minor adaptations, was feasible and safe in AYAs. The recommendations for future research focus on the inclusion of young adults in trials with adolescents, more refined age reporting in clinical trials, and the encouragement of dismantling studies in youth. To conclude, clinical recommendations for caregiver involvement and the addressing of developmental tasks, motivational issues and emotion regulation problems are discussed.
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Affiliation(s)
- Anna Vogel
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany.
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany
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9
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Rimane E, Steil R, Renneberg B, Rosner R. Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. Eur Child Adolesc Psychiatry 2021; 30:1591-1601. [PMID: 32918100 PMCID: PMC8505313 DOI: 10.1007/s00787-020-01637-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/29/2020] [Indexed: 11/20/2022]
Abstract
Severe posttraumatic stress symptoms (PTSS) are connected to a variety of health-related and interpersonal problems, among them are the insecure attachment orientations. However, psychotherapy seems to improve not only PTSS but also attachment insecurities. In a large multicenter, randomized clinical trial, the attachment characteristics and PTSS of 85 adolescents and young adults (aged 14-21 years) with clinically relevant abuse-related PTSS were assessed at study entry, at the end of treatment, and 3 months after the end of treatment. Participants were randomized either to a developmentally adapted cognitive processing therapy (D-CPT) or to a wait-list with treatment advice (WL/TA). The purpose of the study was to analyze the association between PTSS and attachment at study entry as well as changes in attachment during the trial. We found that attachment-related avoidance (AR avoidance) was positively associated with PTSS from both self-reports and clinician ratings, whereas attachment-related anxiety (AR anxiety) was only related to self-reported PTSS (Pearson correlation coefficients between 0.37 and 0.46). Changes in AR anxiety occurred in both conditions at some point during the study (baseline to 3-month follow-up effect size was d = 0.60 for D-CPT and d = 0.44 for WL/TA) whereas for AR avoidance, only participants in D-CPT improved significantly (baseline to 3-month follow-up effect size was d = 0.75). The results indicate that PTSS and attachment are connected. Positive changes in attachment insecurities brought about by trauma-focused psychotherapy seem possible.Trial registration: German Clinical Trials Register (DRKS); Germanctr.de; identifier: DRKS00004787; date of registration: 18 March 2013.
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Affiliation(s)
- Eline Rimane
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany.
| | - Regina Steil
- grid.7839.50000 0004 1936 9721Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Babette Renneberg
- grid.14095.390000 0000 9116 4836Department of Clinical Psychology and Psychotherapy, Freie Universitaet of Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Rita Rosner
- grid.440923.80000 0001 1245 5350Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072 Eichstätt, Germany
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10
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van der Asdonk S, Cyr C, Alink L. Improving parent-child interactions in maltreating families with the Attachment Video-feedback Intervention: Parental childhood trauma as a moderator of treatment effects. Attach Hum Dev 2020; 23:876-896. [PMID: 32746730 DOI: 10.1080/14616734.2020.1799047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Research is demonstrating the effectiveness of attachment-based interventions for maltreating families. However, parents' own traumatic childhood experiences may interfere with treatment effects. The current study investigated in a sample of maltreating families whether effects of the Attachment Video-feedback Intervention (AVI) on parent-child interactive quality were moderated by parental childhood trauma. Families were randomized to receive AVI (n = 29) or a Psychoeducative intervention (PI; n = 19), or they were in anon-randomized comparison group (RS; n = 40). Parents filled out the Childhood Trauma Questionnaire and videotapes of parent-child interactions were coded for interactive quality. Parents who received AVI showed improved parent-child interactive quality compared to parents in PI and RS groups. However, parents with more severe levels of childhood trauma showed less improvements. Future research should explore whether clinical attention with a specific focus on trauma would increase treatement effects.
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Affiliation(s)
- Sabine van der Asdonk
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
| | - Chantal Cyr
- Université du Québec à Montréal, Montréal, Canada.,Institut Universitaire Jeunes en Difficulté, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'île-de-Montréal, Montréal, Canada
| | - Lenneke Alink
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
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Baas MAM, van Pampus MG, Braam L, Stramrood CAI, de Jongh A. The effects of PTSD treatment during pregnancy: systematic review and case study. Eur J Psychotraumatol 2020; 11:1762310. [PMID: 33029304 PMCID: PMC7473051 DOI: 10.1080/20008198.2020.1762310] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND PTSD in pregnant women is associated with adverse outcomes for mothers and their children. It is unknown whether pregnant women with PTSD, or symptoms of PTSD, can receive targeted treatment that is safe and effective. OBJECTIVE The purpose of the present paper was to assess the effectiveness and safety of treatment for (symptoms of) PTSD in pregnant women. METHOD A systematic review was conducted in accordance with the PRISMA guidelines in Pubmed, Embase, PsychINFO, and Cochrane. In addition, a case is presented of a pregnant woman with PTSD who received eye-movement desensitization and reprocessing (EMDR) therapy aimed at processing the memories of a previous distressing childbirth. RESULTS In total, 13 studies were included, involving eight types of interventions (i.e. trauma-focused cognitive behavioural therapy, exposure therapy, EMDR therapy, interpersonal psychotherapy, explorative therapy, self-hypnosis and relaxation, Survivor Moms Companion, and Seeking Safety Intervention). In three studies, the traumatic event pertained to a previous childbirth. Five studies reported obstetrical outcomes. After requesting additional information, authors of five studies indicated an absence of serious adverse events. PTSD symptoms improved in 10 studies. However, most studies carried a high risk of bias. In our case study, a pregnant woman with a PTSD diagnosis based on DSM-5 no longer fulfilled the criteria of PTSD after three sessions of EMDR therapy. She had an uncomplicated pregnancy and delivery. CONCLUSION Despite the fact that case studies as the one presented here report no adverse events, and treatment is likely safe, due to the poor methodological quality of most studies it is impossible to allow inferences on the effects of any particular treatment of PTSD (symptoms) during pregnancy. Yet, given the elevated maternal stress and cortisol levels in pregnant women with PTSD, and the fact that so far no adverse effects on the unborn child have been reported associated with the application of trauma-focused therapy, treatment of PTSD during pregnancy is most likely safe.
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Affiliation(s)
- Melanie A. M. Baas
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | | | - Laura Braam
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | | | - Ad de Jongh
- Department of Obstetrics and Gynecology, OLVG, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands
- School of Health Sciences, Salford University, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
- School of Psychology, Queen’s University, Belfast, UK
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Chamberlain C, Gee G, Harfield S, Campbell S, Brennan S, Clark Y, Mensah F, Arabena K, Herrman H, Brown S. Parenting after a history of childhood maltreatment: A scoping review and map of evidence in the perinatal period. PLoS One 2019; 14:e0213460. [PMID: 30865679 PMCID: PMC6415835 DOI: 10.1371/journal.pone.0213460] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background and aims Child maltreatment is a global health priority affecting up to half of all children worldwide, with profound and ongoing impacts on physical, social and emotional wellbeing. The perinatal period (pregnancy to two years postpartum) is critical for parents with a history of childhood maltreatment. Parents may experience ‘triggering’ of trauma responses during perinatal care or caring for their distressed infant. The long-lasting relational effects may impede the capacity of parents to nurture their children and lead to intergenerational cycles of trauma. Conversely, the perinatal period offers a unique life-course opportunity for parental healing and prevention of child maltreatment. This scoping review aims to map perinatal evidence regarding theories, intergenerational pathways, parents’ views, interventions and measurement tools involving parents with a history of maltreatment in their own childhoods. Methods and results We searched Medline, Psychinfo, Cinahl and Embase to 30/11/2016. We screened 6701 articles and included 55 studies (74 articles) involving more than 20,000 parents. Most studies were conducted in the United States (42/55) and involved mothers only (43/55). Theoretical constructs include: attachment, social learning, relational-developmental systems, family-systems and anger theories; ‘hidden trauma’, resilience, post-traumatic growth; and ‘Child Sexual Assault Healing’ and socioecological models. Observational studies illustrate sociodemographic and mental health protective and risk factors that mediate/moderate intergenerational pathways to parental and child wellbeing. Qualitative studies provide rich descriptions of parental experiences and views about healing strategies and support. We found no specific perinatal interventions for parents with childhood maltreatment histories. However, several parenting interventions included elements which address parental history, and these reported positive effects on parent wellbeing. We found twenty-two assessment tools for identifying parental childhood maltreatment history or impact. Conclusions Perinatal evidence is available to inform development of strategies to support parents with a history of child maltreatment. However, there is a paucity of applied evidence and evidence involving fathers and Indigenous parents.
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Affiliation(s)
- Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Graham Gee
- Victorian Aboriginal Health Service, Melbourne, Victoria, Australia
| | - Stephen Harfield
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Sandra Campbell
- Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
- Centre for Indigenous Health Equity Research, Central Queensland University, Cairns, Queensland, Australia
| | - Sue Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yvonne Clark
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- School of Psychology, University of Adelaide, Hughes, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Fiona Mensah
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Royal Children’s Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kerry Arabena
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Herrman
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Stephanie Brown
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
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13
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Yoon Y, Cederbaum JA, Mennen FE, Traube DE, Chou CP, Lee JO. Linkage between teen mother's childhood adversity and externalizing behaviors in their children at age 11: Three aspects of parenting. CHILD ABUSE & NEGLECT 2019; 88:326-336. [PMID: 30554124 PMCID: PMC6661175 DOI: 10.1016/j.chiabu.2018.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 05/14/2023]
Abstract
BACKGROUND Experiences of childhood adversity are consistently associated with compromised behavioral health later in life. Less clear is the intergenerational influence of maternal childhood adversity on developmental outcome in children. Completely unknown are the mechanisms linking teen mother's childhood adversity to child developmental outcomes. OBJECTIVE The present study tested whether aspects of parenting (parenting stress, physical discipline, and disagreement with grandparents) served as the pathways between teen mother's childhood adversity and the externalizing behaviors of their offspring at age 11, by gender. PARTICIPANTS AND SETTING Data were from a longitudinal panel study of teen mothers and their children, the Young Women and Child Development Study (N = 495; 57% male). METHODS The pathways from teen mother's childhood adversity to their offspring's externalizing behavior were tested by two subscales: rule-breaking behavior and aggressive behavior. In addition, multiple-group analysis was examined for potential gender differences. RESULTS Teen mother's childhood adversity was positively associated with greater use of parenting stress (β = 0.16, p < .01) and physical discipline (β=0.11, p < .05). In addition, parenting stress, physical discipline, and disagreement with grandparent were all associated with increased rule-breaking and aggressive behaviors in children. Multiple group analysis revealed that the path between physical discipline and externalizing behavior differed by gender, with the path only significant for girls. CONCLUSIONS These findings have implications for early intervention efforts that emphasize the need to intervene with children and parents, particularly helping teen mothers gain knowledge and skills to offset the impact of their experiences of childhood adversity on their parenting behaviors.
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Affiliation(s)
- Yoewon Yoon
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Department of Children, Youth, and Families, Los Angeles, CA, 669 W. 34th Street, 90089, United States.
| | - Julie A Cederbaum
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Department of Children, Youth, and Families, Los Angeles, CA, 669 W. 34th Street, 90089, United States
| | - Ferol E Mennen
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Department of Children, Youth, and Families, Los Angeles, CA, 669 W. 34th Street, 90089, United States
| | - Dorian E Traube
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Department of Children, Youth, and Families, Los Angeles, CA, 669 W. 34th Street, 90089, United States
| | - Chih-Ping Chou
- University of Southern California, Department of Preventive Medicine, 2001 N. Soto. Street, Los Angeles, CA, 90032, United States
| | - Jungeun Olivia Lee
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Department of Children, Youth, and Families, Los Angeles, CA, 669 W. 34th Street, 90089, United States
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Lewey JH, Smith CL, Burcham B, Saunders NL, Elfallal D, O’Toole SK. Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:457-472. [PMID: 32318168 PMCID: PMC7163897 DOI: 10.1007/s40653-018-0212-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Efficacy of EMDR and TF-CBT for posttraumatic stress symptoms (PTSS) was explored through meta-analysis. A comprehensive search yielded 494 studies of children and adolescents with PTSS who received treatment with these evidence-based therapeutic modalities. Thirty total studies were included in the meta-analysis. The overall Cohen's d was small (-0.359) and statistically significant (p < 0.05), indicating EMDR and TF-CBT are effective in treating PTSS. Major findings posit TF-CBT is marginally more effective than EMDR; those with sub-clinical PTSS responded more favorably in treatment than those with PTSD; and greater reductions in PTSS were observed with presence of comorbidity in diagnosis. Assessment of publication bias with Classic fail-safe N revealed it would take 457 nonsignificant studies to nullify these findings.
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Affiliation(s)
- Jennifer H. Lewey
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
- Direct Care and Treatment - Forensic Services (DCT-FS), Minnesota Department of Human Services (DHS), St. Peter, MN USA
| | - Christopher L. Smith
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, San Francisco, CA USA
- Youth Opportunities Upheld, Inc. (YOU, Inc.), Worchester, MA USA
| | - Brandi Burcham
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
| | - Nia L. Saunders
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
| | - Dina Elfallal
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
| | - Siobhan K. O’Toole
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
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15
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Brouwer ME, Williams AD, van Grinsven SE, Cuijpers P, Lambregtse-van den Berg MP, Burger H, Bockting CLH. Offspring outcomes after prenatal interventions for common mental disorders: a meta-analysis. BMC Med 2018; 16:208. [PMID: 30428883 PMCID: PMC6237028 DOI: 10.1186/s12916-018-1192-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is presumed that pharmacological and non-pharmacological treatment of prenatal common mental disorders can mitigate associated adverse effects in offspring, yet strong evidence for the prophylactic benefits of treatment is lacking. We therefore examined the effect of prenatal treatments for common mental disorders on offspring outcomes. METHODS For this meta-analysis, articles published up to August 31, 2017, were obtained from PubMed, PsycInfo, Embase, and Cochrane databases. Included studies needed to be randomized controlled trials (RCTs) on the effect of treatment of prenatal common mental disorders comparing an intervention to a control condition, including offspring outcome(s). Random effects models were used to calculate Hedges' g in the program Comprehensive Meta-Analysis© (version 3.0). RESULTS Sixteen randomized controlled trials among 2778 pregnant women compared offspring outcomes between prenatal interventions and control groups. There were zero pharmacological, 13 psychological, and three other interventions (homeopathy, relaxation interventions, and short psycho-education). Birth weight (mean difference 42.88 g, g = 0.08, 95% CI -0.06 to 0.22, p = 0.27, n = 11), Apgar scores (g = 0.13, 95% CI -0.28 to 0.54, p = 0.53, n = 4), and gestational age (g = 0.03, 95% CI -0.06 to 0.54, p = 0.49, n = 10) were not significantly affected. Other offspring outcomes could not be meta-analyzed due to the inconsistent reporting of offspring outcomes and an insufficient number of studies. CONCLUSIONS Non-pharmacological interventions had no significant effect on birth outcomes, although this outcome should be considered with caution due to the risk of biases. No randomized controlled trial examined the effects of prenatal pharmacological treatments as compared to treatment as usual for common mental disorders on offspring outcomes. Present clinical guidelines may require more research evidence on offspring outcomes, including child development, in order to warrant the current recommendation to routinely screen and subsequently treat prenatal common mental disorders. TRIAL REGISTRATION PROSPERO CRD42016047190.
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Affiliation(s)
- Marlies E Brouwer
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Alishia D Williams
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.,Faculty of Science, School of Psychology, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Sam E van Grinsven
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Psychiatry and Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Rotterdam, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - Huibert Burger
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Abstract
AbstractResearch on attachment transmission has focused on variable-centered analyses, where hypotheses are tested by examining linear associations between variables. The purpose of this study was to apply a relationship-centered approach to data analysis, where adult states of mind, maternal sensitivity, and infant attachment were conceived as being three components of a single, intergenerational relationship. These variables were assessed in 90 adolescent and 99 adult mother–infant dyads when infants were 12 months old. Initial variable-centered analyses replicated the frequently observed associations between these three core attachment variables. Relationship-based, latent class analyses then revealed that the most common pattern among young mother dyads featured maternal unresolved trauma, insensitive interactive behavior, and disorganized infant attachment (61%), whereas the most prevalent adult mother dyad relationship pattern involved maternal autonomy, sensitive maternal behavior, and secure infant attachment (59%). Three less prevalent relationship patterns were also observed. Moderation analyses revealed that the adolescent–adult mother distinction differentiated between secure and disorganized intergenerational relationship patterns, whereas experience of traumatic events distinguished between disorganized and avoidant patterns. Finally, socioeconomic status distinguished between avoidant and secure patterns. Results emphasize the value of a relationship-based approach, adding an angle of understanding to the study of attachment transmission.
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Intervention with Adolescent Mother–Child Dyads and Cognitive Development in Early Childhood: a Meta-Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 18:116-130. [DOI: 10.1007/s11121-016-0731-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Donnelly TJ, Jaaniste T. Attachment and Chronic Pain in Children and Adolescents. CHILDREN-BASEL 2016; 3:children3040021. [PMID: 27792141 PMCID: PMC5184796 DOI: 10.3390/children3040021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 11/16/2022]
Abstract
Although attachment theory is not new, its theoretical implications for the pediatric chronic pain context have not been thoroughly considered, and the empirical implications and potential clinical applications are worth exploring. The attachment framework broadly focuses on interactions between a child’s developing self-regulatory systems and their caregiver’s responses. These interactions are believed to create a template for how individuals will relate to others in the future, and may help account for normative and pathological patterns of emotions and behavior throughout life. This review outlines relevant aspects of the attachment framework to the pediatric chronic pain context. The theoretical and empirical literature is reviewed regarding the potential role of attachment-based constructs such as vulnerability and maintaining factors of pediatric chronic pain. The nature and targets of attachment-based pediatric interventions are considered, with particular focus on relevance for the pediatric chronic pain context. The potential role of attachment style in the transition from acute to chronic pain is considered, with further research directions outlined.
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Affiliation(s)
- Theresa J Donnelly
- Department of Pain & Palliative Care, Sydney Children's Hospital, Randwick, NSW 2031, Australia.
| | - Tiina Jaaniste
- Department of Pain & Palliative Care, Sydney Children's Hospital, Randwick, NSW 2031, Australia.
- School of Women's and Children's Health, University of New South Wales, Kensington, NSW 2052, Australia.
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Kobak RR, Kerig PK. Introduction to the special issue: attachment-based treatments for adolescents. Attach Hum Dev 2016; 17:111-8. [PMID: 25833287 DOI: 10.1080/14616734.2015.1006382] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
During the past decade, new attachment-based treatments (ABTs) for adolescents have been developed and tested in both field and randomized control trials. The papers in this special issue represent important contributions to defining a more general model of ABTs for adolescents. Our discussion of these papers is organized by a series of challenges to developing and evaluating these treatments. We first consider how disturbances in the caregiver-adolescent attachment bond are implicated in adolescent psychopathology and family distress. We then describe different potential targets for attachment-based interventions for adolescents and their caregivers. Finally we review the different interventions and change mechanisms that have been used to increase security in the caregiver-adolescent bond. A general model of ABTs for adolescents can be useful in guiding future efforts to measure change in attachment constructs, evaluate the dynamic process of change in attachment bonds, and test the effectiveness of specific treatment elements in reducing adolescents' symptoms and increasing attachment security.
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Affiliation(s)
- R Rogers Kobak
- a Department of Psychology , University of Delaware , Newark , DE 19716 , USA
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Konanur S, Muller RT, Cinamon JS, Thornback K, Zorzella KPM. Effectiveness of Trauma-Focused Cognitive Behavioral Therapy in a community-based program. CHILD ABUSE & NEGLECT 2015; 50:159-170. [PMID: 26318778 DOI: 10.1016/j.chiabu.2015.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/10/2015] [Accepted: 07/19/2015] [Indexed: 06/04/2023]
Abstract
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a widely used treatment model for trauma-exposed children and adolescents (Cohen, Mannarino, & Deblinger, 2006). The Healthy Coping Program (HCP) was a multi-site community based intervention carried out in a diverse Canadian city. A randomized, waitlist-control design was used to evaluate the effectiveness of TF-CBT with trauma-exposed school-aged children (Muller & DiPaolo, 2008). A total of 113 children referred for clinical services and their caregivers completed the Trauma Symptom Checklist for Children (Briere, 1996) and the Trauma Symptom Checklist for Young Children (Briere, 2005). Data were collected pre-waitlist, pre-assessment, pre-therapy, post-therapy, and six months after the completion of TF-CBT. The passage of time alone in the absence of clinical services was ineffective in reducing children's posttraumatic symptoms. In contrast, children and caregivers reported significant reductions in children's posttraumatic stress (PTS) following assessment and treatment. The reduction in PTS was maintained at six month follow-up. Findings of the current study support the use of the TF-CBT model in community-based settings in a diverse metropolis. Clinical implications are discussed.
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Affiliation(s)
- Sheila Konanur
- Department of Psychology, Faculty of Health, York University, Canada
| | - Robert T Muller
- Department of Psychology, Faculty of Health, York University, Canada
| | - Julie S Cinamon
- Department of Psychology, Faculty of Health, York University, Canada
| | - Kristin Thornback
- Department of Psychology, Faculty of Health, York University, Canada
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