Maternal sensitivity and mental health: does an early childhood intervention programme have an impact?

The genetic architecture of youth anxiety: a study protocol

BACKGROUND

Anxiety disorders are the most common psychiatric problems among Canadian youth and typically have an onset in childhood or adolescence. They are characterized by high rates of relapse and chronicity, often resulting in substantial impairment across the lifespan. Genetic factors play an important role in the vulnerability toward anxiety disorders. However, genetic contribution to anxiety in youth is not well understood and can change across developmental stages. Large-scale genetic studies of youth are needed with detailed assessments of symptoms of anxiety disorders and their major comorbidities to inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care.

METHODS

The Genetic Architecture of Youth Anxiety (GAYA) study is a Pan-Canadian effort of clinical and genetic experts with specific recruitment sites in Calgary, Halifax, Hamilton, Toronto, and Vancouver. Youth aged 10-19 (n = 13,000) will be recruited from both clinical and community settings and will provide saliva samples, complete online questionnaires on demographics, symptoms of mental health concerns, and behavioural inhibition, and complete neurocognitive tasks. A subset of youth will be offered access to a self-managed Internet-based cognitive behavioral therapy resource. Analyses will focus on the identification of novel genetic risk loci for anxiety disorders in youth and assess how much of the genetic risk for anxiety disorders is unique or shared across the life span.

DISCUSSION

Results will substantially inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. Given that the GAYA study will be the biggest genomic study of anxiety disorders in youth in Canada, this project will further foster collaborations nationally and across the world.

Latin American Attachment studies: A narrative review

Attachment theory´s core hypotheses (universality, normativity, sensitivity, and competence) are assumed to be applicable worldwide. However, the majority of studies on attachment theory have been conducted in Western countries, and the extent to which these core hypotheses are supported by research conducted in Latin America has never been systematically addressed. The purpose of this systematic narrative literature review is to provide an integrative discussion of the current body of empirical studies concerning attachment theory conducted in Latin American countries. For that purpose, a search was conducted in four electronic databases (Web of Science, PsycInfo, SciELO, and Redalyc) and 82 publications on attachment and/or sensitivity met inclusion criteria. None of the studies reported cases in which an attachment relationship was absent, and a predominance of secure attachment patterns was found, mainly for non-risk samples (NRS). Sensitivity levels were generally deemed adequate in NRS, and related to attachment quality. Attachment security and caregivers' sensitivity were positively associated with child outcomes. Attachment-based intervention studies mostly showed efficacy. In conclusion, Latin American research supports the key theoretical assumptions of attachment theory, mainly in samples of urban middle-class NRS. However, the field of attachment-related research would be enriched by also investing in Latin American studies on caregiving rooted in local concepts and theories.

The Association Between Exposure to Maternal Depression During Year 2 of a Child's Life and Future Child Problem Behavior

INTRODUCTION

We examined the association of exposure to maternal depression during year 2 of a child's life with future child problem behavior. We conducted a secondary analysis to investigate whether race/ethnicity is a moderator of this relationship.

METHODS

We used Fragile Families and Child Well-Being Study data (age 3 N = 3288 and 49% Black, 26% Hispanic, 22% non-Hispanic White; age 5 N = 3001 and 51% Black, 25% Hispanic, 21% non-Hispanic White; age 9 N = 3630 and 50% Black, 25% Hispanic, 21% non-Hispanic White) and ordinal logistic regression to model problem behavior at ages 3, 5, and 9 on maternal depression status during year 2.

RESULTS

At age 9, children whose mother was depressed during year 2 were significantly more likely to have higher internalizing (AOR = 1.92, 95% CI: 1.42,2.61) and externalizing (AOR = 1.65, 95% CI: 1.10,2.48) problem behavior scores. In our secondary analysis, race/ethnicity did not have moderating effects, potentially due to a limitation of the data that required use of maternal self-reported race/ethnicity as a proxy for child race/ethnicity.

DISCUSSION

Exposure to maternal depression after the prenatal and perinatal periods may have a negative association with children's behavioral development through age 9. Interventions that directly target maternal depression during this time should be developed. Additional research is needed to further elucidate the role of race/ethnicity in the relationship between maternal depression and child problem behavior.

Context- and Subgroup-Specific Language Changes in Individuals Who Develop PTSD After Trauma

Post-traumatic stress disorder (PTSD) is a very common condition with more than 3 million new cases per year in the US alone. The right diagnosis in a timely manner is key to ensuring a prompt treatment that could lead to a full recovery. Unfortunately, avoidance of trauma reminders, social stigma, self-presentation, and self-assessment biases often prevent individuals from seeking timely evaluation, leading to delays in treatment and suboptimal outcomes. Previous studies show that various mental health conditions are associated with distinct patterns of language use. Analyzing language use may also help to avoid response bias in self-reports. In this study, we analyze text data from online forum users, showing that language use differences between PTSD sufferers and controls. In all groups of PTSD sufferers, the usage of singular first-person pronouns was higher and that of plural first-person pronouns was lower than in control groups. However, the analysis of other word categories suggests that subgroups of people with the same mental health disorder (here PTSD) may have salient differences in their language use, particularly in word usage frequencies. Additionally, we show that word usage patterns may vary depending on the type of the text analyzed. Nevertheless, more studies will be needed to increase precision by further examine a variety of text types and different comorbidities. If properly developed, such tools may facilitate earlier PTSD diagnosis, leading to timely support and treatment, which are associated with better outcomes.

Responsive Parenting Buffers the Impact of Maternal PTSD on Young Children

OBJECTIVE

This study investigates maternal responsive parenting behaviors as a theorized buffer to the detrimental impact of maternal PTSD symptoms on young children's depression and anxiety symptoms, disruptive behavior, and stress-related symptoms.

DESIGN

A multi-ethnic sample of 242 trauma-exposed mothers and their preschool-aged children was assessed. Maternal responsive parenting behaviors were observed during standardized parent-child interactions. Maternal and child mental health symptoms were reported by mothers.

RESULTS

Maternal PTSD symptoms were associated with their responsive parenting behaviors and predicted children's mental health symptoms. Responsive parenting was inversely associated with children's depression and stress-related symptoms. Moderation analyses revealed an interactive effect of maternal symptoms and responsive parenting on preschool children's disruptive behavior and stress-related symptoms.

CONCLUSIONS

Responsive parenting behaviors can mitigate the ill effects of maternal PTSD symptoms. Nurturing relationships buffer the impact of maternal PTSD. Helping parents' to sensitively respond to their young children's distress can support positive outcomes in children.

Supporting the caregiver-child dyad's relationship: An evaluation of implementation quality in the Chilean Crecer Jugando program

This study presents an evaluation of the implementation quality of the Chilean program Crecer Jugando (CJ), a 16 weekly sessions group-based parenting program for children 0 to 4 years old and their primary caregivers aiming at promoting positive caregiver-child interaction. The implementation of CJ in two public health care centers (HCC) in Chile's Metropolitan Region was assessed based on Donabedian's theoretical model, focusing on the dimensions of the program's structure (e.g., infrastructure and supplies), processes (e.g., coordination of CJ team with the HCCs, participants' attendance, CJ team interaction with participating children), and preliminary outcomes (i.e., parenting stress, caregiver-child interaction). A total of 63 main caregiver-child dyads participated in the study, which took place over a six-month period. Results indicated that the CJ program was feasible to be implemented in two HCCs and would benefit from improving the coordination with the HCCs and the quality of interaction of the CJ team with participating children. After participation in the CJ program, caregivers showed a decrease in their parenting stress. Lessons learned are discussed.

Preventive Behavioral Health Programs in Primary Care: A Systematic Review

CONTEXT

Early childhood is a critical period for socioemotional development. Primary care is a promising setting for behavioral health programs.

OBJECTIVES

To identify gaps in the literature on effectiveness and readiness for scale-up of behavioral health programs in primary care.

DATA SOURCES

PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Embase, Evidence-Based Medicine Reviews, and Scopus databases were searched for articles published in English in the past 15 years. Search terms included terms to describe intervention content, setting, target population, and names of specific programs known to fit inclusion criteria.

STUDY SELECTION

Inclusion criteria were: (1) enrolled children 0 to 5 years old, (2) primary care setting, (3) measured parenting or child behavior outcomes, and (4) clinical trial, quasi-experimental trial, pilot study, or pre-post design.

DATA EXTRACTION

Data were abstracted from 44 studies. The rigor of individual studies and evidence base as a whole were compared with the Society of Prevention Research's standards for efficacy, effectiveness, and scale-up research.

RESULTS

Gaps in the literature include: study findings do not always support hypotheses about interventions' mechanisms, trust in primary care as a mediator has not been sufficiently studied, it is unclear to which target populations study findings can be applied, parent participation remains an important challenge, and the long-term impact requires further evaluation.

LIMITATIONS

Potential limitations include publication bias, selective reporting within studies, and an incomplete search.

CONCLUSIONS

Targeting gaps in the literature could enhance understanding of the efficacy, effectiveness, and readiness for scale-up of these programs.

Subjective Social Status and Psychological Distress in Mothers of Young Children

Introduction Perceptions of social standing have increasingly well-documented relationships with health. Higher subjective social status (SSS) is associated with better psychological well-being among women, and mothers of newborns. The relationship between SSS and psychological distress among mothers of young children, however, is largely unknown. SSS may provide insight into aspects of maternal functioning that are relevant to parenting capacity, as well as insight into future health; in addition, SSS is brief, and may be perceived as less intrusive than other measures of socioeconomic status or mental health. We evaluated the relationship between SSS and psychological distress among mothers of 5-year-old children from diverse socioeconomic backgrounds. Methods One hundred and sixty-two mothers of 5-year old children, who participated in a study of child self-regulation, completed surveys that assessed sociodemographics, mental health, and perceived social support. The MacArthur Scale of SSS used pictures of ten-rung ladders to assess respondents' social position in relation to the US (SES ladder) and their community (community ladder). Quantile regression models were used to assess the relationship between maternal psychological distress (perceived social support, depressive symptoms, anxiety) and the ladders (individually and together), adjusting for maternal age, race, education, and number of children. To examine whether the SSS-health relationships differed by race, the models were also stratified by race. Results Community ladder ranking was positively associated with social support (β = 1.34, SE = 0.33, p < .001), and negatively associated with depressive symptoms (β = -1.34, SE = 0.52, p < .05). SES ladder ranking was positively associated with social support (β = 1.17, SE = 0.52, p < .05). Findings in the full sample were driven by more robust relationships between psychological distress and community SSS among Black/African-American mothers. Discussion The findings suggest that perceived social standing in one's community is associated with maternal psychological well-being. Community SSS may be particularly influential for Black/African-American mothers' well-being.