Parent-child bonding and family functioning in depressed children and children at high risk and low risk for future depression

Eye movement desensitization and processing for adolescents with major depressive disorder: study protocol for a multi-site randomized controlled trial

BACKGROUND

Major depressive disorder (MDD) is one of the most common mental disorders in adolescence carrying a serious risk of adverse development later in life. Extant treatments are limited in effectiveness and have high drop-out and relapse rates. A body of literature has been published on the association between distressing/ traumatic experiences and development and maintenance of MDD, but the effectiveness of a trauma-focused treatment approach for MDD has hardly been studied. This study aims to determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as stand-alone intervention in adolescents diagnosed with MDD.

METHODS

This study will be a randomized controlled trial with two conditions: (1) EMDR treatment (6 sessions) and (2) waiting list condition (WL: 6 weeks, followed by EMDR treatment). First, participants receive a baseline measure after which they will be randomized. Participants will be assessed post-intervention after which the WL participants will also receive six EMDR sessions. Follow-up assessments will be conducted at 3 and 6 months follow-up.

STUDY POPULATION

In total, 64 adolescents (aged 12-18) diagnosed with a major depressive disorder (DSM-5) and identified memories of at least one distressing or traumatic event related to the depressive symptomatology will be included. Main study parameters/endpoints: Primary outcome variables will be the percentage of patients meeting criteria for MDD classification, and level of depressive symptoms. Secondary outcome measures include symptoms of PTSD, anxiety, and general social-emotional problems. At baseline, family functioning and having experienced emotional abuse or neglect will be assessed to explore whether these factors predict post-treatment outcome.

DISCUSSION

With the present study, we aim to investigate whether EMDR as a trauma-focussed brief intervention may be effective for adolescents with a primary diagnosis of MDD. EMDR has been proven an effective treatment for traumatic memories in other disorders. It is hypothesized that traumatic memories play a role in the onset and maintenance of depressive disorders. Particularly in adolescence, early treatment of these traumatic memories is warranted to prevent a more chronic or recurrent course of the disorder.

TRIAL REGISTRATION

International Clinical Trial Registry Platform (ICTRP): NL9008 (30-10-2020).

Parental rejection in early adolescence predicts a persistent ADHD symptom trajectory across adolescence

Despite a general decrease of attention-deficit/hyperactivity disorder (ADHD) symptoms during adolescence, these may persist in some individuals but not in others. Prior cross-sectional studies have shown that parenting style and their interaction with candidate genes are associated with ADHD symptoms. However, there is a lack of longitudinal research examining the independent and interactive effects of parenting and plasticity genes in predicting the course of attention-deficit/hyperactivity disorder (ADHD) symptoms across adolescence. Here, we investigated how children perceived their parents' parenting style (i.e., rejection, overprotection, and emotional warmth) at the age of 11, and their interaction with DRD4, MAOA, and 5-HTTLPR genotypes on parent-reported ADHD symptoms at three time points (mean ages 11.1, 13.4, and 16.2 years) in 1730 adolescents from the TRacking Adolescents' Individual Lives Survey (TRAILS). Growth Mixture Modeling in Mplus identified four ADHD symptom trajectories: low, moderate stable, high decreasing, and high persistent. Perceived parental rejection predicted class membership in the high persistent trajectory compared to the other classes (p < 0.001, odds ratios between 2.14 and 3.74). Gene-environment interactions were not significantly related to class membership. Our results indicate a role of perceived parental rejection in the persistence of ADHD symptoms. Perceived parental rejection should, therefore, be taken into consideration during prevention and treatment of ADHD in young adolescents.

Factor structure and psychometric properties of Polish version of Parental Bonding Instrument (PBI) among adults and adolescents

Parental Bonding Instrument (PBI) by Parker et al., is a widely known and used tool in studies on the assessment of parenting behavior in adult, adolescent and child populations. This tool has had many translations and adaptations globally. In Poland, the factor structure and psychometric properties of PBI have not been studied so far. The aim of the presented research was to perform such an analysis both in the group of adults and adolescents. The data from four research projects, in which the 25-item version of the PBI translated into Polish was used, were analyzed. Data from 698 participants in total, including 473 adults and 225 adolescents were collected. Exploratory factor analyzes was performed for both mother and father version. A study of the reliability of individual factors, stability over time (test-retest) and an analysis of criterion validity were carried out. Both in the group of adults and adolescents, obtained a three-factor structure, acceptable reliability and stability over time. Moreover PBI correlated with another Polish tool in line with the adopted hypotheses, showing satisfactory criteria validity.

Parents' right strategy on preventing youngsters' recent suicidal ideation: a 13-year prospective cohort study

BACKGROUND

Suicide remains the second leading cause of death among youths. Family-related factors are considered important determinants of children's suicidal ideation, whereas their short-/long-term influence is seldom quantified.

AIMS

We aim to confirm the simultaneous/lagged effects of family-related factors on the occurrence of recent suicidal ideation from childhood to young adulthood (aged from 10 to 22 years old).

METHOD

Data were derived from a longitudinal prospective cohort study. Participants included 2065 students who were followed up for 13 years. Generalized estimating equations were used to clarify the influential effects of family-related factors on suicidal ideation during the past month.

RESULTS

The peak of the rate of recent suicidal ideation arrived during junior high school years. Family interaction, family support, family involvement, and parental punishment had simultaneous effects on recent suicidal ideation. Family involvement, parental conflict, and psychological control had lagged and lasting effects on suicidal ideation. Notably, the lasting protective effects of family involvement were more obvious than simultaneous effects.

CONCLUSIONS

Providing parents with sustained support and education to improve their "positive parenting literacy" can help with their children's mental health development. This is especially the case during COVID-19 quarantine periods when families spend the most time together at home.

Psychometric Properties of the Parental Bonding Instrument in a Sample of Canadian Children

The parental bonding instrument (PBI) is a self-report questionnaire that was initially designed to retrospectively assess perceived parenting style during childhood in adult respondents. Recent studies have used the PBI to assess current perception of parenting in children. However, few studies have evaluated the psychometric properties of the PBI in children. This study examined the factor structure and reliability of the PBI in a sample of Canadian children aged 7-18 years (n = 257). Confirmatory factor analyses (CFA) were conducted separately for the mother and father form of the PBI and composite reliability was used to determine internal consistency of the PBI. A four-factor model (care, overprotection, autonomy, indifference) showed the best fit to the data. The PBI exhibited good internal consistency but poor convergent validity. Configural invariance was not found for the PBI between two age groups (7-12 and 13-18 years), however these findings should be interpreted with caution due to the small sample size in each age group. This study suggests the PBI may be a valid and reliable self-report measure of parental bonding in children but further research is needed.

The relationship between parental involvement in childhood and depression in early adulthood

BACKGROUND

Positive early life experiences may help prevent depression later in life. We examined the accumulated benefit, timing, and trajectories of positive parental involvement in childhood in association with incident depression in early adulthood.

METHODS

Prospectively assessed Avon Longitudinal Study of Parents and Children (ALSPAC) data (n = 7120) were analyzed. Overall and developmental stage-specific parental involvement scores were estimated from multiple measures from birth to age 7 years. Trajectory groups of parental involvement were derived via latent class growth analysis. At 18 years, depression cases were identified with diagnostic instruments. Multiple imputation was used to handle missingness. We constructed logistic regression models with potential confounders adjusted.

RESULTS

Participants from trajectory groups with higher average parenting scores over time had 30% to 40% lower odds of developing depression in early adulthood than participants from the group with the lowest average parenting score over time. However, the relationship became non-significant when all covariates were adjusted. A one-unit increase in the overall parenting score corresponded to 12% lower odds of developing depression (adjusted OR=0.88 [0.79-0.98]). Protective effects on incident depression in early adulthood from parental involvement in school age (5-7 years), and not at other ages, were observed (OR=0.87 [0.77-0.99] for a one-unit increase in the parenting score at school age). However, the relationship became non-significant when all covariates were adjusted (OR=0.91 [0.80-1.03]).

LIMITATIONS

Measurements of parental involvement were only based on maternal report. The study has limited generalizability to other racial/ethnic groups.

CONCLUSION

Higher level of parental involvement during childhood lowers the risk of developing depression in early adulthood. These results suggest positive early life experiences may promote mental health across the life course.

The Impact of Peer and Family Functioning on Transgender and Gender-Diverse Children's Mental Health

Although high levels of internalizing and externalizing psychopathology have been documented among transgender and gender-diverse (TGD) youth, contextual factors influencing the development of psychopathology among TGD children are relatively understudied. The current study tested the interaction between two relational factors, children's caregiver-reported peer relations and family functioning, on TGD children's internalizing and externalizing symptoms. The sample consisted of 49 primary caregivers of TGD children, who were age 6-12 at baseline. A cross-sectional path analysis was run to test the relations between peer relations, family functioning, and their interaction on internalizing and externalizing symptoms. A longitudinal path analysis was run to test the relations between variables over time. In the cross-sectional model, among families with adequate family functioning, peer problems were associated with greater internalizing symptoms. Among families that were functioning poorly, there was not a significant relationship between peer problems and internalizing symptoms. Further, among children who did not experience peer problems, poorer family functioning was associated with greater internalizing symptoms. Peer problems, but not family functioning or the interaction term, was associated with externalizing symptoms. Longitudinal analyses did not support the hypothesis of an interaction between peer relations and family functioning. The current research indicated that poor peer relations and poor family functioning each confer risk for internalizing symptoms among TGD children, and poor peer relations carries risk for externalizing symptoms among TGD youth.

Good overall behavioural adjustment in children and adolescents with classic congenital adrenal hyperplasia

PURPOSE

Patients with classic congenital adrenal hyperplasia (CAH) are treated postnatally with life-long glucocorticoid (GC) replacement therapy. Although prolonged exposure to GCs may have a negative impact on behaviour, few studies have studied this issue. We therefore investigated behavioural outcomes in male and female children and adolescents with CAH.

METHODS

An observational study in which Swedish and Italian children and adolescents with CAH identified through neonatal screening for CAH (n = 57, age range 7-17 years) were compared with healthy population controls matched for age and sex (n = 72, age range 7-17 years). Thirteen (eight females) of the fifty-seven children and adolescents with CAH had been treated prenatally with dexamethasone (DEX). Standardised questionnaires for parents and self-report scales for children/adolescents were used to assess behavioural and emotional problems, social anxiety, temperament and scholastic competence.

RESULTS

There were no statistically significant differences between CAH patients (not prenatally treated with DEX) and controls on most of the scales measuring adaptive functioning or behavioural problems. However, children with CAH were rated by their parents to have more social problems than controls (Child Behaviour Checklist, CBCL social problems, p = 0.032). In the small group (n = 13) of prenatally DEX-treated cases parents rated their children/adolescents to have more mood problems compared with non-DEX-treated children/adolescents with CAH (CBCL-withdrawn/depressed, p = 0.019).

CONCLUSION

Children/adolescents with CAH showed good overall adjustment. The clinical significance of the parentally perceived increase in social problems in children/adolescents with CAH requires further investigation. The findings underline the importance of psychological support for children/adolescents with a chronic condition.

Maternal Bonding Predicts Actigraphy-Measured Sleep Parameters in Depressed and Nondepressed Adults

Associations between subjective maternal bonding recalled from the first 16 years of life and current sleep indices were investigated in a clinical sample of 34 adults with major depressive disorder and 36 normal controls (n = 70) using the self-report parental bonding instrument and wrist actigraphy. Results of multiple linear regression analyses indicated that reports of maternal bonding indices were associated with several sleep indices in adulthood independent of depression status. Higher levels of maternal care were associated with greater time in bed and total sleep time. Higher levels of maternal overprotection were associated with fewer awakenings. Findings indicate that reported maternal bonding characteristics in childhood are related to objectively measured sleep characteristics in adulthood, independent of mood state.

Family functioning in youth at-risk for serious mental illness

BACKGROUND

There is evidence that family functioning can be impaired in families of individuals with schizophrenia, first-episode psychosis, bipolar disorder, and recurrent depression, which are considered to be serious mental illnesses (SMI). Poor family functioning is one of the predictors of the course of SMI. However, it is unclear if poor family functioning is a result of illness, or conversely if poor family leads to higher risk of illness. Nonetheless, family functioning may be impaired even before the onset of illness, and little is known about earlier stages of risk and the importance of the family environment for youth at-risk for SMI.

OBJECTIVE

The present study aimed to examine differences in family functioning in a sample of youth at-risk of SMI across different clinical stages compared to healthy controls (HCs).

METHODS

Family functioning was evaluated with the Family Adaptability and Cohesion Evaluation Scales-IV (FACES-IV) for 41 non-help seeking youth with risk factors for SMI (Stage 0), 52 help-seeking youth with early mood and anxiety symptoms and distress (Stage 1a), 108 youth with an attenuated psychiatric syndrome (Stage 1b), and 42 HCs.

RESULTS

Results from multivariate linear regression analyses showed that participants in Stage 1a and Stage 1b significantly differ from participants in Stage 0 and HCs on most of the family functioning scales. However, these results were statistically but not clinically significant as the percentile values for each group fell within the same clinical ranges. The only clinical difference was that participants in stages 1a and 1b were somewhat less satisfied with their family compared to healthy controls and stage 0 participants.

CONCLUSIONS

An examination of group mean values demonstrated no difference in family functioning between the different groups with all groups in the healthy functioning range. However, family satisfaction is lower in youth at-risk for SMI who present with early signs of mood, anxiety or subthreshold psychotic symptoms than other participants. Early family psychoeducational interventions could be beneficial to improve family functioning.

Paradoxical associations between familial affective responsiveness, stress, and amygdala reactivity

Studies of early life extremes such as trauma, abuse, and neglect highlight the critical importance of quality caregiving in the development of brain circuits supporting emotional behavior and mental health. The impact of normative variability in caregiving on such biobehavioral processes, however, is poorly understood. Here, we provide initial evidence that even subtle variability in normative caregiving maps onto individual differences in threat-related brain function and, potentially, associated psychopathology in adolescence. Specifically, we report that greater familial affective responsiveness is associated with heightened amygdala reactivity to interpersonal threat, particularly in adolescents having experienced relatively low recent stress. These findings extend the literature on the effects of caregiving extremes on brain function to subtle, normative variability but suggest that presumably protective factors may be associated with increased risk-related amygdala reactivity. We consider these paradoxical associations with regard to studies of basic associative threat learning and further consider their relevance for understanding potential effects of caregiving on psychological development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Maternal depression symptoms and internalising problems in the offspring: the role of maternal and family factors

Maternal depression symptoms (MDS) are a robust risk factor for internalising problems (IP) in the offspring. However, the relative importance of MDS and other factors associated with it (i.e. other types of maternal psychopathology, maternal parenting practices, family characteristics) is not well understood. To (a) identify a group of children with high levels of IP between 6 and 12 years using combined maternal and teacher assessments and (b) to quantify the associations between trajectories of MDS during early childhood and children's IP trajectories before and after controlling for family factors associated with MDS. MDS and family factors were assessed in a population-based sample in Canada (n = 1537) between 5 months and 5 years. The outcome variable was membership in trajectories of teacher- and mother-rated IP between ages 6 and 12 years. Family factors were included as covariates in a multinomial logistic regression model. There was a strong association between MDS and children's atypically high levels of IP in unadjusted analyses [OR 4.14 (95% CI 2.60; 6.61)]. The association was reduced, but remained strong [2.60 (1.55; 4.36)] when maternal psychopathology, maternal parenting, and family socioeconomic status were entered in the model. MDS, maternal anxiety, and low parental self-efficacy were associated with offspring's high IP trajectories. MDS is associated with high levels of children's IP independently of other maternal and family characteristics. Intervention targeting maternal psychopathology and parenting self-efficacy and testing the impact on children's IP would provide information on the putative causal pathways between maternal and offspring's symptomatology.

Child symptoms, parent behaviors, and family strain in long-term survivors of childhood acute lymphoblastic leukemia

OBJECTIVE

How family environment and parental factors affect health status and symptoms in childhood cancer survivors is understudied. We examined the influence of family cohesion, parent distress, and overprotection on child symptom burden and health-related quality of life (HRQOL) and family strain in survivors of childhood acute lymphoblastic leukemia.

METHODS

Parents of 213 children treated with chemotherapy only completed a survey when survivors were at least 5-year postdiagnosis. Family Environment Scale, Brief Symptom Inventory-18, Parent Protection Scale, Pediatric Quality of Life Inventory, and Impact on Family were used to assess family cohesion, parental distress, overprotection, child symptom burden and HRQOL, and family strain, respectively. Path analysis was conducted to quantify effects of family cohesion on family strain through parental distress, overprotection, child symptoms, and HRQOL.

RESULTS

Lower family cohesion (β = 0.06, 95% CI, 0.01-0.13), higher parental distress (β = 0.35, 95% CI, 0.20-0.45), and overprotection (β = 0.17, 95% CI, 0.01-0.32) were associated with more child symptom burden. More symptom burden were associated with poorer child HRQOL (β = 0.66, 95% CI, 0.57-0.75), which in turn was associated with more family strain (β = 0.11, 95% CI, 0.01-0.22). Lower maternal education was associated with overprotection (β = -0.23, 95% CI, -0.33 to -0.12), more child symptoms (β = -0.30, 95% CI, -0.41 to -0.16), poorer child HRQOL (β = -0.36, 95% CI, -0.46 to -0.21), and more family strain (β = -0.15, 95% CI, -0.23 to -0.08).

CONCLUSIONS

Family and parental factors contributed to health outcomes of childhood acute lymphoblastic leukemia survivors. Interventions to enhance family cohesion, decrease parental distress and overprotection, and ameliorate child symptoms may improve family functioning.

Behavioral Problems Reported by Adolescents and Parents from HIV Affected Families in China

This study examined the influence of various factors on the behavioral problems of adolescents affected by HIV while considering the agreement between adolescent and parent reports on problem behaviors. A total of 136 families each with one parent living with HIV (PLH) and one child aged 13-18 were included. Structural equation modeling was used to explore relationships between selected family measures and adolescent's problem behaviors. The correlation between the PLH and adolescent-reported behavioral problem measures was low (β = 0.11). PLH-reported adolescent problem behaviors were negatively related to PLH-reported parental bonding (β = -0.39), family routines (β = -0.26), and positively associated with family conflict (β = 0.21). Adolescent-reported family participation was associated with self-reported problem behaviors (β = -0.35). Our study reported discrete perceptions of adolescent problem behaviors from parents' and adolescents' points of view. Future intervention efforts should emphasize family contextual factors to improve behavioral outcomes in adolescents affected by HIV.

Family functioning as perceived by parents and young offspring at high and low risk for depression

BACKGROUND

Family dysfunction has been proposed as one of the environmental mechanisms whereby risk of depression is transmitted from mothers to their children. Using our sample of offspring at high and low familial risk for depression, we hypothesized that: a) high-risk offspring (n = 79) and their mothers will report more extensive family dysfunction than low-risk offspring (n = 82) and their mothers, b) family dysfunction will predict the extent of offspring's depressive symptoms, and c) family dysfunction will mediate the impact of mother's depression on offspring's depressive symptoms.

METHODS

The study enrolled 161 offspring of parents who, in a previous study, were ascertained to have either childhood onset mood disorder or no history of a major psychiatric disorder. Parents completed questionnaires and a clinical interview about themselves, their offspring, and the family, while offspring also completed questionnaires about themselves and the family.

RESULTS

We found support for all three hypotheses. The significant indirect effect between maternal depression and offspring depressive symptoms was driven primarily by offspring's, but not mothers', reports of family dysfunction.

LIMITATIONS

Although our assessment of mother's early history of depression was done in a previous study, it is important to note that our results do not inform about causality because of the present study's cross-sectional nature.

CONCLUSIONS

The results highlight the importance of detecting and treating family dysfunction, particularly via offspring report, as one way to lower the risk of depression transmission from mothers to their children.

Parenting style and mental disorders in a nationally representative sample of US adolescents

PURPOSE

We examined associations between parenting style and past-year mental disorders in a nationally representative cross-sectional survey of US adolescents and whether the associations differed by adolescent demographic characteristics.

METHODS

The sample included 6483 adolescents aged 13-18 years who were interviewed for a full range of DSM-IV mental disorders. Parenting style was assessed by adolescent-reported maternal and paternal care and control using items from the Parental Bonding Instrument. We controlled for socio-demographics, parental history of mental disorders, stressful life events, sexual violence, inter-parental conflict, and household composition. We also tested for two-way interactions between parental care and control and adolescent age, sex, and race/ethnicity.

RESULTS

In adjusted models, high maternal care was associated with lower odds of depressive, eating, and behavioral disorders, and high maternal control was associated with greater odds of depressive, anxiety, eating, and behavioral disorders. High paternal care was associated with lower odds of social phobia and alcohol abuse/dependence. High paternal control was associated with greater odds of agoraphobia and alcohol abuse/dependence but with lower odds of attention-deficit/hyperactivity disorder. Associations of maternal and paternal control with anxiety disorders and substance abuse/dependence differed by sex. High paternal care was associated with lower odds of anxiety disorders only among Hispanics and non-Hispanic blacks.

CONCLUSIONS

Perceived parental care and control were associated with adolescent mental disorders after controlling for multiple potential confounders. Differential patterns of association were found according to adolescent sex and race/ethnicity. Findings have implications for prevention and intervention programs that incorporate familial contextual factors.

Parenting and Adolescents' Depressive Symptoms: The Mediating Role of Future Time Perspective

This study investigated the relations between maternal and paternal rearing practices and adolescents' depressive symptoms, and whether time perspective in adolescence explains these links. The sample included 306 students (158 girls), aged between 10.83 and 14.42 years. Adolescents completed questionnaires assessing their perceptions of maternal and paternal acceptance and psychological control, and of their future time perspective and depressive symptoms. Adolescents who rated their mothers as more accepting and those who rated their fathers as less psychologically controlling also reported lower levels of depressive symptoms and greater future time perspective. Further, adolescents who had greater future time perspective reported lower levels of depressive symptoms. Finally, time perspective partially mediated the relations of maternal and paternal acceptance, and paternal control with depressive symptoms in adolescence. The findings highlight the unique relations of maternal acceptance and paternal psychological control with adolescents' depressive symptoms, and that future time perspective is one mechanism that might explain why parenting strategies are linked with depressive symptoms in adolescence.

Perceived Bonding by Parents Living with HIV and Their Adolescent Children

This study examined the associations between parent and adolescent reports of bonding within families and the relationships among reported parental bonding, family conflict and adolescent stress. A total of 118 families from Anhui, China, were recruited for this study. Two family-level bonding scores were constructed: the average of and difference between parent and adolescent bonding scores. Study results indicated that the difference between parent and adolescent bonding reports was associated with higher levels of adolescent daily stress. A negative association was observed between average family-level bonding and the level of parent-reported conflict. Our findings highlight the importance of combining data from both parents and adolescents when studying issues related to family wellbeing.

Innovations in Practice: a pilot study of interpersonal psychotherapy for depressed adolescents and their parents

BACKGROUND

Problems in adolescents' relationships with their parents are a significant risk factor for the development and maintenance of depression. The purpose of this pilot study was to examine the feasibility and acceptability of an adaptation of interpersonal psychotherapy for depressed adolescents (IPT-A) who were also experiencing problems in their relationships with parents. The adaptation includes greater and more structured parent involvement in the treatment (IPT-AP).

METHOD

Fifteen adolescents (age 12-17) who were diagnosed with depression and were also experiencing conflictual or emotionally disengaged relationships with their parents (based on adolescent or parent report on the Conflict Behavior Questionnaire) participated in a 16 week randomized clinical trial of individually delivered IPT-A versus IPT-AP. Data regarding the feasibility and acceptability of IPT-AP were collected. Assessments of depression and family functioning were completed at baseline and weeks 4, 8, 12, and 16 by evaluators blind to treatment condition.

RESULTS

IPT-AP was feasible to implement, and adolescents and parents reported high treatment satisfaction. Adolescents demonstrated significant improvements in depressive symptoms, general functioning, and family functioning. IPT-AP was more efficacious than individual IPT-A in improving adolescents' perceptions of father-adolescent relations and mothers' perceptions of mother-adolescent relations.

CONCLUSIONS

Interpersonal psychotherapy for depressed adolescents and their parents was feasible to implement and acceptable to families, indicating that a full-scale randomized controlled trial to evaluate its efficacy is warranted.

The Effect of Social Support and Acculturation on Postpartum Depression in Mexican American Women

Postpartum depression was studied in 66 multiparous Mexican American women using a prospective longitudinal design. Interviews were conducted at 34 to 36 weeks prenatally and 4 to 6 weeks postpartum. Women expressing prenatal depression were more likely to continue to experience depression postpartum. Other predictors included a high need for postpartum support, specific support network characteristics, acculturation, and poor quality relationships within the family. It is important for the health care provider to assess the presence of depressive symptoms and available social support during the prenatal period and work with Mexican American mothers to increase support and secure help in dealing with daily life stressors.

Parental Serotonin Transporter Polymorphism (5-HTTLPR) Moderates Associations of Stress and Child Behavior With Parenting Behavior

The serotonin transporter-linked polymorphic region (5-HTTLPR) is associated with caregiving in nonhuman animals and with affective and cognitive correlates of human parenting, yet its association with human parenting is largely unknown. Using a well-characterized sample of parents and offspring, we evaluated the association of parental 5-HTTLPR with observed positive and negative parenting behavior, as well as its biologically plausible moderation of child-related stress and disruptive child behavior as predictors of parenting. One hundred and sixty-two parents (86% mothers) and their 6- to 9-year-old children with and without attention-deficit/hyperactivity disorder were ascertained using multiple methods including structured interviews, rating scales, and observed parent-child interaction, yielding strong measures of key constructs. Controlling for multiple youth-level (e.g., sex, 5-HTTLPR genotype, disruptive behavior) and parent-level (e.g., demographics, depression, attention-deficit/hyperactivity disorder) factors, parents with an S allele exhibited significantly less observed positive parenting than those with the LL genotype. Significant Gene × Environment interactions were also observed: Child-related stress was negatively associated with observed parental negativity among SS/SL genotype parents but not LL genotype parents; next, observed disruptive child behavior was positively associated with parental negativity for both genotypes, but the effect was strongest in SS/SL parents. These preliminary findings suggest that parental 5-HTTLPR is uniquely associated with positive and negative parenting behavior, with more specific patterns according to child-related stress and disruptive child behavior. We consider implications for future research evaluating genetic influences on parenting as well as considerations for designing and delivering parenting-based interventions.

Family functioning in adolescents with major depressive disorder: A comparative study

The goal of this study was to evaluate family functioning in two groups of adolescents: adolescents with major depressive disorder (cases) and adolescents with no psychiatric disorders (controls). A total of 18 adolescents (13-18 years) and their first-degree relatives (N = 70) were evaluated. Cases and controls were matched for the adolescent's age, gender, level of education, number and age of siblings, parental marital status, and economic condition. A family therapist conducted the Structured Family Interview with each family to evaluate nine family functioning dimensions (communication, rules, roles, leadership, conflict, aggressiveness, affect, individuation, and integration). The interview transcripts were independently rated by two different family therapists blinded to case-control status, i.e., without knowing whether they were evaluating cases or controls. The raters scored all interview items using a standardized coding system (overall agreement = 83.5%), and when compared to the controls, the cases showed lower mean scores in seven dimensions, particularly affect (p = 0.0078). There was no difference between cases and controls regarding the dimensions rules and leadership. Difficulty in expressing affect in parent-child relationship was the main disturbance in the families of depressive adolescents evaluated.

Perceived family functioning, adolescent psychopathology and quality of life in the general population: a 6-month follow-up study

PURPOSE

The aim of the study was to investigate whether perceived family functioning of adolescent is moderating or mediating the longitudinal association of adolescent internalizing and externalizing psychopathology with quality of life (QoL) after 6 months in the general population.

METHODS

Using a cluster sampling technique in one Norwegian county 1331, 10- to 16-year-old students were included in the study (51 % girls). Parents completed the Child Behavior Checklist for the assessment of adolescent psychopathology at Time 1. The students completed the General Functioning Scale of the McMaster Family Assessment Device and the Inventory of Life Quality in Children and Adolescents at time 2 6 months later. Psychopathology, family functioning and QoL were treated as latent variables in a structural equation model adjusted for sex, age and parent education.

RESULTS

The regression coefficients for paths from psychopathology decreased (β = .199 for the internalizing and β = .102 for the externalizing model) in each case when including the indirect path via family functioning compared with the direct path from psychopathology to QoL. The sum of indirect effects on QoL via family functioning was significant for internalizing β = 0.093 (95 % CI 0.054-0.133) and externalizing β = 0.119 (95 % CI 0.076-0.162) psychopathology.

CONCLUSIONS

Family functioning significantly mediated the longitudinal association between psychopathology and QoL. Because the family remains an important social domain for adolescents, it must be an important consideration when attempting to reduce or alleviate psychopathology in youth and improve the quality of their life experience throughout this period.

Assessing the feasibility of providing a parenting intervention for war-affected families in northern Uganda

This article reports the results of a feasibility study of an intervention, Enhancing Family Connection (EFC), conducted in Northern Uganda in 2012. Enhancing Family Connection's sessions were an adaption of the Parent Management Training, Oregon model. Three interrelated areas of feasibility were assessed: (a) acceptability, (b) usability, and (c) limited efficacy. This study utilized questionnaires and semi-structured interviews completed by mothers and a focal child pre- and post-intervention. Results indicated that mothers found the intervention acceptable to their families and culture and showed promise for Enhancing Family Connection's efficacy in changing parenting behaviors. This study supports continued development of this intervention.

Oxytocin promotes protective behavior in depressed mothers: a pilot study with the enthusiastic stranger paradigm

BACKGROUND

Successful parenting requires maternal behaviors that promote infant survival such as protection from predators. In animal studies, oxytocin (OT) has been linked to maternal aggression to protect offspring. No human study has explored this topic. Mothers with a diagnosis of postnatal depression (PND) are at higher risk of neglecting their infants. We hypothesized that intranasal OT administration would increase the protective behaviors of mothers with PND, toward their infants.

METHODS

Sixteen mothers with a diagnosis of PND participated in a double-blind, randomized-controlled, within-subject pilot study. Participants received intranasal OT during one visit and placebo spray on the alternate visit. Maternal protective behavior toward their infant was measured, in the presence of a socially intrusive stranger.

RESULTS

The enthusiastic stranger paradigm stimulated participants' protective responses in the presence of an intrusive stranger. Furthermore, this protective response of mothers with a diagnosis of PND was increased in the OT condition.

CONCLUSIONS

The study introduces a new paradigm, the enthusiastic stranger paradigm, which may be used to examine a neglected type of parental behavior, that is, protection of offspring. The protective response of mothers with PND increased, in line with the 'tend and defend' effects of OT in animal models. In future work it should be tested whether this protection effect can also be found in nonclinical samples, or whether it is specific for clinically depressed mothers.

Child perceptions of parental care and overprotection in children with cancer and healthy children

The primary aims of this study were to: (a) examine child perceptions of overprotection; and (b) explore how these perceptions relate to child health and adjustment. Children with a prior diagnosis of cancer (n = 205) and children without a history of serious illness (n = 76) reported on parental overprotective and caring behaviors. Children with cancer were recruited from one of four strata based on the elapsed time since their cancer diagnosis (1-6 months; 6-24 months; 2-5 years; >5 years) Children also reported on symptoms of depression, anxiety, and posttraumatic stress. Children with cancer did not differ from healthy children in their perceptions of parental care or overprotection. Child distress was more strongly related to perceptions of care and overprotection than child's health status. Children with cancer do not report their parents approach to care and protection differently than children without a cancer history. These findings mirror prior research examining parental perceptions of overprotection and suggest that, despite the challenges of parenting a child with serious illness, parental protection is not significantly altered.

Maternal Depression, Parenting, and Youth Depressive Symptoms: Mediation and Moderation in a Short-Term Longitudinal Study

Although multiple studies find that offspring of depressed mothers are at risk for depressive disorders, there is uncertainty about the specific mechanisms that are at work--particularly with respect to modifiable factors that might be targeted for early intervention. The present work examines that parenting behaviors may operate as mediators, moderators, or independent influences on the development of youth depressive symptoms. One hundred one mothers and their early adolescent children participated in positive and negative interaction tasks. Maternal and youth self-reports of youth depressive symptoms were collected at baseline, 9-month, and 18-month assessments. Maternal history of depression was significantly associated with maternal-reported, but not youth self-reported, depressive symptomatology. Maternal positive and negative interaction behaviors in positive contexts were associated with higher youth self-reported depressive symptoms. Maternal positive interaction behaviors in positive contexts and maternal negative interactive behaviors in conflict contexts were associated with higher youth self-reported depressive symptoms. We found no evidence for maternal interaction behaviors serving as a mediator and little evidence of maternal interaction behaviors serving as a moderator of the relationship between maternal and offspring depression. Low maternal positive engagement tended to be more consistently associated with maternal- and self-reported youth depressive symptoms. The present findings suggest that characteristics of mother-child interactions that are associated with youth depressive symptomatology are pertinent to youth with and without a mother with a history of depression.

Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans

The presence of posttraumatic stress disorder (PTSD) in male war veterans has been linked with family dysfunction and psychopathology in their children [1, 2]. This study aimed to evaluate self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans and determine the degree that parent-child bonding and family functioning contributed to adolescent behavior problems. Internalizing and externalizing behavior problems, parent-child bonding and family functioning were assessed in a sample of clinically referred Croatian PTSD veterans adolescent offspring (N = 122) and non-PTSD veteran adolescent offspring (N = 122) matched for age, sex, educational level, family income, parental employment status, ethnicity, and residential area. Youth Self-Report, Parental Bonding Instrument, Family Assessment Device were used. Adolescent offspring of PTSD veterans reported having significantly more internalizing and externalizing problems than non-PTSD veteran offspring, and also more difficulties in their family functioning, lower levels of maternal and paternal care, and more impaired mother-child and father-child bonding than control subjects. Internalizing symptoms were associated with family dysfunction, while externalizing symptoms were associated with paternal overcontrol/overprotection, and low maternal and paternal care. In conclusion, the increase in internalizing and externalizing symptoms as well as family and parental dysfunction among clinically referred adolescent offspring of PTSD veterans compared to their non-PTSD veteran counterparts indicates a need for early detection and interventions targeting both adolescent psychopathology and family relationships.

Parental bonds in children at high and low familial risk for panic disorder

A rejecting and overprotective parenting style is considered to be an important risk factor for the development of anxiety disorders. This study examined the role of perceived parental bonding as a potential environmental risk factor for panic disorder (PD) in unaffected offspring with parental PD. Children with a biological parent with PD (n = 71) and children of parents with no psychiatric history (n = 80) participated in the study. Results indicate that high risk children do not perceive their parents as being more protective and less caring than low risk controls. The optimal bonding type (high care, low protection) was the most frequently reported parenting style across groups. The constraining type of maternal bonding (high care, high protection) was less frequently reported by high risk children (p < 0.05). Overall, these data suggest that parental PD does not compromise the parent-child bonds in never-ill offspring.

Engaging fathers in child protection services: A review of factors and strategies across ecological systems

Current policy regarding child protection services places increasing demands for providers to engage fathers whose children are involved in the child protection process. This requisite brings to the fore the ongoing challenges that fathers have historically faced in working within these systems. Despite this need, there is little empirical evidence regarding the factors and strategies that impact the engagement of fathers in interventions relevant to child protection services. This comprehensive and systemic review synthesizes the available literature regarding factors and strategies that may foster paternal involvement in the child protection system and their services. We organize the literature concerning paternal engagement in child and family services around an ecological model that examines paternal engagement from individual, family, service provider, program, community, and policy levels. We consider factors and strategies along a continuum of engagement through intent to enroll, enrollment, and retention. This review advances theory by elucidating key factors that foster father engagement. The review also highlights the gaps in the literature and provides strategies for how researchers can address these areas. Future directions in the arenas of practice and policy are discussed.

Parental bonding in males with adjustment disorder and hyperventilation syndrome

BACKGROUND

The purpose of the study was to identify the style of parental bonding and the personality characteristics that might increase the risk of hyperventilation and adjustment disorder.

METHODS

A total of 917 males were recruited, 156 with adjustment disorder and hyperventilation syndrome (AD + HY), 273 with adjustment disorder without hyperventilation syndrome (AD-HY), and 488 healthy controls. All participants completed the Parental Bonding Instrument, Eysenck Personality Questionnaire, and Chinese Health Questionnaire.

RESULTS

Analysis using structural equation models identified a pathway relationship in which parental bonding affected personality characteristics, personality characteristics affected mental health condition, and mental health condition affected the development of hyperventilation or adjustment disorder. Males with AD-HY perceived less paternal care, and those with AD + HY perceived more maternal protection than those with adjustment disorder and those in the control group. Participants with AD-HY were more neurotic and less extroverted than those with AD + HY. Both groups showed poorer mental health than the controls.

CONCLUSIONS

Although some patients with hyperventilation syndrome demonstrated symptoms of adjustment disorder, there were different predisposing factors between the two groups in terms of parental bonding and personality characteristics. This finding is important for the early intervention and prevention of hyperventilation and adjustment disorder.

Can parental bonding be assessed in children? Factor structure and factorial invariance of the Parental Bonding Instrument (PBI) between adults and children

This study examined the factorial structure of the Parental Bonding Instrument (PBI) in the Greek population. Using confirmatory factor analysis different proposed models of the basic dimensions of PBI were evaluated. The results indicated that Kendler's three-factor (i.e. care, protectiveness and authoritarianism) solution was found to be more satisfactory than the other competing two-, three- and four-factor models. A second aim was the investigation of the factorial invariance of the PBI across different age groups (adults vs. children). The results revealed that PBI can be used in children samples (measurement invariance) but it seems that PBI latent variables may be perceived differently across different age groups (not structural invariance). The authors conclude that further research is needed in order to understand whether the differences are due to actual developmental changes in children's perceptions of the parent-child relationship or conceptual problems regarding the children's ability to conceive the PBI's theoretical constructs.

Enhancing the developmental appropriateness of treatment for depression in youth: integrating the family in treatment

Treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on family involvement in treatment. It then discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Finally, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt.

Affective functioning among early adolescents at high and low familial risk for depression and their mothers: a focus on individual and transactional processes across contexts

This study aimed to characterize affective functioning in families of youth at high familial risk for depression, with particular attention to features of affective functioning that appear to be critical to adaptive functioning but have been underrepresented in prior research including: positive and negative affect across multiple contexts, individual and transactional processes, and affective flexibility. Interactions among early adolescents (ages 9-14) and their mothers were coded for affective behaviors across both positive and negative contexts. Primary analyses compared never-depressed youth at high (n = 44) and low (n = 57) familial risk for depression. The high risk group showed a relatively consistent pattern for low positive affect across negative and positive contexts at both the individual and transactional level. In contrast to prior studies focusing on negative contexts that did not support disruptions in negative affect among high risk youth, the data from this study suggest variability by context (i.e. increased negativity in a positive, but not negative, context), and individual vs. transactional processes (e.g., negative escalation). Findings are discussed in concert with attention to affect flexibility, contextual and transactional factors.

Altered error-related brain activity in youth with major depression

Depression is associated with impairments in cognitive control including action monitoring processes, which involve the detection and processing of erroneous responses in order to adjust behavior. Although numerous studies have reported altered error-related brain activity in depressed adults, relatively little is known about age-related changes in error-related brain activity in depressed youth. This study focuses on the error-related negativity (ERN), a negative deflection in the event-related potential (ERP) that is maximal approximately 50ms following errors. High-density ERPs were examined following responses on a flanker task in 24 youth diagnosed with MDD and 14 low-risk healthy controls (HC). Results indicate that compared to HC, MDD youth had significantly smaller ERN amplitudes and did not exhibit the normative increases in ERN amplitudes as a function of age. Also, ERN amplitudes were similar in depressed youth with and without comorbid anxiety. These results suggest that depressed youth exhibit different age-related changes in brain activity associated with action monitoring processes. Findings are discussed in terms of existing work on the neural correlates of action monitoring and depression and the need for longitudinal research studies investigating the development of neural systems underlying action monitoring in youth diagnosed with and at risk for depression.

Parents living with HIV and children's stress and delinquent behaviors in China

OBJECTIVE: The current study aims to explore the association of parents living with HIV (PLHs) and their children's self-esteem, everyday stress, and delinquent behaviors. DESIGN: The study samples included 79 families with 79 PLHs and 79 children. METHODS: Multiple regression analysis was used on baseline data collected in 2009 from a pilot study in Anhui Province, China. RESULTS: The results indicated that children from a family with both parents infected with HIV or children from families having multiple children were more likely to report a higher level of everyday stress. Male PLHs have significant influence on their children's everyday stress compared with female PLHs. Children reporting a lower level of parental care and lower self-esteem were significantly more likely to report a higher level of delinquent behaviors. In addition, we have found a strong positive correlation between families with multiple children and their children's delinquent behaviors. CONCLUSIONS: The findings indicate that the severity of psychological and behavioral problems of children living in different HIV-affected families may be dependent not only on factors related to the children but also on factors related to their parents and families. Therefore, parental and family level factors should be considered when providing care and support to children living in HIV-affected families.

Expressed emotion in mothers of currently depressed, remitted, high-risk, and low-risk youth: links to child depression status and longitudinal course

This study examined expressed emotion in the families of children and adolescents who were (a) in a current episode of Major Depressive Disorder (MDD), (b) in remission from a past episode of MDD, (c) at high familial risk for developing MDD, and (d) low-risk controls. Participants were 109 mother-child dyads (children ages 8-19). Expressed emotion was assessed using the Five Minute Speech Sample, and psychiatric follow-ups were conducted annually. Mothers of children with a current or remitted episode of MDD and at high risk for MDD were more likely to be rated high on criticism than mothers of controls. There were no differences in critical expressed emotion among mothers of children in the current, remitted, or high-risk for depression groups. Higher initial critical expressed emotion was associated with a greater likelihood of having a future onset of a depressive episode in high-risk and depressed participants. Diagnostic groups did not differ in Emotional Overinvolvement.

Predicting Children's Depressive Symptoms from Community and Individual Risk Factors

Community, demographic, familial, and personal risk factors of childhood depressive symptoms were examined from an ecological theoretical approach using hierarchical linear modeling. Individual-level data were collected from an ethnically diverse (73% African-American) community sample of 197 children and their parents; community-level data were obtained from the U.S. Census regarding rates of community poverty and unemployment in participants' neighborhoods. Results indicated that high rates of community poverty and unemployment, children's depressive attributional style, and low levels of self-perceived competence predict children's depressive symptoms, even after accounting for demographic and familial risk factors, such as parental education and negative parenting behaviors. The effect of negative parenting behaviors on depressive symptoms was partially mediated by personal variables like children's self-perceived competence. Recommendations for future research, intervention and prevention programs are discussed.

Mother-child interactions in depressed children and children at high risk and low risk for future depression

OBJECTIVE

To compare mother-child interactions and parenting styles in families of children with major depressive disorder, youths at high risk for depression, and healthy controls.

METHOD

Currently depressed (n = 43), high-risk (n = 28), and healthy control (n = 41) youths and their mothers engaged in a standardized videotaped problem-solving interaction. Measures of affect and behavior for both mothers and children were obtained, in addition to global measures of parenting.

RESULTS

Depressed children demonstrated more negativity and less positivity in dyadic interactions than did children at high risk and control children. Mothers of depressed children were more disengaged than control mothers. Exploratory repeated-measures analyses in a subgroup of depressed children (n = 16) suggested mother-child interactions do not significantly change when children recover from depression. Children at high risk demonstrated less positivity in dyadic interactions than did controls. Mothers with a history of major depressive disorder and mothers with higher current depressive symptoms demonstrated patterns of disengagement and low control in interactions with children.

CONCLUSIONS

Mother-child interactions in depressed youths are marked by maternal disengagement and low child positivity that may not improve when children recover. The bidirectional effects of maternal disengagement and low levels of child positivity may precede onset of major depressive disorder in children and serve as risk factors for recurrent depression in youths.

Suicide ideation among later elementary school-aged youth

Suicide is extremely rare among persons under age 15 years old. Nationwide, it has been reported that 18% of students in grade 6 had thoughts of killing themselves. The Social Disintegration Model (SDM) summarizes intra-personal, interpersonal, peer network, physical and heath risk behaviour characteristics that may influence suicide ideation. As part of a larger study to test a family strengthening programme, 179 later elementary school children from two cities responded to 20 items about their participation in health risk behaviour. Sixteen youth indicated they had thought of killing themselves. Based on the SDM, these 16 youth were compared with the larger sample on measures of ways of coping; family communication, functioning and caring; school connectedness, pubertal development; and alcohol use and weapon carrying. Youth who responded positively to the 'thought of killing self' screening question, felt less connected to their school, used more internalizing behaviours and reported less cohesion, open communication, supervision and family caring than youth who answered no. Youth who thought of killing themselves may benefit from additional school support to feel more comfortable and connected at school. Community resources may help parents modify child-rearing behaviours. Building communication among parents and youth may prevent suicidal behaviour among young adolescents.

Change in adolescents' internalizing symptomatology as a function of sex and the timing of maternal depressive symptomatology

OBJECTIVE

The purpose of this exploratory study was to examine change in internalizing symptoms from late childhood (age 10) into mid-adolescence (age 15) in a nationally representative sample of Canadian children. The roles of a child's sex, maternal depressive symptoms in late childhood, and their interactions were investigated.

METHOD

The sample was derived from the National Longitudinal Survey of Children and Youth. Mothers reported on their own depressive symptoms and children reported on their own internalizing symptoms at three time (T) points (T1: 1994/1995; T2: 1996/1997; T3: 1998/1999). Change in children's internalizing symptoms was investigated using multiple regression.

RESULTS

Girls increased and boys decreased in their internalizing symptoms from T1 to T3. The effect of maternal depressive symptoms at T1 was moderated by sex and remained significant after controlling for maternal depressive symptoms at T2 and T3, with more adverse effects in girls.

CONCLUSIONS

The internalizing symptoms of girls increased from childhood to adolescence, whereas those for boys decreased. Female children exposed to maternal depressive symptoms T1 continued to show negative effects 4 years later.

Stability of the sense of coherence in adolescence

The aim of this prospective study was to explore the stability of sense of coherence (SOC) in adolescents from the age of 15 to 18 years.

METHODS

A prospective population-based follow-up study of 1294 first-born children was started in 1986. When the children were 15 (N = 846) and 18 (N = 792) years old, SOC was measured using questionnaires filled out at home.

RESULTS

The mean change in SOC scores (0.10, SD 10.2; in percentages 1.98%, SD 18.4) in the whole sample between the ages of 15 and 18 years was negligible and non-significant (p = .788). At the individual level, some changes were seen in the scores. The SOC scores of boys at the ages of 15 and 18 years were significantly higher than those of girls (mean 65.4 vs. 60.8 and 65.4 vs. 61.7, respectively). The SOC scores of adolescents living with both parents were higher than those with one parent or other guardian (mean 64.5 vs. 59.9), and the difference was significant in both age groups (p < .001).

CONCLUSION

Contrary to assumptions made in Antonovsky's theory, we found no significant change in SOC between the ages of 15 to 18 years, and coherence stability did not depend on the initial SOC. Some fluctuation in SOC scores was seen at the individual level. For planning of interventions, it is important to know that SOC seems to be reasonably stabilized before the age of 15 years.

Parental attachment, premorbid personality, and mental health in young males with hyperventilation syndrome

The aim of the study was to examine the predisposing and precipitating factors in the development of hyperventilation syndrome in males during military training in Taiwan. The participants included 110 young males who visited the emergency room of a teaching hospital in southern Taiwan because of an episode of acute hyperventilation during military training. Another 53 males, who had the same military training, and who did not experience hyperventilation or any psychiatric symptoms, were recruited as the control group. The risk of hyperventilation syndrome was increased by the following factors: greater neuroticism, less extraversion, parental overprotection, and less parental caring. A final parsimonious structural equation model showed a cause-effect relationship between the direct effects of maternal overprotection and introversion and the individual's neurotic characteristics, which contributed to the individual's current mental health status and the development of hyperventilation syndrome. Military training could be a precipitating factor in the development of hyperventilation syndrome in young males. The elucidation of these factors may contribute to the understanding and treatment of hyperventilation syndrome. The determination of competing risk factors and mediating effects in males with hyperventilation syndrome should be considered in future studies.

Inventário de percepção de suporte familiar (IPSF): estudo componencial em duas configurações

O objetivo deste estudo foi o de comparar os componentes do inventário de percepção de suporte familiar (IPSF) em duas configurações de participantes, por intermédio de análise fatorial. A amostragem da segunda configuração foi constituída por mil e sessenta e quatro estudantes do ensino médio e universitário, com idades que variavam entre dezessete e sessenta e quatro anos, de ambos os sexos, de instituições particulares e públicas do Estado de São Paulo. Foi utilizada a análise de componentes principais, com rotação oblimim nessa configuração. A análise fatorial extraiu a presença de três fatores, intitulados afetivo-consistente, adaptação e autonomia, o que expressou uma variância total de 41,433% do construto. O IPSF demonstrou ser um inventário com dimensões bem definidas, sendo que todos os itens possuíram cargas fatoriais acima de 0,30. O fator afetivo-consistente demonstrou precisão de 0,91, expresso pelo alfa de Cronbach, seguido pelo fator inadaptação, com alfa de 0,90, e, por último, o fator autonomia expressou um alfa de 0,78, além do alfa da escala total ser de 0,93. As cargas fatoriais dos itens foram sempre superiores a 0,30.O IPSF também expressa as dimensões encontradas em diversos instrumentos e teorias internacionais sobre o construto suporte familiar. As comparações das configurações são discutidas. Outras evidências de validade, bem como a padronização do IPSF, se fazem necessárias, a fim de se obter outros dados psicométricos do inventário, já que o processo de validação de qualquer instrumento se comprova de forma dinâmica e constante.

Comparison of children's self-reports of depressive symptoms among different family interaction types in northern Taiwan

BACKGROUND

Previous research has shown that family interactions are associated with depressive symptoms in children. However, detailed classifications of family interaction types have not been studied thoroughly. This study aims to understand the types of family interactions children experience and to identify the specific types of family interactions that are associated with a higher risk of depressive symptoms in children.

METHODS

Data used in the study was collected as part of the Child and Adolescent Behavior in Long term Evolution (CABLE) project in 2003. CABLE is a longitudinal cohort study that commenced in 2001 and collects data annually from children in Taipei city and Hsinchu county in northern Taiwan. The data analyzed in this study was that obtained from the sixth graders (aged 11 to 12 years old) in 2003. Of the 2,449 sixth graders, 51.2% were boys and 48.8% were girls. Factor analysis and cluster analysis were used to investigate the types of family interactions. One way ANOVA was used to establish the relationship between family interaction types and children's self-reports of depressive symptoms.

RESULTS

Based on the results of factor analysis, the latent factors for family interactions included supporting activities, psychological control, parental discipline, behavioral supervision, and family conflict. After conducting cluster analysis using factor scores, four types of family interactions were revealed: supervised (29.66%), disciplined (13.56%), nurtured (40.96%) and conflict (15.82%). Children from the disciplined or conflict families were more likely to report depressive symptoms. Children from the nurtured families were least likely to report depressive symptoms.

CONCLUSION

Family interactions can be classified into four different types, which are related to children's self-reports of depressive symptoms. The creation of a family interaction environment that is beneficial for children's mental health is an important issue for health education and health promotion professionals.