Children of treated substance-abusing mothers: a 10-year prospective study

Mental health and use of health care services in opioid-exposed school-aged children compared to foster children

Given the concerns raised regarding the effects of prenatal exposure to methadone and buprenorphine on the developmental outcomes of the children, this study assessed mental health and use of services in a national sample of school-aged children (N = 78) born to women enrolled in opioid maintenance treatment during pregnancy, compared with a group of foster children (N = 140). The majority of the opioid-exposed children lived with their birth parent(s) at the time of assessment (N = 62), while 16 lived in foster homes. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and the Reactive Attachment Disorder scale. Teachers completed the SDQ. Three kinds of services were included in measuring service use: school-based education services, child mental health services, and hospital-based habilitation services. The main finding of the study is that children prenatally exposed to methadone or buprenorphine living with their family of origin had significantly better mental health status than their foster-placed counterparts and that of the comparison group of foster children. In addition, the exposed children living at home had less child welfare involvement, and only half of them were using any of the three services measured. The odds for using services increased significantly in accordance with increasing mental health problems, independent of group affiliation, indicating a need-based access to services. In line with other studies, we found that the odds for using one or more services was 2.3 times greater for boys than for girls. Our results contribute to a more-nuanced understanding of the developmental outcomes of prenatal exposure to methadone and buprenorphine, and factors associated with increased service use in groups of at-risk children.

Mothering in the Context of Mental Disorder: Effect of Caregiving Load on Maternal Health in a Predominantly Hispanic Sample

BACKGROUND

Mothering in the context of mental disorders presents with multiple challenges. However, this phenomenon is poorly understood: It is not known how child caregiving affects the health of their mothers.

AIMS

The purpose of this study was to examine associations between child caregiving load and health indicators in mothers receiving outpatient behavioral health services for mental or substance use disorders.

METHOD

A total of 172 mothers (80% Hispanic/Latina) completed surveys on their mental and physical health, and children's behaviors and medical problems. Child caregiving load consisted of number of children living with the mother, and presence of children's internalizing, externalizing, or medical problems.

RESULTS

Child caregiving load had significantly positive associations with mother's psychological distress, fatigue, pain, and body mass index. Child internalizing and medical problems were associated with mothers' poor health status.

CONCLUSIONS

Hispanics/Latinos experience health disparities, and Hispanic/Latina mothers who are already at risk due to their mental disorders experience an additional health burden associated with caring for children with emotional or health problems. Psychiatric and mental health nurse practitioners should assess child caregiving impact on mothers with mental disorders and seek to mitigate their caregiving burden and maintain their health. Further research is needed to clarify child characteristics and the mechanisms associated with maternal caregiver burden, suboptimal self-care, and adverse health outcomes. Structural Ecosystems Therapy for women in Recovery (SET-R) study/Healthy Home; Clinical Trial ID NCT02702193.

Health Correlates of Abuse History and Moderating Effect of Parenting Stress for Mothers with Mental Disorders

Parenting stress is common and may lead to worsening health, particularly in the context of other risk factors such as mental disorders or a history of abuse. This study investigated how parenting-related stress impacts the effect of abuse experiences on health among mothers with mental health disorders. Survey data was analyzed from 172 predominantly Hispanic mothers receiving outpatient behavioral health services. Most (80.2%) mothers had experienced abuse. Those reporting childhood abuse had 3.82 greater odds of experiencing abuse in adulthood. Findings demonstrated worse health outcomes among those experiencing abuse in both childhood and adulthood and those with a greater number of abuse experiences. Caregiving load intensified the relationship between abuse and anxiety and sleep disturbance. Parenting self-agency intensified the relationship between abuse and cigarette use. These findings have important implications for mental health nursing practice by identifying parenting-stress as an important target for interventions to improve health among women with histories of abuse and mental health disorders.

PROTOCOL: Psychosocial, pharmacological and legal interventions for improving the psychosocial outcomes of children with substance misusing parents

This review aims to first enhance and update existing reviews by comprehensively synthesising the full array of psychosocial, pharmacological and legal interventions that aim to improve the psychosocial outcomes of children with substance misusing parents. Second, the review aims to use network meta-analysis to integrate and examine the comparative impact of these interventions. Specifically, the review will address the following research questions: (1) What is the comparative impact of psychosocial, pharmacological, and legal interventions for improving the psychosocial outcomes of children with substance misusing parents? (2) Does the impact of interventions vary according to the child developmental period (e.g., infancy, early childhood, adolescence) or the type of (a) outcome measure; (b) substance misuse; (c) practitioner implementing the intervention; or (d) intervention setting? (3) Does the impact of interventions vary by the country of implementation?

Parenting With a Substance Abuse History: The Moderating Role of Parenting Behaviors on Obesity and Internalizing Symptoms in Adolescence

Although numerous studies have shown that child obesity is associated with internalizing symptoms, relatively few studies have examined the role of parenting behaviors on this relationship. Youth meeting obesity status may be at higher risk of psychosocial maladjustment when exposed to more vulnerable parenting contexts. The current study interviewed mothers with a history of substance abuse to assess whether parenting behaviors moderated the relationship between obesity and internalizing symptoms among adolescents (N = 160; 51% girls; M = 12.76 years). Hierarchical regression analyses identified physical discipline as a moderator; girls meeting obesity status displayed higher levels of internalizing symptoms when exposed to higher versus lower levels of physical discipline. Prevention/intervention efforts targeting mothers with substance abuse histories should aim to not only improve physical and emotional health but also highlight the connections between physical and emotional health and the influence of parenting behaviors on associations.

Psychosocial problems of children whose parents visit the emergency department due to intimate partner violence, substance abuse or a suicide attempt

BACKGROUND

High levels of maltreatment are found in children who are identified because their parents visit the emergency department due to partner violence, substance abuse or suicide attempt. However, it is unknown if these children experience psychosocial problems. This study aims to assess their levels of post-traumatic stress, anxiety, depression, behavioural problems and health-related quality of life.

METHODS

A cross-sectional study was conducted in six hospitals. All consecutive families of which a parent visited the emergency department due to partner violence, substance abuse or suicide attempt between 1 July 2012 and 1 March 2014 with children aged 1.5-17 years were approached for participation. Parents and children aged 8 years and older filled out questionnaires measuring post-traumatic stress [13-item version of Children's Revised Impact of Event Scale (CRIES-13)], anxiety, depression (Revised Child Anxiety and Depression Scale), behavioural problems [Child Behavior Checklist (CBCL) and Youth Self-Report (YSR)] and health-related quality of life (PedsQL). Scores of participants were compared with reference data obtained in children in similar age ranges from representative Dutch community samples (CRIES-13, Revised Child Anxiety and Depression Scale, PedsQL and CBCL) and to a normed cutoff score (CRIES-13).

RESULTS

Of 195 eligible families, 89 (46%) participated in the study. Participating children did not score different from community children, both on child-reported and parent-reported instruments. Standardized mean differences of total sum scores were 0 (CRIES-13 and CBCL 1.5-5), 0.1 (YSR), 0.2 (CBCL 6-18) and -0.3 (PedsQL) and not statistically different from community children. Thirty-five percent of the participating children scored above the cutoff score on the CRIES-13, indicating post-traumatic stress disorder, but this difference was not statistically significant from community children (mean difference 8%; 95% CI -4-22%).

CONCLUSIONS

We found no differences in psychosocial problems between children whose parents visited the emergency department due to partner violence, substance abuse or suicide attempt and children from community samples. Because 35% of the children scored in the range of post-traumatic stress disorder, we advise healthcare providers to pay attention to post-traumatic stress symptoms.

Review of Teenlink: A health service for children and adolescents of parents with substance use

AIM

To evaluate Teenlink, a wide-ranging medical and psychological health service addressing the needs of children and adolescents in substance-using families, who are at increased risk of developmental and psychosocial problems.

METHODS

Retrospective record review of 124 children, from 92 families seen over a 13 year period.

RESULTS

Polysubstance use and mental illness were common amongst parents. Children often presented with emotional and behavioural problems. Teenlink provided parenting skills, individual and family work, medical care, case management, advocacy, collaboration and education with adult drug and alcohol services.

CONCLUSIONS

The chronic and complex nature of parental addiction, need for ongoing support and tailored service utilisation, reflected the length of engagement.

Mothers in Substance Abuse Recovery: Perspectives on Motivators, Challenges and Family Involvement

Background

Most women in substance abuse treatment are of childbearing age, and many of them have children who both are affected by and influence the mother's substance abuse and treatment behaviors.

Objectives

This qualitative study (n = 13) was conducted in two drug treatment centers in southern Florida and explored the perspectives of mothers currently or recently in substance abuse treatment regarding their recovery motivators and challenges, as well as their attitudes and preferences regarding family involvement in their treatment.

Patients and Methods

We used a qualitative descriptive approach. In-depth interviews were conducted with the participants and centered on 3 major themes: (a) motivators for recovery, (b) challenges for recovery, and (c) attitudes and preferences for family involvement in recovery.

Results

Findings revealed that family plays an important role in the recovery of these mothers, and that mothers are willing to incorporate their families in their recovery process. Women expressed a positive attitude towards family therapy, and they believed that it could benefit their recovery, and their relationship with their children and families.

Conclusions

The findings of this study can contribute to the development of a family-based substance abuse treatment aftercare intervention that might benefit women in substance abuse treatment.

Maternal mental health and children's internalizing and externalizing behaviors: Beyond maternal substance use disorders

Maternal substance abuse and mental disorders can have adverse impacts on child development. We investigated the impact of maternal mental health on child behaviors based on a long-term follow-up study of mothers and their children approximately 10 years after mothers' admission to drug abuse treatment. Mothers (n=396) were assessed at admission to drug treatment during 2000 to 2002, and at follow-up in 2010-2011. At follow-up, each mother was asked to assess one target child using the Child Behavior Checklist for ages 6-18 (CBCL). Mothers' mental disorder diagnoses were obtained from records maintained by the California Department of Mental Health in 2009. About 46% of mothers had comorbid mental disorders; 27% had depressive disorder, 15% bipolar disorder, 15% adjustment disorder, 13% anxiety disorder, and 6% psychotic disorder. Of these mothers, more than half had two or more mental disorder diagnoses. The average age of the target child was approximately 10 years old (range 6 to 17). Relative to children of mothers without comorbid mental disorders, children were more likely to demonstrate internalizing behaviors if their mothers had comorbid depression/anxiety disorders (OR=2.0, 95%CI:1.0-4.0) or severe mental disorders (psychoses, bipolar) (OR=3.4, 95%CI:1.5-7.6). For externalizing behaviors, family problems was the only significant predictor (OR=3.2, 95%CI:1.7-6.0 for children of mothers with depression/anxiety disorders, OR=3.9, 95%CI:1.9-7.8 for severe mental disorders). Addressing maternal mental disorders (particularly severe mental disorders) and family problems are important for child well-being as these factors were significantly related to emotional and problem behaviors of children.

Pregnancy and fetal loss reported by methamphetamine-using women

To better understand substance use disorder treatment needs of pregnant and parenting women who use methamphetamine (MA), this paper describes pregnancy histories and fetal losses for women who were treated for MA use (N = 153) with reference to a national sample, and describes their drug use, sexual risk behaviors, and mental health status. MA users reported an average of 4.6 total pregnancies and 2.1 fetal losses, whereas women in a general population survey reported 3.2 and 1.2, respectively. Higher numbers of pregnancies and fetal losses were correlated with specific substance abuse and mental health problems including early sexual abuse and cognitive problems. The combination of MA users' especially high numbers of pregnancies, fetal losses, and rates of risk behaviors suggest high social and health care costs for this population. Prenatal care may provide a vector through which women can be connected to risk reduction interventions and gender-responsive treatment services addressing substance use and mental health needs.