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Strøyer de Voss S, Wilson PMJ, Kirk Ertmann R, Overbeck G. Increased family psychosocial focus during children's developmental assessments: a study of parents' views. BMC Pediatr 2024; 24:335. [PMID: 38750557 PMCID: PMC11094963 DOI: 10.1186/s12887-024-04800-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Family psychosocial challenges during the early years of a child's life are associated with later mental and physical health problems for the child. An increased psychosocial focus on parents in routine child developmental assessments may therefore be justified. METHODS Participants in this qualitative study included 11 mothers and one parental couple (mother and father) with children aged 9-23 months. Participants were recruited to Project Family Wellbeing through their general practice in Denmark. Twelve interviews were conducted, transcribed and analysed with a deductive approach. The topic guide drew on the core components of the Health Belief Model, which also served as a framework for the coding that was conducted using thematic analysis. RESULTS Results are presented in four themes and 11 subthemes in total. Parents welcome discussion of their psychosocial circumstances during their child's developmental assessments. Clinicians' initiatives to address psychosocial challenges and alignment of parents' and clinicians' expectations may be required to allow this discussion. A flowing conversation, an open communication style and a trustful relationship facilitate psychosocial discussion. Barriers included short consultation time, concerns about how information was used and when parents found specific psychosocial aspects stigmatising or irrelevant to discuss. CONCLUSION Enquiry about the family's psychosocial circumstances in routine developmental assessments is acceptable among parents. Alignment of clinical and parental expectations of developmental assessments could facilitate the process. Future research should examine the predictive validity of the various components of developmental assessments. TRIAL REGISTRATION This is a qualitative study. The study participants are part of the cohort from Project Family Wellbeing (FamilieTrivsel). The project's trial registry number: NCT04129359. Registered October 16th 2019.
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Affiliation(s)
- Sarah Strøyer de Voss
- Centre for General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, bg. 24, opg. Q, København K, 1353, Denmark.
| | - Philip Michael John Wilson
- Centre for General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, bg. 24, opg. Q, København K, 1353, Denmark
| | - Ruth Kirk Ertmann
- Centre for General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, bg. 24, opg. Q, København K, 1353, Denmark
| | - Gritt Overbeck
- Centre for General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, bg. 24, opg. Q, København K, 1353, Denmark
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de Voss S, Wilson P, Saxild S, Overbeck G. Increasing the psychosocial focus in child developmental assessments: a qualitative study. BMC Pediatr 2023; 23:44. [PMID: 36698093 PMCID: PMC9875422 DOI: 10.1186/s12887-023-03849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Previous studies have indicated a need for increased psychosocial focus on children and their families to improve children's wellbeing and mental health. Child developmental assessments could be a place to implement changes to achieve this. A standardised record might be helpful to clinicians trying to increase psychosocial focus. The aim of this study is to investigate clinical barriers and facilitators when introducing standardised child records with increased focus on psychosocial wellbeing and mental health into child developmental assessments. METHODS This is a qualitative study based on 12 semi-structured interviews with four midwives and nine doctors who carry out child developmental assessments in general practice. Data is analysed in the framework of Normalisation Process Theory. RESULTS General practice-based clinicians were positive towards increasing the psychosocial focus in child developmental assessments. The main barriers when clinicians used the standardised child records were: feeling forced to ask certain questions, in turn making the conversation rigid; leaving less room for parents to bring up other issues; making clinicians feel awkward when addressing problems that they cannot solve; the need for extended consultation time; and medico-legal concerns when registering findings. The experience of positive aspects when using the standardised child records facilitated continuous use of the records. Positive aspects included having a standardised approach to recording important findings, thereby uncovering psychosocial problems that could potentially be overlooked. Additionally, structured observation of parent-child interaction and gaining a new vocabulary to describe the findings were valued by clinicians. Balancing a standardised approach with clinicians' ability to steer the consultation and explore topics in depth while preserving the potential for patients to bring up other issues became an important theme. CONCLUSION Clinicians need to be well-equipped to handle psychosocial problems through coping strategies, referral options and communication techniques in the psychosocial domain. The parent-child-interaction assessment might expose potentially dysfunctional parenting behaviours and could improve communication between health professionals. Implementing standardised child development records with an increased psychosocial focus is feasible but improvements could optimise the use of the records. Parental views on an increased psychosocial focus during child developmental assessments should be investigated prior to further implementation. TRIAL REGISTRATION Trial registry number for the FamilieTrivsel (Family Wellbeing) trial: NCT04129359.
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Affiliation(s)
- Sarah de Voss
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
| | - Philip Wilson
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark ,grid.7107.10000 0004 1936 7291Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Old Perth Road Inverness, IV2 3JH Aberdeen, Scotland
| | - Sofie Saxild
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
| | - Gritt Overbeck
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
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Disparities in Emergency Department Utilization Among Women with Postpartum Mood Disorders (2006-2016). Matern Child Health J 2023; 27:158-167. [PMID: 36352280 DOI: 10.1007/s10995-022-03544-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/17/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Postpartum mood disorders are associated with adverse outcomes for newborns and mothers and may require urgent evaluation. The emergency department is often a healthcare entry point, but factors associated with these emergency department visits are unknown. METHODS A longitudinal retrospective analysis using the Nationwide Emergency Department Sample to assess national estimates of emergency department visits by women ages 15-49 with primary diagnosis of a postpartum mood disorder between 2006 and 2016. Emergency department visit rates for postpartum mood disorders per 100,000 live births were calculated. RESULTS Emergency department visits related to postpartum mood disorders remained stable from 2006 to 2016 (5153 to 5390 respectively). Two-thirds of visits were by patients younger than 30. Approximately half of visits for postpartum mood disorders were funded by Medicaid (42.4-56.7%) compared to 27.4-41.2% funded by Medicaid for all other age-matched women. Of postpartum mood disorder visits 30.3% were by women from the lowest income quartile. The highest rate of emergency department visits occurred in the youngest patients (ages 15-19: 231 visits versus ages 35-49: 105 visits). Postpartum mood disorder admissions were higher than those for age-matched women with all other diagnoses (19.8% vs. 6.5%). DISCUSSION The high rate of women that are young and with public insurance visiting the emergency department for postpartum mood disorders demonstrates an increased risk for these disorders in these populations and an opportunity for targeted intervention by policymakers and providers. Higher admission rates for postpartum mood disorders compared to all other diagnoses reveals a chance to optimize outpatient screening and treatment.
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Park J, Kim SY, Lee K. Effectiveness of behavioral sleep interventions on children's and mothers' sleep quality and maternal depression: a systematic review and meta-analysis. Sci Rep 2022; 12:4172. [PMID: 35264627 PMCID: PMC8907206 DOI: 10.1038/s41598-022-07762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
This systematic review and meta-analysis was conducted to investigate the effectiveness of behavioral sleep interventions (BSIs) on the number of child night awakenings, and maternal sleep quality and depression. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) using PubMed, CINAHL, Cochrane, and EMBASE databases and retrieved studies published until April 2021. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for child sleep problems, and the mean differences (MD) and 95% CI for the number of child night awakenings, and maternal sleep quality and depression. Ten studies of 1628 initial searched were included in the final analysis. Two of the 10 studies were divided into two subgroups by participants and intervention type; thus, 12 subgroups were included in the meta-analysis. BSIs significantly reduced child sleep problems (OR 0.51; 95% CI 0.37–0.69) and improved maternal sleep quality (MD − 1.30; 95% CI − 1.82 to − 0.77) in the intervention group. There were no significant differences in the number of child night awakenings and maternal depression between the two groups. More RCTs to examine the effect of BSIs considering children’s age, duration of intervention, and outcome measuring time points are needed.
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Affiliation(s)
- Jeongok Park
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 616 College of Nursing, Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Korea
| | - Soo Yeon Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 616 College of Nursing, Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Korea
| | - Kyoungjin Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 616 College of Nursing, Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Korea. .,College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Korea.
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Lefchak B, Cushwa A, Kersten H, Courts K, McPeak K. Characterization of Social Risk Factors Among Newborns Seen at an Urban Pediatric Primary Care Predictive of Appointment Nonattendance During the First 6 Months of Life. Health Equity 2022; 6:40-48. [PMID: 35112045 PMCID: PMC8804246 DOI: 10.1089/heq.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Appointment attendance is critical in monitoring health and well-being of children. Low income Medicaid-insured families with newborns often experience social risks that may affect attendance. This project sought to characterize social risk factors present at first newborn visits predictive of future appointment nonattendance. Methods: Retrospective cohort study of minority and Medicaid-insured population at St. Christopher's Hospital for Children using a standardized social risk screener administered at first newborn visits as part of routine clinical care. In total, 720 survey responses between December 2016 and June 2017 were correlated with electronic health record-derived sociodemographic and appointment attendance data in the first 6 months of life. Nonattendance included missed and canceled appointments. Caregiver-reported social risk factors were included as covariates in linear regressions predicting proportion nonattendance outcomes. Results: Newborn caregivers identified many social risk factors including mental health diagnoses (14%), lack of child care support (45%), and food insecurity (9%). Approximately 74% had nonattendance with 41% missing or canceling a quarter or more appointments. Number of siblings (p<0.01) and maternal age (p<0.01) were most predictive for nonattendance, respectively. Other social risks were not significant except for maternal mental health (p=0.01) among those identifying number of risk factors above cohort average (16%). Conclusion: Screening of newborns at first medical visits can be used to characterize social risks. Most social risk factors at first visits were not strongly predictive of nonattendance, although our results suggested associations between non-attendance and maternal demographics, mental health and household makeup.
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Affiliation(s)
- Brian Lefchak
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ann Cushwa
- Center for the Urban Child and General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Hans Kersten
- Center for the Urban Child and General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Kelly Courts
- Center for the Urban Child and General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Katie McPeak
- Center for the Urban Child and General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
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Overbeck G, Rasmussen IS, Siersma V, Andersen JH, Kragstrup J, Wilson P, Hauskov Graungaard A, Ertmann RK. Depression and anxiety symptoms in pregnant women in Denmark during COVID-19. Scand J Public Health 2021; 49:721-729. [PMID: 34011216 DOI: 10.1177/14034948211013271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Maternal mental distress in pregnancy can be damaging to the mother's and child's physical and mental health. This study aimed to provide an insight into mental well-being of pregnant women in Denmark during COVID-19 by assessing symptoms of depression and anxiety. METHODS Data from two cohorts of pregnant women recruited from Danish general practice were compared. A COVID-19 lockdown cohort (N=330) completed questionnaires between 8 April and 6 May. Responses were compared to those from a control cohort of women from 2016 (N=1428). Mental well-being was measured with the Major Depression Inventory (MDI) and the Anxiety Symptom Scale (ASS). RESULTS Questionnaires were returned by 83% of the COVID-19 lockdown cohort and by 93% of the control cohort. Multivariable analysis controlling for age, cohabitation status, occupation, smoking, alcohol use, chronic disease, fertility treatment, parity and children living at home showed no difference in depressive symptoms (MDI). Anxiety symptoms (ASS) were slightly worse in the COVID-19 lockdown cohort (mean difference=1.4 points), mainly driven by questions concerning general anxiety. The largest differences in anxiety were seen in first trimester (adjusted mean difference=4.0 points). CONCLUSIONS Pregnant women questioned during the COVID-19 pandemic showed no change in symptoms of depression and only a modest elevation of anxiety when compared to pregnant women questioned during a non-pandemic period in 2016.
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Affiliation(s)
- Gritt Overbeck
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Ida Scheel Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Julie Høgsgaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Jakob Kragstrup
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Philip Wilson
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark.,Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, UK
| | - Anette Hauskov Graungaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Ruth Kirk Ertmann
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
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Benasi G, Fava GA, Rafanelli C. Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:74-89. [PMID: 32050199 DOI: 10.1159/000506110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment. OBJECTIVE The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being). METHODS The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included. RESULTS A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo. CONCLUSIONS The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.
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Affiliation(s)
- Giada Benasi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy,
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Chando S, Craig JC, Burgess L, Sherriff S, Purcell A, Gunasekera H, Banks S, Smith N, Banks E, Woolfenden S. Developmental risk among Aboriginal children living in urban areas in Australia: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). BMC Pediatr 2020; 20:13. [PMID: 31931753 PMCID: PMC6956483 DOI: 10.1186/s12887-019-1902-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers’ concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. Methods Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children < 8 years old enrolled in a longitudinal cohort study (Study of Environment on Aboriginal Resilience and Child Health: SEARCH) were collected by interview. The Parents’ Evaluation of Developmental Status (PEDS) was used to assess developmental risk through report of caregiver concerns. Odds ratios (OR) were calculated using multinomial logistic regression to investigate risk factors and develop a risk prediction model. Results Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62–3.61), being older (4.5 to < 8 years versus < 3 years old, 3.80, 2.21–6.54), prior history of ear infection (1.95, 1.21–3.15), having lived in 4 or more houses versus one house (4.13, 2.04–8.35), foster care versus living with a parent (5.45, 2.32–12.78), and having a caregiver with psychological distress (2.40, 1.37–4.20). Conclusion In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed.
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Affiliation(s)
| | - Jonathan C Craig
- University of Sydney, Sydney, Australia.,Flinders University, Adelaide, Australia
| | - Leonie Burgess
- Sax Institute, Sydney, Australia.,Australian National University, Canberra, Australia
| | - Simone Sherriff
- University of Sydney, Sydney, Australia.,Sax Institute, Sydney, Australia
| | | | - Hasantha Gunasekera
- University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Sydney, Australia
| | - Sandra Banks
- Tharawal Aboriginal Medical Service, Campbelltown, Australia
| | - Natalie Smith
- Riverina Medical and Dental Corporation, Wagga Wagga, Australia
| | - Emily Banks
- Australian National University, Canberra, Australia
| | - Sue Woolfenden
- Sydney Children's Hospitals Network, Sydney, Australia. .,University of New South Wales, School of Women and Children's Health, Sydney, Australia.
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Wu X, Chen W, Lin F, Huang Q, Zhong J, Gao H, Song Y, Liang H. DNA methylation profile is a quantitative measure of biological aging in children. Aging (Albany NY) 2019; 11:10031-10051. [PMID: 31756171 PMCID: PMC6914436 DOI: 10.18632/aging.102399] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/26/2019] [Indexed: 12/21/2022]
Abstract
DNA methylation changes within the genome can be used to predict human age. However, the existing biological age prediction models based on DNA methylation are predominantly adult-oriented. We established a methylation-based age prediction model for children (9-212 months old) using data from 716 blood samples in 11 DNA methylation datasets. Our elastic net model includes 111 CpG sites, mostly in genes associated with development and aging. The model performed well and exhibited high precision, yielding a 98% correlation between the DNA methylation age and the chronological age, with an error of only 6.7 months. When we used the model to assess age acceleration in children based on their methylation data, we observed the following: first, the aging rate appears to be fastest in mid-childhood, and this acceleration is more pronounced in autistic children; second, lead exposure early in life increases the aging rate in boys, but not in girls; third, short-term recombinant human growth hormone treatment has little effect on the aging rate of children. Our child-specific methylation-based age prediction model can effectively detect epigenetic changes and health imbalances early in life. This may thus be a useful model for future studies of epigenetic interventions for age-related diseases.
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Affiliation(s)
- Xiaohui Wu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Technology and Engineering Research Center for Molecular Diagnostics of Human Genetic Diseases, Guangzhou, Guangdong, China.,Guangdong Province Key Laboratory of Psychiatric Disorders, Guangzhou, Guangdong, China
| | - Weidan Chen
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Fangqin Lin
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qingsheng Huang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiayong Zhong
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huan Gao
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yanyan Song
- The Guangdong Early Childhood Development Applied Engineering and Technology Research Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Doove B, Feron J, Feron F, van Os J, Drukker M. Validation of short instruments assessing parental and caregivers' perceptions on child health and development for personalized prevention. Clin Child Psychol Psychiatry 2019; 24:608-630. [PMID: 30628460 DOI: 10.1177/1359104518822673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Systematically exploring parental as well as other caregivers' concerns is a main component in preventive child health care (PCHC) for family-centred practice and personalized health care. To facilitate communication and early identification of emerging mental health problems, a PCHC toolkit based on short instruments was developed. This article investigates the reliability and validity of (1) two visual analogue scales (VAS) to assess parent-reported 'parenting' and 'child behaviour', (2) a professional caregiver-reported VAS to assess 'child competence' and (3) the parents' evaluation of developmental status (PEDS) in Dutch PCHC. Parents as well as child care, kindergarten and preschool teachers completed instruments in a community-based sample of children (N = 346) aged 3 years at baseline. The three VAS and PEDS were associated with standardized questionnaires assessing the same constructs. Overall predictive accuracy showed: good to excellent for 'parenting' VAS, fair to good for 'child behaviour' VAS and poor for 'child competence' VAS. The PEDS, 'parenting' VAS and 'child behaviour' VAS, demonstrated high sensitivity at various cut-off points of index test and reference standard. At follow-up, approximately 1 year later, results were similar. Although the 'child competence' VAS scored lower on one aspect of validity, the PEDS and the different VAS are reliable, valid and useful as brief monitoring tools in daily Dutch PCHC practice.
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Affiliation(s)
- Bernice Doove
- 1 Well-Child Care Centre, Preventive Child Health Care Division, Envida, The Netherlands.,2 Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
| | | | - Frans Feron
- 2 Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands.,4 Youth Health Care Division, Regional Public Health Service South Limburg, The Netherlands
| | - Jim van Os
- 5 Department of Psychiatry and Psychology, MHeNS School for Mental Health and NeuroScience, Maastricht University Medical Centre, The Netherlands.,6 King's Health Partners and Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,7 Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Marjan Drukker
- 5 Department of Psychiatry and Psychology, MHeNS School for Mental Health and NeuroScience, Maastricht University Medical Centre, The Netherlands
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Short K, Eadie P, Kemp L. Paths to language development in at risk children: a qualitative comparative analysis (QCA). BMC Pediatr 2019; 19:94. [PMID: 30953552 PMCID: PMC6449893 DOI: 10.1186/s12887-019-1449-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background Childhood language development is related to long term educational, employment, health and social outcomes. Previous research identifies a complex range of risk and protective factors which result in good and poor language outcomes for children, however children at risk are an underrepresented group in these studies. Our aim is to investigate the combinations of factors (paths) that result in good and poor language outcomes for a group of 5 year old children of mothers experiencing adversity. Methods This mixed methods study utilised longitudinal data from a randomised control trial of sustained home visiting (MECSH) to determine the language outcomes in at risk children. Mothers were randomly assigned to a comparison group at entry to the study (prior to child’s birth). Their children who were retained at entry to school completed language assessments (n = 41) and were participants in this study. Influence of 13 key factors derived from the extant literature that impact language development were explored. Regression was used to determine the six key factors of influence and these were used in the Qualitative Comparative Analysis (QCA). QCA was employed to examine the necessary and sufficient conditions and paths affecting language development linked to good and poor language outcomes. A post hoc analysis of the risk and protective paths to good and poor language outcomes was also conducted. Results Thirteen distinct pathways led to good language outcomes and four paths to poor language outcomes in five year old at risk children. A variety of condition combinations resulted in these outcomes, with maternal responsivity, toddler development and number of children in the home being key. High and low maternal education influenced both good and poor language development. Conclusions The paths to good and poor language outcomes were different and complex. Most paths to a good language outcome involved protective factors, though not always. In addition, paths to poor language more often involved risk factors. The varied patterns of risk and protective factors point to the need for interventions across the first five years of life in both health and education for families which can respond to these risk and protective patterns. Trial registration The original RCT was retrospectively registered in the ANCTR: ACTRN12608000473369. Electronic supplementary material The online version of this article (10.1186/s12887-019-1449-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kate Short
- School of Public Health and Community Medicine, University of NSW, Sydney, NSW, Australia. .,Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
| | - Patricia Eadie
- Graduate School of Education, University of Melbourne, Parkville, Victoria, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
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12
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Dababnah S, Rizo CF, Campion K, Downton KD, Nichols HM. The Relationship Between Children's Exposure to Intimate Partner Violence and Intellectual and Developmental Disabilities: A Systematic Review of the Literature. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 123:529-544. [PMID: 30421974 DOI: 10.1352/1944-7558-123.6.529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Children exposed to intimate partner violence (IPV) can experience negative social, emotional, behavioral, and academic outcomes. A growing body of research has examined the relationship between intellectual and developmental disabilities (IDD) and IPV exposure. We systematically reviewed the literature for research exploring this relationship and found a limited number of studies meeting inclusion criteria ( N = 11). Over half (64%) identified a significant relationship between IPV and IDD, although the cross-sectional methodologies of the majority of studies (82%) prevented the ability to ascertain directionality. Further, the studies defined and measured IPV and IDD in various ways. Some studies were limited by poor external validity and small sample sizes. More research is needed to understand the intersection between IPV exposure and IDD.
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Affiliation(s)
- Sarah Dababnah
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
| | - Cynthia Fraga Rizo
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
| | - Karen Campion
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
| | - Katherine D Downton
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
| | - Helen M Nichols
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
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13
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Winter L, Colditz PB, Sanders MR, Boyd RN, Pritchard M, Gray PH, Whittingham K, Forrest K, Leeks R, Webb L, Marquart L, Taylor K, Macey J. Depression, posttraumatic stress and relationship distress in parents of very preterm infants. Arch Womens Ment Health 2018; 21:445-451. [PMID: 29502280 DOI: 10.1007/s00737-018-0821-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
To determine the prevalence, associated factors, and relationships between symptoms of depression, symptoms of posttraumatic stress (PTS), and relationship distress in mothers and fathers of very preterm (VPT) infants (< 32 weeks). Mothers (n = 323) and fathers (n = 237) completed self-report measures on demographic and outcome variables at 38 days (SD = 23.1, range 9-116) postpartum while their infants were still hospitalised. Of mothers, 46.7% had a moderate to high likelihood of depression, 38.1% had moderate to severe symptoms of PTS, and 25.1% were in higher than average relationship distress. The corresponding percentages in fathers were 16.9, 23.7, and 27%. Depression was positively associated with having previous children (p = 0.01), speaking little or no English at home (p = 0.01), financial stress (p = 0.03), and recently accessing mental health services (p = 0.003) for mothers, and financial stress (p = 0.005) and not being the primary income earner (p = 0.04) for fathers. Similar associations were found for symptoms of PTS and relationship distress. Being in higher relationship distress increased the risk of depression in both mothers (p < .001) and fathers (p = 0.03), and PTS symptoms in mothers (p = 0.001). For both mothers and fathers, depression was associated with more severe PTS symptoms (p < .001). Fathers of VPT infants should be screened for mental health problems alongside mothers, and postpartum parent support programs for VPT infants should include strategies to improve the couple relationship.
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Affiliation(s)
- Leanne Winter
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia. .,The Parenting and Family Support Centre, School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
| | - Paul B Colditz
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Matthew R Sanders
- The Parenting and Family Support Centre, School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Australia
| | - Margo Pritchard
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Mater Mothers' Hospital, Brisbane, Australia.,Australian Catholic University, Brisbane, Australia
| | - Peter H Gray
- Mater Mothers' Hospital, Brisbane, Australia.,Mater Research Institute-University of Queensland, Brisbane, Australia
| | - Koa Whittingham
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Australia
| | - Kylee Forrest
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Mater Mothers' Hospital, Brisbane, Australia
| | - Rebecca Leeks
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Lachlan Webb
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Louise Marquart
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Karen Taylor
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
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14
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Hetherington E, McDonald S, Williamson T, Patten SB, Tough SC. Social support and maternal mental health at 4 months and 1 year postpartum: analysis from the All Our Families cohort. J Epidemiol Community Health 2018; 72:933-939. [PMID: 29921649 DOI: 10.1136/jech-2017-210274] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/25/2018] [Accepted: 05/28/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Low social support is consistently associated with postpartum depression. Previous studies do not always control for previous mental health and do not consider what type of support (tangible, emotional, informational or positive social interaction) is most important. The objectives are: to examine if low social support contributes to subsequent risk of depressive or anxiety symptoms and to determine which type of support is most important. METHODS Data from the All Our Families longitudinal pregnancy cohort were used (n=3057). Outcomes were depressive or anxiety symptoms at 4 months and 1 year postpartum. Exposures were social support during pregnancy and at 4 months postpartum. Log binomial models were used to calculate risk ratios (RRs) and absolute risk differences, controlling for past mental health. RESULTS Low total social support during pregnancy was associated with an increased risk of depressive symptoms (RR 1.50, 95% CI 1.24 to 1.82) and anxiety symptoms (RR 1.63, 95% CI 1.38 to 1.93) at 4 months postpartum. Low total social support at 4 months was associated with an increased risk of anxiety symptoms (RR 1.65, 95% CI 1.31 to 2.09) at 1 year. Absolute risk differences were largest among women with previous mental health challenges resulting in a number needed to treat of 5 for some outcomes. Emotional/informational support was the most important type of support for postpartum anxiety. CONCLUSION Group prenatal care, prenatal education and peer support programmes have the potential to improve social support. Prenatal interventions studies are needed to confirm these findings in higher risk groups.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sheila McDonald
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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15
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Rosenblum K, Lawler J, Alfafara E, Miller N, Schuster M, Muzik M. Improving Maternal Representations in High-Risk Mothers: A Randomized, Controlled Trial of the Mom Power Parenting Intervention. Child Psychiatry Hum Dev 2018; 49:372-384. [PMID: 28936602 PMCID: PMC5862741 DOI: 10.1007/s10578-017-0757-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A key mechanism of risk transmission between maternal risk and child outcomes are the mother's representations. The current study examined the effects of an attachment-based, trauma-informed parenting intervention, the Mom Power (MP) program, in optimizing maternal representations of high-risk mothers utilizing a randomized, controlled trial design (NCT01554215). High-risk mothers were recruited from low-income community locations and randomized to either the MP Intervention (n = 42) or a control condition (n = 33) in a parallel design. Maternal representations were assessed before and after the intervention using the Working Model of the Child Interview. The proportion of women with balanced (secure) representations increased in the MP group but not in the control group. Parenting Reflectivity for mothers in the treatment group significantly increased, with no change in the control condition. Participation in the MP program was associated with improvements in a key indicator of the security of the parent-child relationship: mothers' representations of their children.
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Affiliation(s)
- Katherine Rosenblum
- University of Michigan, Department of Psychiatry, Ann Arbor, MI,University of Michigan, Center for Human Growth and Development, Ann Arbor, MI,Corresponding author: Dr. Maria Muzik, MD, MS; Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd Ann Arbor, MI 48109; Phone: 734-232-0206;
| | - Jamie Lawler
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Emily Alfafara
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Nicole Miller
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Melisa Schuster
- University of Michigan, Department of Social Work, Ann Arbor, MI
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA. .,Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.
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16
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Benediktsson I, McDonald S, Tough S. Examining the Psychometric Properties of Three Standardized Screening Tools in a Pregnant and Parenting Population. Matern Child Health J 2018; 21:253-259. [PMID: 27475825 DOI: 10.1007/s10995-016-2128-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Significance Although standardized tools such as the Speilberger State Anxiety scale (1970) and Cohen's Perceived Stress Index (1983) have often been used in pregnant and postpartum populations to evaluate psychosocial risk, there exists very little literature on the reliability of these scales in this population. Given the potentially grave consequences of undiagnosed pre and postpartum mental distress, it is of paramount importance that the tools that are commonly used are evaluated for their psychometric properties within the pregnant and parenting population. Methods The psychometric properties of three mental health scales were evaluated using the All Our Babies data. The All Our Babies cohort is a prospective longitudinal study based in Calgary, Alberta. A total of 3300 women were recruited from prenatal care sites from all four quadrants of the city. Participants were mailed questionnaires at 24-26 weeks gestation, 34-36 weeks and at 4 months postpartum. Reliability for the Speilberger State Anxiety Scale, the Perceived Stress Index and the Life Optimism Test-revised were evaluated by calculating Cronbach's alphas. Validity with related constructs were tested for the State Anxiety Scale and the Perceived Stress Index by calculating Pearson Correlation Coefficients with closely related constructs. Sample size varied from 2670 to 3376, according to the response rate and time point. Depression as a related construct was evaluated using the Edinburgh Postpartum Depression Scale. Results The Cronbach's Alphas for the Speilberger State Anxiety scale were 0.92, 0.92 and 0.93 for 24-26 weeks, 34-36 weeks and 4 months postpartum respectively. The Alpha's for the Perceived Stress index were 0.88, 0.88 and 0.89 respectively. The Life Optimism Test Revised was only measured in the third trimester and the Cronbach's alpha was 0.83. The Pearson Correlation Coefficient for Anxiety with depression were r = 0.73, r = 0.72 and r = 0.77 respectively. The coefficients for stress and depression were r = 0.75, r = 0.75 and r = 0.77 respectively. Discussion/Conclusion The psychometric properties for all three scales were strong, with alphas that were comparable or higher to literature values. These data provide evidence that the use of these scales, previously validated in other populations are appropriate for use in among pregnant and parenting women at risk for mental distress.
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Affiliation(s)
| | - Sheila McDonald
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Canada
- Maternal and Child Health, Research and Innovation, Public, Population and Aboriginal Health, Alberta Health Services, Calgary, Canada
| | - Suzanne Tough
- Faculty of Medicine, University of Calgary, Calgary, Canada
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada
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17
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Kutuk MO, Altintas E, Tufan AE, Guler G, Aslan B, Aytan N, Kutuk O. Developmental delays and psychiatric diagnoses are elevated in offspring staying in prisons with their mothers. Sci Rep 2018; 8:1856. [PMID: 29382903 PMCID: PMC5789882 DOI: 10.1038/s41598-018-20263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/16/2018] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to describe the sociodemographic and clinical features of the mothers and their offspring staying with them in prison. The study was planned as a cross-sectional, single-center study of mothers residing in Tarsus Closed Women's Prison of Turkish Ministry of Justice along with their 0 to 6 years old offspring. Mothers were evaluated via Structured Clinical Interview for DSM-IV Axis I Disorders. A psychologist blind to maternal evaluations applied the Denver Developmental Screening Test II (DII-DST). Children/mothers were also evaluated by a child and adolescent psychiatrist via K-SADS-PL. Twenty-four mothers with a mean age of 29.3 years were included. Most common diagnoses in mothers were nicotine abuse (n = 17, 70.8%), specific phobia (n = 8, 33.3%), alcohol abuse (n = 7, 29.2%) and substance abuse (n = 5, 20.8%). Twenty-six children (53.9% female) were living with their mothers in prison, and the mean age of those was 26.3 months. Results of the D-II-DST were abnormal in 33.3% of the children. Most common diagnoses in children were adjustment disorder (n = 7, 26.9%) separation anxiety disorder (n = 3, 11.5%) and conduct disorder (n = 2, 7.7%). A multi-center study is necessary to reach that neglected/under-served population and address the inter-generational transmission of abuse, neglect, and psychopathology.
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Affiliation(s)
- Meryem Ozlem Kutuk
- Department of Child and Adolescent Psychiatry, Baskent University School of Medicine, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey.
| | - Ebru Altintas
- Department of Psychiatry, Baskent University School of Medicine, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University, School of Medicine, Bolu, Turkey
| | - Gulen Guler
- Elazig Mental Health Hospital, Department of Child and Adolescent Psychiatry, Elazig, Turkey
| | - Betul Aslan
- Department of Child Neurology, Baskent University, School of Medicine, Adana, Turkey
| | - Nurgul Aytan
- Department of Neurology, Boston University School of Medicine, Boston, USA
| | - Ozgur Kutuk
- Department of Medical Genetics, Baskent University School of Medicine, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey.
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18
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Schoeman JC, Swanepoel DW, van der Linde J. Developmental screening: predictors of follow-up adherence in primary health care. Afr Health Sci 2017; 17:52-61. [PMID: 29026377 DOI: 10.4314/ahs.v17i1.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The importance of early identification for infants and young children with developmental delays is well established. Poor follow-up on referrals, however, undermines the effectiveness of early intervention programmes. OBJECTIVES To identify factors, including text message reminders, that influence follow-up adherence for early intervention after developmental screening in primary health care. A secondary objective surveyed reasons for follow-up default. METHODS The PEDS tools were used to screen 247 high-risk children. A risk assessment questionnaire was completed with caregivers whose children were referred for speech-language and/or occupational therapy (n=106, 43%). A quasi-experimental correlational study was employed to identify risk factors for defaulting on appointments. A thematic analysis of telephonic interviews was also employed to determine reasons for follow-up defaults. RESULTS Follow-up adherence was 17%. Participants who were never married, divorced or widowed were 2.88 times more likely to attend a follow-up appointment than those who were married or living together (95%, CI 0.97-8.63). Text message reminders did not improve follow-up. More than half (58%) of participants who defaulted on appontments could be reached for telephonic interviews. Interviews showed that 87% of participants were unconcerned about their child's development. Other reasons for defaulting were employment, logistical issues, other responsibilities and forgetfulness. CONCLUSION Follow-up adherence for early intervention services following a positive primary health care screen was poor. Increased awareness and education regarding the importance of development for educational success is needed.
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Affiliation(s)
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands
- Australia Ear Science Institute Australia, Subiaco, Australia
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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19
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Tough SC, McDonald SW, Collisson BA, Graham SA, Kehler H, Kingston D, Benzies K. Cohort Profile: The All Our Babies pregnancy cohort (AOB). Int J Epidemiol 2017; 46:1389-1390k. [DOI: 10.1093/ije/dyw363] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/15/2022] Open
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20
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Delivering integrated child development care in Pakistan: protocol for a clustered randomised trial. BJGP Open 2017; 1:bjgpopen17X100677. [PMID: 30564646 PMCID: PMC6172678 DOI: 10.3399/bjgpopen17x100677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Early childhood developmental delay is associated with significant disadvantage in adult life. In Pakistan, high prevalence of developmental delay is associated with poverty, under-nutrition, and maternal depression. Aim To assess the effectiveness of an early child development counselling intervention delivered at private GP clinics, in poor urban communities. Design & setting A clustered randomised trial in Pakistan. Method The intervention was developed following a period of formative research, and in consultation with local experts. A total of 2112 mother–child pairs will be recruited at 32 clinics, from within the locality (cluster); 16 clinics per arm. A primary care counselling intervention (promoting child development, nutrition, and maternal mental health) will be delivered at 6 weeks, 3, 6, and 9 months of the child’s age. Monitoring, assessment, and treatment will also be performed at quarterly visits in intervention clinics. Primary outcome is the developmental delay at 12 months (ASQ-3 scores). Secondary outcomes are stunting rate, and maternal depression (PHQ-9 score). In addition, a process evaluation and costing study will be conducted. Discussion This trial will be the first to assess an early child development intervention, delivered in private GP clinics for poor urban communities in Pakistan. If found to be effective, this public–private model may offer a more sustainable, and feasible option for populations in poor urban settings, where private GP clinics are the most accessible provider of primary health care. There is scope for scale-up at provincial level, should the intervention be effective. Trial registration The trial has been registered with the Current Controlled Trials ISRCTN48032200.
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21
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Kim M, Kang SK, Yee B, Shim SY, Chung M. Paternal involvement and early infant neurodevelopment: the mediation role of maternal parenting stress. BMC Pediatr 2016; 16:212. [PMID: 27955632 PMCID: PMC5153858 DOI: 10.1186/s12887-016-0747-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Father–child interactions are associated with improved developmental outcomes among infants. However, to the best of our knowledge, no study has addressed the effects of paternal involvement on the neurodevelopment of infants who are less than 6 months of age, and no study has reported how maternal parenting stress mediates the relationship between paternal involvement and infant neurodevelopment during early infancy. This study investigates the direct and indirect relationship between paternal involvement and infant neurodevelopment at 3–4 months of age. The indirect relationship was assessed through the mediating factor of maternal parenting stress. Methods The participants were recruited through the Sesalmaul Research Center’s website from April to June 2014. The final data included 255 mothers and their healthy infants, who were aged 3–4 months. The mothers reported paternal involvement and maternal parenting stress by using Korean Parenting Alliance Inventory (K-PAI) and Parenting Stress Index (PSI), respectively. Experts visited the participants’ homes to observe infant neurodevelopment, and completed a developmental examination using Korean version of the Ages and Stages Questionnaire II (K-ASQ II). A hierarchical multiple regression analysis was used for data analysis. Results Infants’ mean ages were 106 days and girls accounted for 46.3%. The mean total scores (reference range) of the K-PAI, PSI, and the K-ASQ II were 55.5 (17–68), 45.8 (25–100), and 243.2 (0–300), respectively. Paternal involvement had a positive relationship with K-ASQ II scores (β = 0.29, p < 0.001) at 3–4 months of age, whereas maternal parenting stress was negatively related with K-ASQ II scores (β = −0.32, p < 0.001). Maternal parenting stress mediated the relationship between paternal involvement and early infant neurodevelopment (Z = 3.24, p < 0.001). A hierarchical multiple regression analysis showed that paternal involvement reduced maternal parenting stress (β = −0.25, p < 0.001), which led to positive infant outcomes (β = 0.23, p < 0.001). Conclusions Paternal involvement is significantly associated with infant neurodevelopment during early infancy, and maternal parenting stress partially mediates that association. This result emphasizes the importance of fathers’ involvement and mothers’ parenting stress on early infant neurodevelopment.
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Affiliation(s)
- Minjeong Kim
- Sesalmaul Research Center, Gachon University, Seongnamdae-ro 1342, Seongnam, 13120, Gyeonggi-do, South Korea
| | - Su-Kyoung Kang
- Department of Early Childhood Education, Gachon University, Seongnamdae-ro, 1342, Seongnam, Gyeonggi-do, 13120, South Korea
| | - Bangsil Yee
- Department of Childcare & Education, Osan University, Cheonghak-ro 45, Osan, 18116, Gyeonggi-do, South Korea
| | - So-Yeon Shim
- Department of Pediatrics, School of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
| | - Mira Chung
- Department of Early Childhood Education, Gachon University, Seongnamdae-ro, 1342, Seongnam, Gyeonggi-do, 13120, South Korea.
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McDonald SW, Kehler HL, Tough SC. Protective factors for child development at age 2 in the presence of poor maternal mental health: results from the All Our Babies (AOB) pregnancy cohort. BMJ Open 2016; 6:e012096. [PMID: 28186930 PMCID: PMC5128911 DOI: 10.1136/bmjopen-2016-012096] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify the combination of factors most protective of developmental delay at age 2 among children exposed to poor maternal mental health. DESIGN Observational cohort study. SETTING Pregnant women were recruited from primary healthcare offices, the public health laboratory service and community posters in Calgary, Alberta, Canada. PARTICIPANTS 1596 mother-child dyads who participated in the All Our Babies study and who completed a follow-up questionnaire when their child was 2 years old. Among participants who completed the 2-year questionnaire and had complete mental health data (n=1146), 305 women (27%) were classified as high maternal mental health risk. PRIMARY MEASURES Child development at age 2 was described and a resilience analysis was performed among a subgroup of families at maternal mental health risk. The primary outcome was child development problems. Protective factors were identified among families at risk, defined as maternal mental health risk, a composite measure created from participants' responses to mental health life course questions and standardised mental health measures. RESULTS At age 2, 18% of children were classified as having development problems, 15% with behavioural problems and 13% with delayed social-emotional competencies. Among children living in a family with maternal mental health risk, protective factors against development problems included higher social support, higher optimism, more relationship happiness, less difficulty balancing work and family responsibilities, limiting the child's screen time to <1 hour per day and the child being able to fall asleep in <30 min and sleeping through the night by age 2. CONCLUSIONS Among families where the mother has poor mental health, public health and early intervention strategies that support interpersonal relationships, social support, optimism, work-life balance, limiting children's screen time and establishing good sleep habits in the child's first 2 years show promise to positively influence early child development.
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Affiliation(s)
- Sheila W McDonald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heather L Kehler
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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McDonald S, Kehler H, Bayrampour H, Fraser-Lee N, Tough S. Risk and protective factors in early child development: Results from the All Our Babies (AOB) pregnancy cohort. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 58:20-30. [PMID: 27587353 DOI: 10.1016/j.ridd.2016.08.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/27/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Understanding factors that protect against early developmental delay among children who are experiencing adversity can inform prevention and early intervention strategies. AIMS To identify risk factors for development delay at one year and protective factors for developmental delay in 'at risk' environments (poor maternal mental health and socio-demographic risk). METHODS AND PROCEDURES Data was analyzed from 3360 mother-child dyads who participated in the All Our Babies (AOB) pregnancy cohort. Participants completed four questionnaires spanning pregnancy to one year postpartum and provided access to medical records. Risk factors for developmental delay at age one were identified using bivariate methods and multivariable modeling. Protective factors for child development in 'at risk' family environments were identified using bivariate analyses. OUTCOMES AND RESULTS At one year, 17% of children were developmentally delayed, defined as scoring in the monitoring zone on at least 2 of the 5 developmental domains of the Ages and Stages Questionnaire. Prenatal depression, preterm birth, low community engagement, and non-daily parent-child interaction increased the risk of delay. Protective factors for children in 'at risk' environments included relationship happiness, parenting self-efficacy, community engagement, higher social support, and daily parent-child interaction. CONCLUSIONS AND IMPLICATIONS The study results suggest that maternal and infant outcomes would be improved, even for vulnerable women, through identification and intervention to address poor mental health and through normalizing engagement with low cost, accessible community resources that can also support parent-child interaction.
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Affiliation(s)
- Sheila McDonald
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada.
| | - Heather Kehler
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada
| | - Hamideh Bayrampour
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada
| | - Nonie Fraser-Lee
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada
| | - Suzanne Tough
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada; Department of Community Health Science, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada
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McDonald SW, Ginez HK, Vinturache AE, Tough SC. Maternal perceptions of underweight and overweight for 6-8 years olds from a Canadian cohort: reporting weights, concerns and conversations with healthcare providers. BMJ Open 2016; 6:e012094. [PMID: 27798005 PMCID: PMC5073603 DOI: 10.1136/bmjopen-2016-012094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The majority of mothers do not correctly identify their child's weight status. The reasons for the misperception are not well understood. This study's objective was to describe maternal perceptions of their child's body mass index (BMI) and maternal report of weight concerns raised by a health professional. DESIGN Prospective, community-based cohort. PARTICIPANTS Data were collected in 2010 from 450 mothers previously included in a longitudinal birth cohort. Mothers of children aged 6-8 years reported their child's anthropometric measures and were surveyed concerning their opinion about their child's weight. They were also asked if a healthcare provider raised any concerns regarding their child's body weight. Child BMI was categorised according to the WHO Growth Charts adapted for Canada. Descriptive statistics and bivariate analyses were used to evaluate mothers' ability to correctly identify their children's body habitus. RESULTS 74% of children had a healthy BMI, 10% were underweight, 9% were overweight and 7% were obese. 80%, 89% and 62% of mothers with underweight, overweight and obese children, respectively, believed that their child was at the right weight. The proportion of mothers who recalled a health professional raising concerns about their child being underweight, overweight, and obese was low (12.5%). CONCLUSIONS The majority of mothers with children at unhealthy weights misclassified and normalised their child's weight status, and they did not recall a health professional raising concerns regarding their child's weight. The highest rates of child body weight misclassification occurred in overweight children. This suggests that there are missed opportunities for healthcare professionals to improve knowledge exchange and early interventions to assist parents to recognise and support healthy weights for their children.
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Affiliation(s)
- Sheila W McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Population, Public, and Aboriginal Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Heather K Ginez
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angela E Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Muzik M, Rosenblum KL, Alfafara EA, Schuster MM, Miller NM, Waddell RM, Stanton Kohler E. Mom Power: preliminary outcomes of a group intervention to improve mental health and parenting among high-risk mothers. Arch Womens Ment Health 2015; 18:507-21. [PMID: 25577336 PMCID: PMC4439267 DOI: 10.1007/s00737-014-0490-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Abstract
Maternal psychopathology and traumatic life experiences may adversely impact family functioning, the quality of the parent-child relationship and the attachment bond, placing the child's early social-emotional development at risk. Attachment-based parenting interventions may be particularly useful in decreasing negative outcomes for children exposed to risk contexts, yet high risk families frequently do not engage in programs to address mental health and/or parenting needs. This study evaluated the effects of Mom Power (MP), a 13-session parenting and self-care skills group program for high-risk mothers and their young children (age <6 years old), focused on enhancing mothers' mental health, parenting competence, and engagement in treatment. Mothers were referred from community health providers for a phase 1 trial to assess feasibility, acceptability, and pilot outcomes. At baseline, many reported several identified risk factors, including trauma exposure, psychopathology, poverty, and single parenthood. Ninety-nine mother-child pairs were initially recruited into the MP program with 68 women completing and providing pre- and post-self-report measures assessing demographics and trauma history (pre-assessment only), maternal mental health (depression and post-traumatic stress disorder (PTSD)), parenting, and intervention satisfaction. Results indicate that MP participation was associated with reduction in depression, PTSD, and caregiving helplessness. A dose response relationship was evident in that, despite baseline equivalence, women who attended ≥70 % of the 10 groups (completers; N = 68) improved on parenting and mental health outcomes, in contrast to non-completers (N = 12). Effects were most pronounced for women with a mental health diagnosis at baseline. The intervention was perceived as helpful and user-friendly. Results indicate that MP is feasible, acceptable, and holds promise for improving maternal mental health and parenting competence among high-risk dyads. Further research is warranted to evaluate the efficacy of MP using randomized controlled designs.
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Affiliation(s)
- Maria Muzik
- Department of Psychiatry, University of Michigan Depression Center, 4250 Plymouth Road, Ann Arbor, MI, 48109-2701, USA,
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Kingston D, Tough S. Prenatal and postnatal maternal mental health and school-age child development: a systematic review. Matern Child Health J 2015; 18:1728-41. [PMID: 24352625 DOI: 10.1007/s10995-013-1418-3] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
One in six children entering school experiences developmental delay. Maternal mental health represents one of the earliest, modifiable influences in a child's life. The objective of the review was to evaluate the association between maternal mental health and school-age child development, and we hypothesized there would be a negative association. Five databases were searched (Embase, CINAHL, Eric, PsycInfo, Medline). Key journals and reference lists were hand-searched. Two reviewers assessed studies based on inclusion criteria: (1) the exposure was any form of maternal mental health occurring during pregnancy or postpartum periods; (2) the outcome was child development (>48 months to 8 years); (3) the study recruited participants from developed countries; and (4) publication was in English between January, 1990 and December, 2012. Disagreements were resolved by consensus. Study quality was assessed by two reviewers using the Scottish Intercollegiate Guideline Network and disagreements were resolved by consensus. Data extraction was conducted by one reviewer using standardized forms. Maternal mental health problems in pregnancy and/or the postpartum period increased the likelihood that school-age children experienced suboptimal global, behavioral, cognitive, and socio-emotional development. The findings highlight the need for maternal mental health assessment during the prenatal, postnatal, and early childhood periods.
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Affiliation(s)
- Dawn Kingston
- Faculty of Nursing, 5-258 Edmonton Clinic Health Academy, University of Alberta, 11405-87th Avenue, Edmonton, AB, T6G 1C9, Canada,
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Moncayo R, Ortner K. Multifactorial determinants of cognition - Thyroid function is not the only one. BBA CLINICAL 2015; 3:289-98. [PMID: 26672993 PMCID: PMC4661586 DOI: 10.1016/j.bbacli.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/11/2015] [Accepted: 04/14/2015] [Indexed: 12/31/2022]
Abstract
Background Since the 1960s hypothyroidism together with iodine deficiency have been considered to be a principal determinant of cognition development. Following iodine supplementation programs and improved treatment options for hypothyroidism this relation might not be valid in 2015. On the other hand neurosciences have added different inputs also related to cognition. Scope of review We will examine the characteristics of the original and current publications on thyroid function and cognition and also add some general determinants of intelligence and cognition. One central issue for us is the relation of stress to cognition knowing that both physical and psychological stress, are frequent elements in subjects with thyroid dysfunction. We have considered a special type of stress called pre-natal stress which can influence cognitive functions. Fear and anxiety can be intermingled requiring mechanisms of fear extinction. Major conclusions Recent studies have failed to show an influence of thyroid medication during pregnancy on intellectual development. Neuroscience offers a better explanation of cognition than hypothyroidism and iodine deficiency. Additional factors relevant to cognition are nutrition, infection, prenatal stress, and early life stress. In turn stress is related to low magnesium levels. Magnesium supplementation can correct both latent hypothyroidism and acquired mild cognitive deficits. General significance Cognition is a complex process that depends on many determinants and not only on thyroid function. Magnesium deficiency appears to be a basic mechanism for changes in thyroid function as well as of cognition. Untreated hypothyroidism, i.e. hypothyroxinemia, can influence IQ. Thyroxine administration to euthyroid pregnant women has no effect on cognition. The hippocampus and NMDA receptors play a central role in cognitive processes. Antenatal and early life stressors can influence cognition later in life. Stressors can lead to decreased levels of magnesium and demands supplementation.
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Affiliation(s)
- Roy Moncayo
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Karina Ortner
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Benzies K, Mychasiuk R, Tough S. What patterns of postpartum psychological distress are associated with maternal concerns about their children's emotional and behavioural problems at the age of three years? EARLY CHILD DEVELOPMENT AND CARE 2015; 185:1-16. [PMID: 25544794 PMCID: PMC4270423 DOI: 10.1080/03004430.2014.899592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/26/2014] [Indexed: 06/04/2023]
Abstract
Mothers experiencing psychological distress in the postpartum period may have difficulties parenting their children. Inconsistent and unresponsive parenting may increase the risk of later emotional and behavioural problems in children. The purpose of this study was to identify how maternal psychological characteristics cluster at eight weeks postpartum, and whether these clusters were associated with maternal-reported child emotional and behavioural problems at the age of three years, as measured by the Parents' Evaluation of Developmental Status (PEDS) questionnaire. In a longitudinal pregnancy cohort (N = 647), three clusters of postpartum psychological characteristics were identified. Contrary to expectations, mothers with the greatest psychological distress did not report concerns about their child's emotional and behavioural problems; rather, they reported concerns about global developmental delay. These findings suggest that infants of mothers experiencing postpartum psychological distress should receive additional follow-up to reduce the risk for global developmental delay.
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Affiliation(s)
- Karen Benzies
- Faculty of Nursing and Department of Pediatrics, University of Calgary, PF2222 – 2500 University Drive, Calgary, Alberta, CanadaT2N 1N4
| | - Richelle Mychasiuk
- Faculty of Medicine, University of Calgary, 2500 University Drive NW, Calgary, CanadaAB T2N 1N4
| | - Suzanne Tough
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Suite 200, 3820 – 24th Avenue NW, Calgary, CanadaAB T3B 2X9
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Woolfenden S, Eapen V, Williams K, Hayen A, Spencer N, Kemp L. A systematic review of the prevalence of parental concerns measured by the Parents' Evaluation of Developmental Status (PEDS) indicating developmental risk. BMC Pediatr 2014; 14:231. [PMID: 25218133 PMCID: PMC4175611 DOI: 10.1186/1471-2431-14-231] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parental concerns about their children's development can be used as an indicator of developmental risk. We undertook a systematic review of the prevalence of parents' concerns as an indicator of developmental risk, measured by the Parents' Evaluation of Developmental Status (PEDS) and associated risk factors. METHODS Electronic databases, bibliographies and websites were searched and experts contacted. Studies were screened for eligibility and study characteristics were extracted independently by two authors. A summary estimate for prevalence was derived. Meta-regression examined the impact of study characteristics and quality. Meta-analysis was used to derive pooled estimates of the impact of biological and psychosocial risk factors on the odds of parental concerns indicating high developmental risk. RESULTS Thirty seven studies were identified with a total of 210,242 subjects. Overall 13.8% (95% CI 10.9 -16.8%) of parents had concerns indicating their child was at high developmental risk and 19.8% (95% CI 16.7-22.9%) had concerns indicating their child was at moderate developmental risk. Male gender, low birth weight, poor/fair child health rating, poor maternal mental health, lower socioeconomic status (SES), minority ethnicity, not being read to, a lack of access to health care and not having health insurance were significantly associated with parental concerns indicating a high developmental risk. CONCLUSIONS The prevalence of parental concerns measured with the PEDS indicating developmental risk is substantial. There is increased prevalence associated with biological and psychosocial adversity. TRIAL REGISTRATION PROSPERO Registration: CRD42012003215.
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Affiliation(s)
- Susan Woolfenden
- />Department of Community Child Health, Sydney Children’s Hospital Network, High St Randwick NSW 2031, Sydney, Australia
- />School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Valsamma Eapen
- />School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Katrina Williams
- />Royal Children’s Hospital and Murdoch Children’s Research Institute, University of Melbourne, Melbourne, Australia
| | - Andrew Hayen
- />School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Lynn Kemp
- />School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Rosenblum S, Frisch C, Deutsh-Castel T, Josman N. Daily functioning profile of children with attention deficit hyperactive disorder: A pilot study using an ecological assessment. Neuropsychol Rehabil 2014; 25:402-18. [PMID: 25054849 DOI: 10.1080/09602011.2014.940980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Children with attention-deficit hyperactivity disorder (ADHD) often present with activities of daily living (ADL) performance deficits. This study aimed to compare the performance characteristics of children with ADHD to those of controls based on the Do-Eat assessment tool, and to establish the tool's validity. Participants were 23 children with ADHD and 24 matched controls, aged 6-9 years. In addition to the Do-Eat, the Children Activity Scale-Parent (ChAS-P) and the Behavioral Rating Inventory of Executive Function (BRIEF) were used to measure sensorimotor abilities and executive function (EF). Significant differences were found in the Do-Eat scores between children with ADHD and controls. Significant moderate correlations were found between the Do-Eat sensorimotor scores, the ChAS-P and the BRIEF scores in the ADHD group. Significant correlations were found between performance on the Do-Eat and the ChAS-P questionnaire scores, verifying the tool's ecological validity. A single discriminant function described primarily by four Do-Eat variables, correctly classified 95.5% of the study participants into their respective study groups, establishing the tool's predictive validity within this population. These preliminary findings indicate that the Do-Eat may serve as a reliable and valid tool that provides insight into the daily functioning characteristics of children with ADHD. However, further research on larger samples is indicated.
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Affiliation(s)
- Sara Rosenblum
- a The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences , University of Haifa , Haifa , Israel
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Cabaj JL, McDonald SW, Tough SC. Early childhood risk and resilience factors for behavioural and emotional problems in middle childhood. BMC Pediatr 2014; 14:166. [PMID: 24986740 PMCID: PMC4083129 DOI: 10.1186/1471-2431-14-166] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 06/25/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mental disorders in childhood have a considerable health and societal impact but the associated negative consequences may be ameliorated through early identification of risk and protective factors that can guide health promoting and preventive interventions. The objective of this study was to inform health policy and practice through identification of demographic, familial and environmental factors associated with emotional or behavioural problems in middle childhood, and the predictors of resilience in the presence of identified risk factors. METHODS A cohort of 706 mothers followed from early pregnancy was surveyed at six to eight years post-partum by a mail-out questionnaire, which included questions on demographics, children's health, development, activities, media and technology, family, friends, community, school life, and mother's health. RESULTS Although most children do well in middle childhood, of 450 respondents (64% response rate), 29.5% and 25.6% of children were found to have internalising and externalising behaviour problem scores in the lowest quintile on the NSCLY Child Behaviour Scales. Independent predictors for problem behaviours identified through multivariable logistic regression modelling included being male, demographic risk, maternal mental health risk, poor parenting interactions, and low parenting morale. Among children at high risk for behaviour problems, protective factors included high maternal and child self-esteem, good maternal emotional health, adequate social support, good academic performance, and adequate quality parenting time. CONCLUSIONS These findings demonstrate that several individual and social resilience factors can counter the influence of early adversities on the likelihood of developing problem behaviours in middle childhood, thus informing enhanced public health interventions for this understudied life course phase.
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Affiliation(s)
- Jason L Cabaj
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sheila W McDonald
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Raguz N, McDonald SW, Metcalfe A, O’Quinn C, Tough SC. Mental health outcomes of mothers who conceived using fertility treatment. Reprod Health 2014; 11:19. [PMID: 24581007 PMCID: PMC3996036 DOI: 10.1186/1742-4755-11-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 02/21/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To compare the proportion of women with self-reported depression and anxiety symptoms at four months postpartum between mothers of singletons who conceived spontaneously and mothers who conceived with the aid of fertility treatment. METHODS The sample used for this study was drawn from The "All Our Babies Study", a community-based prospective cohort of 1654 pregnant women who received prenatal care in Calgary, Alberta. This analysis included women utilizing fertility treatment and a randomly selected 1:2 comparison group. The data was collected via three questionnaires, two of which were mailed to the participants during pregnancy and one at four months postpartum. Symptoms of depression and anxiety at four months postpartum were measured using the Edinburg Postnatal Depression Scale and the Spielberger State Anxiety Inventory. Secondary outcomes of parenting morale and perceived stress were also evaluated. Descriptive statistics were used to characterize the population. Chi square tests and in cases of small cell sizes, Fisher Exact Tests were used to assess differences in postpartum mental health symptomatology between groups. RESULTS Seventy-six participants (5.9%) conceived using a form of fertility treatment. At four months postpartum, no significant differences were observed in the proportions reporting excessive depression symptoms (2.6% vs. 5.3%, p = 0.50), anxiety (8.1% vs. 16.9%, p = 0.08) or high perceived stress scores (7.9% vs. 13.3%, p = 0.23). Women who conceived with fertility treatment were less likely to score low on parenting morale compared to women who conceived spontaneously and this was particularly evident in primiparous women (12.5% vs. 33.8%, p = 0.01). There were no group differences in proportions reporting low parenting morale in multiparous women. CONCLUSION This study suggests that at four months postpartum, the proportion of women who experience elevated symptoms of depression, anxiety or perceived stress do not differ between mothers who conceive using fertility treatment and those who conceive spontaneously. Parenting morale at four months postpartum is significantly lower in primiparous mothers conceiving spontaneously compared to those who conceive with fertility treatment.
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Affiliation(s)
- Nikolett Raguz
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Sheila W McDonald
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Candace O’Quinn
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Hooge SL, Benzies KM, Mannion CA. Effects of a Brief, Prevention-Focused Parenting Education Program for New Mothers. West J Nurs Res 2014; 36:957-74. [DOI: 10.1177/0193945913519871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated the effects of a parenting program, Baby and You, on parenting knowledge, parenting morale, and social support using a single-group, pre-test, and post-test design with 159 Canadian mothers of infants aged 2 to 9 months old. Baby and You is a prevention-focused parenting program (PFPP) to improve maternal and infant health through education and social support. The 4-week curriculum focuses on infant development and safety, parent–child relationships, maternal self-care, and community resources. We computed repeated-measures ANOVAs separately for scores on Parenting Knowledge Scale, Parenting Moral Index, and Family Support Scale. We found a significant increase between pre-test and post-test on parenting knowledge, but not parenting morale or social support. Parenting morale may be a stable construct that shows little change over time. It may take more than 4 weeks of programming for mothers to identify and integrate new sources of social support.
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Parfitt Y, Pike A, Ayers S. Infant Developmental Outcomes: A Family Systems Perspective. INFANT AND CHILD DEVELOPMENT 2013. [DOI: 10.1002/icd.1830] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ylva Parfitt
- School of Psychology; University of Sussex; Brighton UK
| | - Alison Pike
- School of Psychology; University of Sussex; Brighton UK
| | - Susan Ayers
- School of Health Sciences; City University London; London UK
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Benediktsson I, McDonald SW, Vekved M, McNeil DA, Dolan SM, Tough SC. Comparing CenteringPregnancy® to standard prenatal care plus prenatal education. BMC Pregnancy Childbirth 2013; 13 Suppl 1:S5. [PMID: 23445830 PMCID: PMC3561159 DOI: 10.1186/1471-2393-13-s1-s5] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ishizaki Y, Nagahama T, Kaneko K. Mental health of mothers and their premature infants for the prevention of child abuse and maltreatment. Health (London) 2013. [DOI: 10.4236/health.2013.53a081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Street drug use during pregnancy: potential programming effects on preschool wheeze. J Dev Orig Health Dis 2012; 4:191-9. [DOI: 10.1017/s2040174412000670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Street drug use during pregnancy is detrimental to fetal development. Although the prevalence of wheeze is high in offspring of substance-abusing mothers, nothing is known about the role of street drug use during pregnancy in its development. We investigated the impact of maternal street drug use and distress during pregnancy on the development of wheeze and allergy in preschool children. Questionnaire data were accessed from the Community Perinatal Care trial of 791 mother–child pairs in Calgary, Alberta. Using logistic regression, the association between maternal substance use and distress during pregnancy, and wheeze and allergy at age 3 years was determined in boys and girls. After adjusting for alcohol use during pregnancy, pre- and postnatal tobacco use, preterm birth, duration of exclusive breastfeeding, daycare attendance and maternal socioeconomic status, maternal street drug use during pregnancy [odds ratio (OR): 5.02, 95% confidence interval (CI): 1.30–19.4] and severe maternal distress during pregnancy (OR: 5.79, 95% CI: 1.25–26.8) were associated with wheeze in girls. In boys, an independent association was found between severe distress during pregnancy (OR: 3.85, 95% CI: 1.11–13.3) and allergies, but there was no association with maternal street drug use. In conclusion, we found an association between maternal street drug use and wheeze in preschool girls that could not be accounted for by maternal distress, smoking or alcohol use during pregnancy. Prenatal programming effects of street drugs may explain this association.
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Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev 2012; 43:683-714. [PMID: 22407278 DOI: 10.1007/s10578-012-0291-4] [Citation(s) in RCA: 429] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Infant development plays a foundational role in optimal child development and health. Some studies have demonstrated an association between maternal psychological distress and infant outcomes, although the main emphasis has been on postpartum depression and infant-maternal attachment. Prevention and early intervention strategies would benefit from an understanding of the influence of both prenatal and postpartum maternal distress on a broader spectrum of infant developmental outcomes. We conducted a systematic review of studies assessing the effect of prenatal and postpartum maternal psychological distress on five aspects of infant development: global; cognitive; behavioral; socio-emotional; and psychomotor. These findings suggest that prenatal distress can have an adverse effect on cognitive, behavioral, and psychomotor development, and that postpartum distress contributes to cognitive and socio-emotional development.
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Wilson C, Thompson L, McConnachie A, Wilson P. Matching parenting support needs to service provision in a universal 13-month child health surveillance visit. Child Care Health Dev 2012; 38:665-74. [PMID: 21916930 DOI: 10.1111/j.1365-2214.2011.01315.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Glasgow Parenting Support Framework is an intervention to support families with preschool children. It provides structured support through universal and targeted interventions. Two routine family visits by health visitors have been piloted, one involving a home assessment when the child is 13 months old. AIMS To establish the need for parenting support in the population at 13 months and whether or not the home assessment improved the match of service provision to need. METHODS Health visitors were asked to collect data on existing problems and service provision to families, the mental state of the child's principal carer, an observation of the parent-child relationship and details of management plans. Data from the Child Health Surveillance System were also used. RESULTS Data were obtained for 549 families. Nine families were noted to have problems in the parent-child relationship. Carers in these families had poorer mental health. In all, 20% of families had a revisit scheduled: they were also more likely to have poor mental health. All families with possible problems in the relationship had a revisit scheduled. Depression scores measured during the pilot were a significant predictor of revisiting and referral, with an odds ratio of 1.37 for every one point increase in score on the Adult Wellbeing Scale depression subscale. CONCLUSIONS Current service provision matches need to some extent but routine visits focused on parenting difficulties at 13 months, particularly parental depression, may help to identify families needing support who would not otherwise have received it.
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Pritchard MA, Colditz PB, Cartwright D, Gray PH, Tudehope D, Beller E. Six-week postnatal depression predicts parenting stress profiles in mothers of preterm children. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.710832] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Margo A. Pritchard
- a Women’s and Newborn Services, Royal Brisbane Wome’s Hospital and The University of Queensland Centre for Clinical Research , Herston , Australia
| | - Paul B. Colditz
- b The University of Queensland Centre for Clinical Research , Herston , Australia
| | - David Cartwright
- c Women’s and Newborn Services, Royal Brisbane Women’s Hospital , Herston , Australia
| | - Peter H. Gray
- d Newborn Services, Mater Mothers’ Hospital , South Brisbane , Australia
| | - David Tudehope
- e Division of Neonatology, Mater Mothers’ Hospital , South Brisbane , Australia
| | - Elaine Beller
- f Centre for Research in Evidenc-Based Practice, Bond University , Robina , Australia
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McDonald S, Wall J, Forbes K, Kingston D, Kehler H, Vekved M, Tough S. Development of a prenatal psychosocial screening tool for post-partum depression and anxiety. Paediatr Perinat Epidemiol 2012; 26:316-27. [PMID: 22686383 DOI: 10.1111/j.1365-3016.2012.01286.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-partum depression (PPD) is the most common complication of pregnancy in developed countries, affecting 10-15% of new mothers. There has been a shift in thinking less in terms of PPD per se to a broader consideration of poor mental health, including anxiety after giving birth. Some risk factors for poor mental health in the post-partum period can be identified prenatally; however prenatal screening tools developed to date have had poor sensitivity and specificity. The objective of this study was to develop a screening tool that identifies women at risk of distress, operationalized by elevated symptoms of depression and anxiety in the post-partum period using information collected in the prenatal period. METHODS Using data from the All Our Babies Study, a prospective cohort study of pregnant women living in Calgary, Alberta (N = 1578), we developed an integer score-based prediction rule for the prevalence of PPD, as defined as scoring 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) at 4-months postpartum. RESULTS The best fit model included known risk factors for PPD: depression and stress in late pregnancy, history of abuse, and poor relationship quality with partner. Comparison of the screening tool with the EPDS in late pregnancy showed that our tool had significantly better performance for sensitivity. Further validation of our tool was seen in its utility for identifying elevated symptoms of postpartum anxiety. CONCLUSION This research heeds the call for further development and validation work using psychosocial factors identified prenatally for identifying poor mental health in the post-partum period.
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Affiliation(s)
- Sheila McDonald
- Department of Paediatrics Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Apter G, Devouche E, Gratier M, Valente M, Nestour AL. What lies behind postnatal depression: is it only a mood disorder? J Pers Disord 2012; 26:357-67. [PMID: 22686224 DOI: 10.1521/pedi.2012.26.3.357] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Postnatal depression (PND) is a common condition that has been extensively researched specifically because of its negative impact on the mother-infant relationship. Psychiatric research has looked at comorbidity of major depressive disorder and found it to be strongly associated with Axis II disorders. This study's principal aim was to investigate whether there is a greater incidence of personality disorder (PD) among a PND population than among a non-PND population at 3 months postpartum. A secondary aim was to define the different types of PD. Depression was assessed with the Montgomery and Asberg Depression Rating Scale (MADRS), and PD was assessed with the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) in 109 women with their 12-week-old infants. Twice as many depressed mothers had PD. The PND group presented a greater number of severe clinical symptoms than the nondepressed group (p < .002). Further research is necessary to reexamine the heterogeneity of PND and reassess its impact on infant development.
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Lee G, McCreary L, Kim MJ, Park CG, Yang S. Individual and Environmental Factors Influencing Questionable Development among Low-income Children: Differential Impact during Infancy versus Early Childhood. J Korean Acad Nurs 2012; 42:1039-49. [DOI: 10.4040/jkan.2012.42.7.1039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gyungjoo Lee
- College of Nursing, University of Illinois at Chicago, Chicago, USA
| | - Linda McCreary
- College of Nursing, University of Illinois at Chicago, Chicago, USA
| | - Mi Ja Kim
- College of Nursing, University of Illinois at Chicago, Chicago, USA
| | - Chang Gi Park
- Office of Research Facilitation, University of Illinois at Chicago, Chicago, USA
| | - Soo Yang
- College of Nursing, The Catholic University of Korea, Seoul, Korea
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Foulkes M. Enablers and barriers to seeking help for a postpartum mood disorder. J Obstet Gynecol Neonatal Nurs 2011; 40:450-7. [PMID: 21771070 DOI: 10.1111/j.1552-6909.2011.01264.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore the barriers and enablers identified by women experiencing a postpartum mood disorder (PPMD) that preclude and facilitate their help-seeking behaviors for this often devastating illness. DESIGN A qualitative study using a grounded theory approach. SETTING Well-Baby Clinics offered through the Public Health Department, Early Years Centres, Mothercraft, and a Parent Resource Centre in a large Canadian city. PARTICIPANTS Ten women who had either been formally diagnosed as having a PPMD or who self-identified as experiencing a constellation of symptoms indicative of a PPMD. METHODS Interviews that were transcribed verbatim and analyzed using a grounded theory approach as described by Strauss and Corbin. RESULTS The core category of "having postpartum" captured the essence of women's experiences in seeking help for a PPMD. Women identified four main stressors that contributed to their development of a PPMD, two barrier categories, and an enabler category that influenced their help-seeking behaviors. Through navigation of formal and informal help, women were able to begin to reclaim the mothering instincts they had lost to mental illness. CONCLUSIONS Pregnancy, birth, and becoming a mother collectively represent a critical period of physical and emotional upheaval in a woman's life. The need for a holistic care approach that supports the emotional and physical health of the dyad is imperative.
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Affiliation(s)
- Michelle Foulkes
- Child and Adolescent Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
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Lung FW, Shu BC, Chiang TL, Lin SJ. Maternal mental health and childrearing context in the development of children at 6, 18 and 36 months: a Taiwan birth cohort pilot study. Child Care Health Dev 2011; 37:211-23. [PMID: 21083687 DOI: 10.1111/j.1365-2214.2010.01163.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study investigated a possible pathway of the childrearing context and maternal mental health at 6 months, and how these factors influence children's development at 6, 18 and 36 months. METHODS Using random sampling, 2048 children and mothers were selected. The mother's health status was evaluated using the Taiwanese version of the 36-Item Short Form Health Survey (SF-36), and infant development was assessed using the high reliable Taiwan birth cohort study instrument. All data were collected using parental self-report, and were analysed using multiple linear regression analysis and further pathway using structural equation modelling. RESULTS This study showed that 12 factors effected children's development at 6 months, and some dissipated with growth. Of these, maternal education had an enduring effect on different domains of child development, and this effect intensified as the child grew older. Children who grew up in a family with more siblings would show a delay in language development at 6 months; they have a delay in motor and social development at 18 and 36 months. Additionally, maternal mental health effected the children's fine motor development at 6 months. However, this effect disappeared at 18 months, and influenced children's social development at 36 months. CONCLUSIONS This study demonstrated that the development of children at as young as 6 months is affected by various factors. These factors may dissipate, continue to influence child development up to 3 years of age, turn from being disadvantageous to beneficial, or affect different domains of child development. Also, parental self-report instrument might be has its limitation and could be contributed by several confounding factors. Thus, continuous longitudinal follow-up on changes in maternal conditions, family factors, and environmental factors is vital to understand how these early infantile factors affect each other and influence the developmental trajectories of children into early childhood.
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Affiliation(s)
- F-W Lung
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
The present study examined the risk of mental disorders within the first 3 postpartum years in a nationally representative sample and the sociodemographic risk factors for mental illness in early motherhood. Women aged 18 to 55 years were asked, "Are you pregnant at this time?" at baseline. A total of 13,839 women answered, with 365 of these women reporting pregnancy. Mental disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV version. After adjusting for sociodemographics, postpartum women were found to be at lower risk than non-postpartum women for having several first onset mental disorders (adjusted odds ratio range: 0.49-0.58). Postpartum women with a history of mental illness were at lower risk for the onset of any mental disorder (adjusted odds ratio: 0.60, 95% confidence interval: 0.39-0.91). No sociodemographic correlates of mental disorders were identified. Clinicians should be aware of these findings when counseling women about mental disorder risk postbirth.
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Lung FW, Chiang TL, Lin SJ, Feng JY, Chen PF, Shu BC. Gender differences of children's developmental trajectory from 6 to 60 months in the Taiwan Birth Cohort Pilot Study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:100-106. [PMID: 20932715 DOI: 10.1016/j.ridd.2010.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 09/07/2010] [Indexed: 05/30/2023]
Abstract
The parental report instrument is the most efficient developmental detection method and has shown high validity with professional assessment instruments. The reliability and validity of the Taiwan Birth Cohort Study (TBCS) 6-, 18- and 36-month scales have already been established. In this study, the reliability and validity of the 60-month scale was tested. The gender differences in children's longitudinal gross motor, fine motor, language and social development were also investigated. Using the dataset from the Taiwan Birth Cohort Pilot Study (TBCS-p), 2048 infants were followed up when they were 6-, 18-, 36- and 60-month-old. At the final stage, 1620 children were followed up. Development of the children was measured using the TBCS 6-, 18-, 36-, and 60-month developmental scales. The reconstructed TBCS 60-month scale yielded 16 items measuring children's development in the four dimensions of gross motor, fine motor, language and social. The scale yielded an internal consistency of 0.39-0.71. Structural equation modeling also showed good construct and predictive validity, in that the 6-, 18-, and 36-month scales were predictive of the 60-month scale. No gender differences between the gross motor dimension was found. Gender had an effect on the fine motor dimension at 36 and 60 months, language dimension at 36 months, and social dimension at 18, 36 and 60 months. Gender had a transient effect in language development and social development a continuous effect from 18 to 60 months. Thus different gender norms may need to be established to prevent misdiagnosis. The TBCS scale is a valid and reliable developmental screening instrument that can be used in continuous surveillance of children's development in community and clinical settings from 6 months to 5 years of age.
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Affiliation(s)
- For-Wey Lung
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
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Tough SC, Siever JE, Benzies K, Leew S, Johnston DW. Maternal well-being and its association to risk of developmental problems in children at school entry. BMC Pediatr 2010; 10:19. [PMID: 20338052 PMCID: PMC2858134 DOI: 10.1186/1471-2431-10-19] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 03/25/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children at highest risk of developmental problems benefit from early identification and intervention. Investigating factors affecting child development at the time of transition to school may reveal opportunities to tailor early intervention programs for the greatest effectiveness, social benefit and economic gain. The primary objective of this study was to identify child and maternal factors associated with children who screened at risk of developmental problems at school entry. METHODS An existing cohort of 791 mothers who had been followed since early pregnancy was mailed a questionnaire when the children were aged four to six years. The questionnaire included a screening tool for developmental problems, an assessment of the child's social competence, health care utilization and referrals, and maternal factors, including physical health, mental health, social support, parenting morale and sense of competence, and parenting support/resources. RESULTS Of the 491 mothers (62%) who responded, 15% had children who were screened at high risk of developmental problems. Based on a logistic regression model, independent predictors of screening at high risk for developmental problems at age 5 were male gender (OR: 2.3; 95% CI: 1.3, 4.1), maternal history of abuse at pregnancy (OR: 2.4; 95% CI: 1.3, 4.4), and poor parenting morale when the child was 3 years old (OR: 3.9; 95% CI: 2.1, 7.3). A child with all of these risk factors had a 35% predicted probability of screening at high risk of developmental problems, which was reduced to 13% if maternal factors were favourable. CONCLUSIONS Risk factors for developmental problems at school entry are related to maternal well being and history of abuse, which can be identified in the prenatal period or when children are preschool age.
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Affiliation(s)
- Suzanne C Tough
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jodi E Siever
- Public Health Innovation and Decision Support, Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Shirley Leew
- Decision Support Research Team, Alberta Health Services, Calgary, Alberta, Canada
| | - David W Johnston
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Behavioural Research Unit, Alberta Children's Hospital, Calgary, Alberta, Canada
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Affiliation(s)
- Gayle Restall
- Department of Occupational Therapy, School of Medical Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
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50
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O'Connor TG. Applying the basics. J Child Psychol Psychiatry 2009; 50:879-80. [PMID: 19659709 DOI: 10.1111/j.1469-7610.2009.02142.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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