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Pnishi I, Shala M, Morina N, Maercker A, Heim E. Cultural concepts of distress among Albanian young adults living in Switzerland - a qualitative study. Front Psychol 2024; 15:1321452. [PMID: 38770258 PMCID: PMC11104449 DOI: 10.3389/fpsyg.2024.1321452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Objectives Existing research recognizes the critical role that social, sociodemographic, and acculturative processes play in increasing vulnerability for experiencing psychological distress among second-generation migrants. However, to date, far too little attention has been given to the study of psychological distress in this social group. The main objective of this study is to examine cultural identities, as well as expressions and causes of psychological distress among second-generation Albanian-speaking migrants in Switzerland. Methods Semi-structured qualitative interviews were conducted with 13 Albanian-speaking participants between 19 and 35 years of age using the interview of the Barts Explanatory Model Inventory. Data were analyzed by qualitative content analysis using MAXQDA-2018 software. Findings Study participants showed bicultural identities, which caused value conflicts and a feeling of being "caught" between Swiss and Albanian culture. Some participants experienced the fear of disappointing their parents. Others find it difficult to deal with conflicting norms and values. Parentification was another important cause within their cultural concept of distress. At the same time, (implicit) social support, i.e., spending time with the family and the community, was an important coping mechanism. Conclusion Second-generation immigrants are exposed to specific risk factors for psychological distress. A better understanding of these risk factors and their coping mechanisms is essential for providing them with meaningful support services, both in prevention and psychotherapy.
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Affiliation(s)
- Imer Pnishi
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zürich, Switzerland
| | - Mirëlinda Shala
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zürich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zürich, Switzerland
| | - Eva Heim
- Institute of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zürich, Switzerland
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Parviainen H, Kiviruusu O, Lämsä R, Skogberg N, Castaneda AE, Santalahti P. Psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived asylum-seeking children in Finland. Child Psychiatry Hum Dev 2023; 54:1699-1709. [PMID: 35587841 PMCID: PMC10582122 DOI: 10.1007/s10578-022-01371-2] [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: 07/11/2021] [Revised: 03/11/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
This study examined psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived accompanied asylum-seeking children in the age groups of 2-6 years (n = 93) and 7-12 years (n = 91). Children and parents were assessed using mental health and trauma measures (SDQ, HSCL-25 and PROTECT). The prevalence of total difficulties was 34.9% among 2-6-year-olds and 29.6% among 7-12-year-olds. The most common symptoms in both age groups were peer problems, followed by conduct problems among 2-6-year-olds and emotional symptoms among 7-12-year-olds. In both age groups, the children's emotional symptoms were associated with the parents' anxiety and depression as well as the trauma symptoms, while the conduct problems were only associated with the parents' trauma symptoms. In conclusion, peer problems as well as conduct problems and emotional symptoms are common among recently arrived asylum-seeking children. To support the mental health of these children, both children and parents need adequate support.
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Affiliation(s)
- Heidi Parviainen
- Department of Public Health, University of Turku, FI-20014, Turku, Finland.
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Olli Kiviruusu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Riikka Lämsä
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Natalia Skogberg
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anu E Castaneda
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Päivi Santalahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Child Psychiatry, University of Turku, Turku, Finland
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Suleri A, White T, Blok E, Cecil CAM, Reiss I, Jaddoe VWV, Gigase FAJ, Hillegers MHJ, de Witte L, Bergink V, Rommel AS. The Association Between Prenatal Infection and Adolescent Behavior: Investigating Multiple Prenatal, Perinatal, and Childhood Second Hits. J Am Acad Child Adolesc Psychiatry 2023; 62:1340-1350. [PMID: 37400063 PMCID: PMC10981534 DOI: 10.1016/j.jaac.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/25/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Exposure to infections during pregnancy may be a potential risk factor for later psychopathology, but large-scale epidemiological studies investigating associations between prenatal infection and long-term offspring behavioral problems in the general population are scarce. In our study, we aimed to investigate the following: (1) the association between prenatal infection and adolescent behavior, (2) putative underlying pathways (mediation), and (3) "second hits" interacting with prenatal infection to increase the risk of adolescent behavior problems (moderation). METHOD Our study was embedded in a prospective Dutch pregnancy cohort (Generation R; n = 2,213 mother-child dyads). We constructed a comprehensive prenatal infection score comprising common infections for each trimester of pregnancy. At age 13 to 16 years, we assessed total, internalizing, and externalizing problems, and autistic traits using the Child Behavioral Checklist and the Social Responsiveness Scale, respectively. We investigated maternal lifestyle and nutrition, perinatal factors (placental health and delivery outcomes), and child health (lifestyle, traumatic events, infections) as mediators and moderators. RESULTS We observed associations of prenatal infection with adolescent total behavioral, internalizing, and externalizing problems. The association between prenatal infection and internalizing problems was moderated by higher levels of maternal psychopathology, alcohol and tobacco use, and a higher number of traumatic childhood events. We found no association between prenatal infection and autistic traits. Yet, children exposed to prenatal infections and maternal substance use, and/or traumatic childhood events, had a higher risk of autistic traits in adolescence. CONCLUSION Prenatal infection may be a risk factor for later psychiatric problems as well as a disease primer making individuals susceptible to other hits later in life. STUDY PREREGISTRATION INFORMATION Prenatal maternal infection and adverse neurodevelopment: a structural equation modelling approach to downstream environmental hits; https://osf.io/cp85a; cp85a. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants.
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Affiliation(s)
- Anna Suleri
- Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Tonya White
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elisabet Blok
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Irwin Reiss
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - F A J Gigase
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Lot de Witte
- Erasmus University Medical Center, Rotterdam, the Netherlands; Icahn School of Medicine at Mount Sinai, New York
| | - Veerle Bergink
- Erasmus University Medical Center, Rotterdam, the Netherlands; Icahn School of Medicine at Mount Sinai, New York
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Bektas G, Boelsma F, Gündüz M, Klaassen EN, Seidell JC, Wesdorp CL, Dijkstra SC. A qualitative study on the perspectives of Turkish mothers and grandmothers in the Netherlands regarding the influence of grandmothers on health related practices in the first 1000 days of a child's life. BMC Public Health 2022; 22:1364. [PMID: 35842646 PMCID: PMC9287533 DOI: 10.1186/s12889-022-13768-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the importance of the first 1000 days of a child's life in terms of laying the foundations for healthy growth and development, parents are a logical target group for supporting health-related practices with regard to young children. However, little attention is paid to the influence of the wider social community on the health and development of young children during this crucial period. This includes grandmothers, who often have a significant influence on health-related practices of their grandchildren. The aim of this study was therefore to explore the influence of grandmothers on health related practices of their grandchildren during the first 1000 days, from the perspectives of both grandmothers and mothers with a Turkish background. METHOD This qualitative study in the Netherlands collected data during focus group discussions with grandmothers (N = 3), interviews with grandmothers (N = 18) and interviews with mothers (N = 16), all with a Turkish background. Data was collected in the period between June 2019 and April 2021 and analysed using a thematic content analysis. RESULTS The influence of grandmothers and the wider social community on health related practices during the first 1000 days of a child's life is substantial and self-evident. The support of grandmothers is often rooted in various socio-cultural norms and practices. The mothers of young children can experience the guidance and pressure they receive from grandmothers and the wider social community as quite stressful. Conflicting views and practices tend to arise between grandmothers and mothers when a grandmother babysits. Both mothers and grandmothers often find it difficult to discuss these differences openly, for fear this might lead to a family conflict. CONCLUSION This study shows that grandmothers and the wider social community play an influential role in supporting a healthy first 1000 days of a child's life. The strong involvement of grandmothers may lead to tension between the mothers and grandmothers when their ideas about healthy practices are not in agreement and may lead to unhealthy practices. In targeting this wider social community, it is important to consider the various socio-cultural factors that underlie the advice, support, practices and beliefs of the individuals involved.
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Affiliation(s)
- Gülcan Bektas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, BT, 1081, Amsterdam, the Netherlands.
| | - Femke Boelsma
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, BT, 1081, Amsterdam, the Netherlands
| | - Meryem Gündüz
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067, SM, Amsterdam, the Netherlands
| | - Eva N Klaassen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, BT, 1081, Amsterdam, the Netherlands
| | - Carline L Wesdorp
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, BT, 1081, Amsterdam, the Netherlands
| | - S Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, BT, 1081, Amsterdam, the Netherlands.
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Sim A, Georgiades K. Neighbourhood and family correlates of immigrant children's mental health: a population-based cross-sectional study in Canada. BMC Psychiatry 2022; 22:447. [PMID: 35790945 PMCID: PMC9254422 DOI: 10.1186/s12888-022-04096-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Immigrant children exhibit significant variation in their mental health outcomes despite disproportionate exposure to socio-economic adversity compared to their non-immigrant peers. Identifying aspects of neighbourhood and family contexts that are most salient for immigrant children's mental health can help to inform and target interventions to prevent mental disorder and promote mental well-being among this population. METHODS The study analyzed multi-informant data from 943 first- and second-generation immigrant caregiver and child dyads from the Hamilton Youth Study, a representative sample of immigrant and non-immigrant families in Hamilton, Ontario. Multivariate multilevel regression models examined associations between neighbourhood and family characteristics and processes, and parent and child self reports of internalizing and externalizing problems. RESULTS Positive and negative parenting behaviours were significantly associated with internalizing and externalizing problems, with negative parenting demonstrating associations with externalizing problems across both parent and child reports (b = 0.26-1.27). Neighbourhood social disorder and parental trauma exposure were associated with greater internalizing and externalizing problems, and neighbourhood immigrant concentration was associated with fewer externalizing problems for parent reports only. Adding parental distress and parenting behaviour to the models reduced the coefficients for parental trauma exposure by 37.2% for internalizing problems and 32.5% for externalizing problems and rendered the association with neighbourhood social disorder non-significant. Besides the parenting variables, there were no other significant correlates of child-reported internalizing and externalizing problems. CONCLUSIONS Results highlight the importance of parenting behaviour and parental experiences of trauma and distress for immigrant children's mental health. While not unique to immigrants, the primacy of these processes for immigrant children and families warrants particular attention given the heightened risk of exposure to migration-related adverse experiences that threaten parental and family well-being. To prevent or mitigate downstream effects on child mental health, it is imperative to invest in developing and testing trauma-informed and culturally responsive mental health and parenting interventions for immigrant families.
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Affiliation(s)
- Amanda Sim
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, The Offord Centre for Child Studies, Hamilton, ON, Canada.
| | - Katholiki Georgiades
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, The Offord Centre for Child Studies, Hamilton, ON Canada
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Supporting parents and healthy behaviours through parent-child meetings - a qualitative study in the Netherlands. BMC Public Health 2021; 21:1169. [PMID: 34144699 PMCID: PMC8211718 DOI: 10.1186/s12889-021-11248-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023] Open
Abstract
Background The first 2 years of a child’s life have been found to be crucial to healthy growth and development. Parent support groups can help parents to promote health-related behaviours during this crucial period. The aim of this study was to explore the experiences of parents who participated in a parent support group (Parent-Child Meetings) which promoted health-related behaviours of their children, and to determine whether and how these meetings supported them in promoting these behaviours. Methods We used a qualitative study design. The parent support group consisted of weekly Parent-Child Meetings organized in a multi-ethnic, relatively low-income neighbourhood in Amsterdam, the Netherlands. Data on the experiences of parents was collected through participatory observations, informal conversations (n = 30 sessions) and semi-structured interviews (n = 13) between April 2019 and March 2020. The data was analysed using thematic content analysis. Results Parents indicated that they experienced the parent-child meetings as enjoyable and as providing them with socio-emotional support. They reported that the meetings increased their parenting knowledge, skills and practices regarding healthy behaviours of their children and that they used this knowledge in their daily lives. They also appreciated the practical information and advice provided by experts in the meetings. Parents indicated that the positive attitude of the experts was crucial in accepting and adopting their advice. Additionally, parents valued the interactive and hands-on workshops, which integrated health-related behaviours and active play with children, as it enabled them to learn while they played with their children. Conclusion This study indicated that parent-child meetings contributed to enhancing parental knowledge, skills and practices regarding healthy behaviours of their children. This could potentially benefit the health of children during the first 2 years of their lives. In particular, the peer support of other parents, the hands-on workshops, and the concrete advice and information provided in an informal setting were highly valued by parents. Future parent support groups could use these findings to improve their meetings or to start meetings that better suit the needs of parents with young children. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11248-z.
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Qureshi F, Derks IPM, Williams MA, Koenen KC, Tiemeier H, Kubzansky LD. Adverse intergenerational effects of ethnically-divisive social contexts on children's mental health: A prospective cohort study in the Netherlands. Soc Sci Med 2021; 277:113932. [PMID: 33892415 DOI: 10.1016/j.socscimed.2021.113932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/04/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Around the world, international migration and growing economic inequality have contributed to heightened perceptions of intergroup threat (i.e., feeling that people outside of one's social group are hostile to their physical or emotional well-being). Exposures related to intergroup threat, like negative intergroup contact, are inherently stressful and may contribute to higher levels of psychological distress in the population. This longitudinal study investigated whether maternal experiences of negative intergroup contact are related to poor mental health outcomes among ethnically diverse children in The Netherlands. METHODS Data are from 4025 mother-child pairs in the Generation R Study, a multi-ethnic Dutch birth cohort initiated in 2005. Mothers' experiences of negative intergroup contact were assessed during pregnancy. Child mental health was indexed by problem behavior reported by parents and teachers using the Child Behavior Checklist. Linear mixed-effects models tested longitudinal associations of maternal-reported negative intergroup contact with child problem behavior reported by mothers at ages 3, 5, and 9 years, considering a range of potential confounders. Sensitivity analyses examined whether results were replicated using child data from other informants. RESULTS In fully adjusted models, higher levels of negative intergroup contact were associated with more problem behavior averaged across childhood for both non-Dutch (standardized B = 0.10, 95% CI = 0.05, 0.14) and Dutch children (standardized B = 0.12, 95% CI = 0.08, 0.15). Sensitivity analyses with data from other informants largely supported primary findings. CONCLUSIONS Comparable adverse intergenerational effects on mental health were observed among both ethnic minority and majority children whose mothers experienced negative intergroup contact. These findings suggest that ethnically divisive social contexts may confer widespread risks, regardless of a child's ethnic background. To our knowledge, this study is the first to examine exposures related to intergroup threat from an epidemiologic perspective and provides proof of principle that such exposures may be informative for population health.
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Affiliation(s)
- Farah Qureshi
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, United States.
| | - Ivonne P M Derks
- Erasmus Medical Center, The Generation R Study Group, Rotterdam, the Netherlands; Erasmus University, Department of Psychology, Education and Child Studies, Rotterdam, the Netherlands
| | - Michelle A Williams
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, United States
| | - Karestan C Koenen
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, United States
| | - Henning Tiemeier
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, United States
| | - Laura D Kubzansky
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, United States
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Brager J, Breitenstein SM, Miller H, Gross D. Low-Income Parents' Perceptions of and Engagement With a Digital Behavioral Parent Training Program: A Mixed-Methods Study. J Am Psychiatr Nurses Assoc 2021; 27:33-43. [PMID: 31509052 DOI: 10.1177/1078390319872534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Parent training is a method for strengthening parenting skills, reducing child behavior problems, and promoting positive parent-child relationships. However, few parents have access to these evidence-based programs. The ezParent program, a tablet-based delivery adaptation of the group-based Chicago Parent Program, is a parent training program designed to address the needs of families raising young children in urban poverty. AIMS: This study aimed to explore (a) parents' perceptions of the benefits and barriers associated with their use of the ezParent program and (b) the ways in which the ezParent components and perceived usability varied by program use (module completion). METHOD: An explanatory mixed-methods design was used with the overall intent to use the qualitative data to help explain in greater detail the quantitative results. RESULTS: Fifty-nine parents of 2- to 5-year-old children from two pediatric primary care clinics serving predominantly low-income and racial/ethnic minority families in Chicago (Cohort 1) and Baltimore (Cohort 2) participated in follow-up interviews. Among those interviewed, 23 (38.9.5%) parents completed all six modules and 12 parents (20.3%) completed none of the modules. However, of those 12, 8 (67%) logged in to the program and completed portions of Module 1. Parents who completed more modules reported more program benefits, and those who completed fewer modules reported more barriers. CONCLUSIONS: Exploring users' experience with current digital applications, researchers and application developers can better design future tablet-based interventions to be both effective and acceptable by consumers.
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Affiliation(s)
- Jenna Brager
- Jenna Brager, PhD, RN, LifeBridge Health-Sinai Hospital, Baltimore, MD, USA
| | - Susan M Breitenstein
- Susan M. Breitenstein, PhD, RN, FAAN, The Ohio State University, Columbus, OH, USA
| | - Hailey Miller
- Hailey Miller, BSN-RN, Johns Hopkins University, Baltimore, MD, USA
| | - Deborah Gross
- Deborah Gross, DNSc, RN, FAAN, Johns Hopkins University, Baltimore, MD, USA
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Bektas G, Boelsma F, Baur VE, Seidell JC, Dijkstra SC. Parental Perspectives and Experiences in Relation to Lifestyle-Related Practices in the First Two Years of a Child's Life: A Qualitative Study in a Disadvantaged Neighborhood in The Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165838. [PMID: 32806644 PMCID: PMC7460357 DOI: 10.3390/ijerph17165838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
The first two years of a child's life are a critical period in preventing several lifestyle-related health problems. A qualitative study was conducted to explore parental experiences and perspectives in relation to lifestyle-related child-rearing practices in order to minimize risk factors at an early stage. Data were collected through interviews (n = 25) and focus groups (n = 4) with parents of children aged 0-2 years, in a disadvantaged neighborhood in Amsterdam, the Netherlands. Results showed that parents were often uncertain about a number of lifestyle-related practices. Ambiguity also appeared regarding the parents' intentions to engage in certain practices and what they were able to achieve in everyday life. In addition, parents experienced strong sociocultural influences from their family, which interfered with their ability to make their own decisions on lifestyle-related practices. Parents also expressed a need for peer-support and confirmation of their practices. Future studies should focus on supporting parents in their parental practices during the first two years of their child's life. Any such study should take into account the specific sociocultural context accompanying lifestyle-related parental practices.
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Affiliation(s)
- Gülcan Bektas
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands; (F.B.); (J.C.S.)
- Correspondence: (G.B.); (S.C.D.); Tel.: +31-20-598-28-02 (G.B.); +31-20-598-61-28 (S.C.D.)
| | - Femke Boelsma
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands; (F.B.); (J.C.S.)
| | - Vivianne E. Baur
- Department of Care Ethics, University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD Utrecht, The Netherlands;
| | - Jacob C. Seidell
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands; (F.B.); (J.C.S.)
| | - S. Coosje Dijkstra
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands; (F.B.); (J.C.S.)
- Correspondence: (G.B.); (S.C.D.); Tel.: +31-20-598-28-02 (G.B.); +31-20-598-61-28 (S.C.D.)
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Klein EM, Müller KW, Wölfling K, Dreier M, Ernst M, Beutel ME. The relationship between acculturation and mental health of 1st generation immigrant youth in a representative school survey: does gender matter? Child Adolesc Psychiatry Ment Health 2020; 14:29. [PMID: 32695221 PMCID: PMC7368737 DOI: 10.1186/s13034-020-00334-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although gender plays a pivotal role in the psychological adaptation of immigrant youth, its association with acculturation strategy and mental health among 1st generation immigrant adolescents are still scarce and inconsistent. Therefore, the purpose of the current study was to investigate gender-related differences in acculturation patterns and their association with mental health (internalizing and externalizing problems). METHODS Self-reported data of immigrant adolescents (N = 440) aged between 12 and 19 years (M = 16.2; SD = 1.6) was collected in a representative German school survey. Fifty-one percent of the sample were female (n = 224). Almost half of the sample was born in the Former Soviet Union, followed by Poland (9.3%). Sociodemographic variables, acculturation strategies, and internalizing as well as externalizing problems were assessed by questionnaires. RESULTS Confirmatory factor analysis supported the four- dimensional model of acculturation styles (assimilation, integration, separation and marginalization). Whereas girls more often showed an integration pattern, boys scored higher on the separation and marginalization scale. After adjusting for age and educational level, regression analyses revealed for both gender that marginalization was associated with more internalizing problems. Separation was related to more externalizing problems. CONCLUSION 1st generation adolescents experiencing a lack of belongingness to German society, socio-economic and educational disadvantages might be particularly vulnerable to mental distress. Findings are discussed in terms of gender-related differential socialization processes in context of immigration.
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Affiliation(s)
- Eva M. Klein
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Kai W. Müller
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Klaus Wölfling
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Michael Dreier
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Mareike Ernst
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Manfred E. Beutel
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
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Klein EM, Brähler E, Petrowski K, Tibubos AN, Ernst M, Wiltink J, Michal M, Wild PS, Schulz A, Münzel T, König J, Lackner K, Pfeiffer N, Beutel ME. The association between recalled parental rearing behavior and depressiveness: a comparison between 1st immigrants and non-immigrants in the population-based Gutenberg Health Study. BMC Psychiatry 2020; 20:367. [PMID: 32660581 PMCID: PMC7358206 DOI: 10.1186/s12888-020-02755-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies in immigrant youth have suggested differences in parenting patterns by immigration status. Knowledge of variation in recalled parenting pattern and its distinctive impact on mental health in adult immigrants, however, is limited. Therefore, the purpose of the current study was to investigate similarities and differences in recalled maternal and paternal rearing behavior and its association with depressiveness in adult 1st generation immigrants compared to non-immigrants. METHODS Seven hundred and forty-three 1st generation immigrants (M = 57.4, SD = 10.1 years) and 6518 non-immigrants (M = 60.3, SD = 10.7 years) participated in a population-based study. Regarding countries of origin, the largest subgroups were immigrants from Eastern-Europe, Former-SU, and Arabic-Islamic countries. All participants completed the ultra-short version of The Recalled Parental Rearing Behavior-questionnaire and the PHQ-9 assessing depressiveness. Multiple linear regressions with depressiveness as outcome variable were analyzed separately for each facet of parental rearing behavior adjusting for socio-demographic and migration-related variables. RESULTS In addition to differences in depressiveness and socioeconomic status, 1st generation immigrants recalled both their mothers and fathers as more controlling and overprotecting than non-immigrants. Parental emotional warmth was negatively associated with depressiveness across all groups. The relationship between parental control, respectively parental rejection and depressiveness, however, varied in direction and severity between the groups. CONCLUSION The results support the notion that parental warmth is a universal protective factor against depressiveness, whereas the impact of parental control on mental health might be more culturally influenced. Analyses point to the importance of considering the unique contribution of fathers' rearing behavior on mental health, particularly in immigrant samples.
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Affiliation(s)
- Eva M. Klein
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Elmar Brähler
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Katja Petrowski
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,grid.410607.4Medical Psychology and Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Ana N. Tibubos
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Mareike Ernst
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Jörg Wiltink
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Matthias Michal
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Philipp S. Wild
- grid.410607.4Preventive Cardiology and Preventive Medicine, Department of Medicine 2, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,grid.410607.4Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Andreas Schulz
- grid.410607.4Preventive Cardiology and Preventive Medicine, Department of Medicine 2, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Thomas Münzel
- grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany ,grid.410607.4Center for Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Jochem König
- grid.410607.4Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Karl Lackner
- grid.410607.4Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Norbert Pfeiffer
- grid.410607.4Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Manfred E. Beutel
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
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Neece CL, Chan N, Klein K, Roberts L, Fenning RM. Mindfulness-Based Stress Reduction for Parents of Children with Developmental Delays: Understanding the Experiences of Latino Families. Mindfulness (N Y) 2018; 10:1017-1030. [PMID: 31191735 DOI: 10.1007/s12671-018-1011-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parents of children with developmental delays (DD) report elevated mental health difficulties compared to parents of children with typical development, which appear largely associated with child behavior problems. Latino parents of children with DD may experience heightened risk for poor mental health outcomes due additional stressors associated with minority status. Mindfulness-Based Stress Reduction (MBSR) appears to be efficacious for reducing parenting stress and improving wellbeing in families of children with DD; however, studies have rarely focused on families from racial and ethnic minority backgrounds. The current study employed a mixed-methods, waitlist-control design to examine the efficacy of MBSR for improving parent and child outcomes in Latino and non-Latino families. Results indicate that MBSR is similarly efficacious for Latino and non-Latino families in improving parent mental health (parenting stress, depressive symptomatology, and life satisfaction) and reducing parent-reported child behavior problems. Qualitative analyses further highlight avenues for improving the efficacy of MBSR for Latino families by providing intervention directly in Spanish, rather than using translation services, for Spanish-speaking families. Findings reveal the efficacy of standard MSBR for Latino parents of children with DD and underscore the potential benefits of disseminating this practice to traditionally underrepresented families.
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Kim THM, Deol S, Lee M, Tamim H. Characteristics of Physical Aggression in Children of Immigrant Mothers and Non-immigrant Mothers: A Cross-Sectional Analysis of the Survey of Young Canadians. J Immigr Minor Health 2018; 21:56-65. [PMID: 29435947 DOI: 10.1007/s10903-018-0712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Physical aggression (PA) is important to regulate as early as the preschool years in order to ensure healthy development of children. This study aims to determine the prevalence and characteristics of PA in children of immigrant and non-immigrant mothers. Secondary data analysis was conducted using the nationwide 2010 Survey for Young Canadians, limited to children 4-9 years of age. Bivariate and multivariable logistic regression was performed, with the outcome, PA, and covariates including maternal, child, household and neighbourhood characteristics. Twenty percent of children of non-immigrant mothers and 16% of children of immigrant mothers reported PA. The only common characteristic of PA between children of non-immigrant (Adj OR 1.44, 95% CI 1.09-1.89) and immigrant mothers (Adj OR 2.08, 95% CI 1.07-4.03) was viewing violent movies/shows. The characteristics of PA differ between children of immigrant versus non-immigrant mothers therefore healthcare providers, policy makers, and researchers should be mindful to address PA in these two groups separately, and find ways to tailor current recommended coping strategies and teach children alternative ways to solve problems based on their needs.
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Affiliation(s)
- Theresa H M Kim
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada. .,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada.
| | - Sukhleen Deol
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada
| | - Monica Lee
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada
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Abstract
The specificity principle in acculturation science asserts that specific setting conditions of specific people at specific times moderate specific domains in acculturation by specific processes. Our understanding of acculturation depends critically on what is studied where, in whom, how, and when. This article defines, explains, and illustrates the specificity principle in acculturation science. Research hypotheses about acculturation can be more adequately tested, inconsistencies and discrepancies in the acculturation literature can be satisfactorily resolved, acculturation interventions can be tailored to be more successful, and acculturation policies can be brought to new levels of effectiveness if the specificity principle that governs acculturation science is more widely recognized.
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Affiliation(s)
- Marc H Bornstein
- Child and Family Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
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Schmidt S, Nag HE, Hunn BS, Houge G, Hoxmark LB. A structured assessment of motor function and behavior in patients with Kleefstra syndrome. Eur J Med Genet 2016; 59:240-8. [PMID: 26808425 DOI: 10.1016/j.ejmg.2016.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 12/12/2022]
Abstract
The present study aimed to further our understanding of Kleefstra syndrome, especially regarding motor function and behavioral characteristics. In total, four males and four females between two and 27 years of age with a genetically confirmed diagnosis of Kleefstra syndrome and their parents participated in this study. Four patients had 9q34.3 deletions that caused Euchromatin Histone Methyl Transferase 1 (EHMT1) haplo-insufficiency, and four patients harbored EHMT1 mutations. The motor function was evaluated via systematic observation. Standardized assessments such as the Vineland Adapted Behavior Scales II (VABS II), the Social Communication Questionnaire (SCQ) and the Child or Adult Behavior Checklist (CBCL, ABCL) were used for the behavioral assessment. All patients showed a delayed developmental status. Muscular hypotonia and its manifestations were present in all patients, regardless of their age. The mean values for all VABS II domains (communication, socialization, daily living skills, and motor skills) were significantly lower than the mean of the reference population (p < 0.001), but similar to other rare intellectual disabilities such as Smith-Magenis syndrome and Angelman syndrome. The results from the SCQ indicated that all patient values exceeded the cut-off value, suggesting the possibility of autism spectrum disorder. The behavioral and emotional problems assessed by CBCL and ABCL were less frequent. In conclusion, patients with Kleefstra syndrome present with a broad range of clinical problems in all age groups and are therefore in need of a multidisciplinary follow-up also after their transition into adulthood.
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Affiliation(s)
| | - Heidi E Nag
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - Bente S Hunn
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - Gunnar Houge
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lise B Hoxmark
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway.
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Belhadj Kouider E, Koglin U, Petermann F. Emotional and behavioral problems in migrant children and adolescents in Europe: a systematic review. Eur Child Adolesc Psychiatry 2014; 23:373-91. [PMID: 24132833 DOI: 10.1007/s00787-013-0485-8] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
Abstract
Based on findings of Stevens and Vollebergh [69], who analyzed cross-cultural topics, this review considers the current prevalence of emotional and behavioral problems of native children and adolescents in comparison with children with a migration background in European countries. 36 studies published from 2007 up to 2013 chosen from a systematic literature research were included and analyzed in their perspective design in detail. Previous studies showed great differences in their results: Especially in Germany, many studies compare the heterogeneous group of immigrant children with native children to analyze an ethnic minority or migration process effect. Only a British and Turkish study demonstrates the selection effect in migration. Most Dutch or British studies examined different ethnic groups, e.g. Turkish, Moroccan, Surinamese, Pakistani, Indian or Black migrant children and adolescents. Migrant childhood in Europe could be declared a risk in increasing internalizing problem behavior while the prevalent rate in externalizing problem behavior was comparable between native and migrant children. A migration status itself can often be postulated as a risk factor for children's mental condition, in particular migration in first generation. Furthermore, several major influence factors in migrant children's mental health could be pointed out, such as a low socio-economic status, a Non-European origin, an uncertain cultural identity of the parents, maternal harsh parenting or inadequate parental occupation, a minority status, the younger age, gender effects or a specific culture declaration in diseases.
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Affiliation(s)
- Esmahan Belhadj Kouider
- Center for Clinical Psychology and Rehabilitation, University Bremen, Grazer Str. 6, 28359, Bremen, Germany,
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Interethnische Analysen der Verteilungen psychischer Störungen bei Kindern und Jugendlichen in einer Inanspruchnahmepopulation. Prax Kinderpsychol Kinderpsychiatr 2014; 63:272-288. [PMID: 26444530 DOI: 10.13109/prkk.2014.63.4.272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Interethnic Analyses of Distributions in Children and Adolescents Mental Disorders in a Health Care Utilization The study examines ethnic differences in mental disorders in a child and adolescent psychiatry population in a major German city from 2007 to 2011 (N = 5,680). Risks of developing specific mental disorders were calculated. African migrant children and adolescents showed higher risk in traumatic stress and adjustment disorders (F 43 in ICD-10), the Asiatic group in dissociative disorders (F 44-45). Compared to other European migrants the German children and adolescents without migration background had a higher risk of affective disorders (F 3). Adolescents (N = 3,556) with Russian and Polish background had a higher risk of disorders induced by psychotropic substances (F 1). Turkish and Arabic adolescents had a 4- to 5-times increasing risk in schizophrenia as well as schizotypal or delusional disorders (F 2). In addition, mental disorders were influenced by gender and nationality. These study results suggest that a different vulnerability to specific mental disorders is associated to ethnicity.
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18
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Secondos. PSYCHOTHERAPEUT 2014. [DOI: 10.1007/s00278-014-1037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Marquis WA, Baker BL. An examination of Anglo and Latino parenting practices: relation to behavior problems in children with or without developmental delay. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:383-392. [PMID: 24334227 DOI: 10.1016/j.ridd.2013.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/13/2013] [Indexed: 06/03/2023]
Abstract
The transactional model of development has received empirical support in research on at-risk children. However, little is known about the role of ethnicity or child delay status (i.e., developmental delay [DD] or typical cognitive development [TD]) in the process of parents adapting to their child's behavior problems and special needs. We examined whether Latina (N=44) and Anglo (N=147) mothers of 3-year-old children with or without DD differed in their use of two parenting practices, maternal scaffolding and sensitivity. We also examined how the status and ethnic groups differed in child behavior problems at ages 3 and 5 and whether parenting predicted change in behavior problems over time in the ethnic and status groups. Analyses generally supported previous research on status group differences in behavior problems (DD higher) and parenting practices (TD higher). Parenting practices predicted a decrease in externalizing problems from child age 3 to 5 years among Latino families only. Child developmental status was not associated with change in behavior problems. Cultural perspectives on the transactional model of development and implications for intervention are discussed.
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Affiliation(s)
- Willa A Marquis
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA.
| | - Bruce L Baker
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA
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Flink IJE, Prins RG, Mackenbach JJP, Jaddoe VW, Hofman A, Verhulst FC, Tiemeier H, Raat H. Neighborhood ethnic diversity and behavioral and emotional problems in 3 year olds: results from the Generation R Study. PLoS One 2013; 8:e70070. [PMID: 23967068 PMCID: PMC3743872 DOI: 10.1371/journal.pone.0070070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 06/16/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Studies suggest that neighborhood ethnic diversity may be important when it comes to understanding ethnic inequalities in mental health. The primary aim of this study was to investigate whether neighborhood ethnic diversity moderated the association between the ethnic minority status and child behavioral and emotional problems. METHODS We included 3076 preschoolers participating in the Generation R Study, a birth cohort study in Rotterdam, the Netherlands. At child age 3-years, parents completed the Child Behavior Checklist (CBCL/1,5-5). Individual-level data, assessed with questionnaires, was combined with neighborhood-level data. Multi-level logistic regression models predicted the Odds Ratios for the CBCL total problems score as a function of maternal ethnic background and neighborhood ethnic diversity, computed with the Racial Diversity Index and categorized into tertiles. Interaction on the additive scale was assessed using Relative Access Risk due to Interaction. RESULTS Being from an ethnic minority was associated with child behavioral and emotional problems in unadjusted (OR 2.76, 95% CI 1.88-4.04) and adjusted models (OR 2.64, 95% CI 1.79-3.92). Residing in a high diversity neighborhood was associated with child behavioral and emotional problems in unadjusted (OR 2.03, 95% CI 1.13-3.64) but not in adjusted models (OR 0.89, 95% CI 0.51-1.57). When stratifying by the three levels of neighborhood ethnic diversity, ethnic inequalities in behavioral and emotional problems were greatest in low diversity neighborhoods (OR 5.24, 95%CI 2.47-11.14), smaller in high diversity neighborhoods (OR 3.15, 95% CI 1.66-5.99) and smallest in medium diversity neighborhoods (OR 1.59, 95% CI 0.90-2.82). Tests for interaction (when comparing medium to low diversity neighborhoods) trended towards negative on both the additive and multiplicative scale for the maternal-report (RERI: -3.22, 95% CI -0.70-0.59; Ratio of ORs: 0.30, 95% CI 0.12-0.76). CONCLUSION This study suggests that ethnic inequalities in child behavioral and emotional problems may be greatest in ethnically homogeneous neighborhoods.
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Affiliation(s)
- Ilse J E Flink
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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