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Li R, Xiao W, Wu J, Zhou Y, Zha J, Wang D, Xing T, Wan Y. Patterns of maternal adverse childhood experiences and the intergenerational association of preschool children's emotional and behavioral problems. Front Psychiatry 2024; 15:1431475. [PMID: 39193581 PMCID: PMC11347350 DOI: 10.3389/fpsyt.2024.1431475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
Introduction Children of whose mothers exposed to adverse childhood experiences (ACEs) are at increased risk for developmental problems. This study aims to investigate the relationship between types and patterns of maternal ACEs and preschool children's emotional and behavioral problems (EBPs) in China, and to explore gender differences associated with these problems. Methods In this cross-sectional study, we selected 9,647 children from 36 preschools in three cities of Anhui province, China. Questionnaires were used to report the details of maternal ACEs and children's EBPs. We used the latent class analysis (LCA) to identify "patterns" in the types of maternal ACEs. Binomial logistic regressions was performed to examine the relationship between types and patterns of maternal ACEs and preschoolers' EBPs. Results Latent class analysis (LCA) revealed four different classes of maternal ACEs. Logistic regression analysis showed that compared with the low ACEs class, children of mothers in the high abuse and neglect class had the highest risk of developing EBPs (OR = 5.93, 95%CI: 4.70-7.49), followed by moderate ACEs class (OR = 2.44, 95%CI: 1.98-3.00), and high household dysfunction class (OR = 2.16, 95%CI: 1.19-3.90). We found gender differences in the effects of high abuse and neglect/moderate ACEs class and maternal childhood physical abuse/neglect on children's EBPs, which had a stronger impact on EBPs in boys than girls (P<0.05). Discussion This study supports and refines existing research that confirms an intergenerational association between types and patterns of maternal ACEs and children's EBPs in a large Chinese sample, so as to provide references for the early prevention and control of children's EBPs.
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Affiliation(s)
- Ruoyu Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wan Xiao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Jun Wu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yang Zhou
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Jinhong Zha
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Danni Wang
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Tian Xing
- Key Laboratory of Oral Disease Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Li R, Jia L, Zha J, Wang X, Huang Y, Tao X, Wan Y. Association of maternal and paternal adverse childhood experiences with emotional and behavioral problems among preschool children. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02542-3. [PMID: 39126496 DOI: 10.1007/s00787-024-02542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
Although maternal adverse childhood experiences (ACEs) are known to be related to the emotional and behavioral problems (EBPs) of offspring, few studies have surveyed the intergenerational effects of paternal ACEs. In addition, no study has yet explored the combination and interaction effects of maternal and paternal ACEs on preschool children's EBPs in China, and the gender differences in these relationships also remain to be explored. A total of 3,575 preschool children from 12 preschools from Hefei city of Anhui province were included in this study. We used a binomial logistic regression to examine the relationship between maternal ACEs, paternal ACEs and children's EBPs. Logistic regression analysis indicated that maternal and paternal ACEs were significantly related to EBPs in children, respectively. The high maternal ACEs + high paternal ACEs group had the greatest association with children's EBPs. Interaction analysis results showed that, compared with the reference group (low maternal ACEs×low paternal ACEs), the other group (high maternal ACEs×high paternal ACEs ) were significantly related to children's EBPs (OR = 1.84, 95%CI: 1.55-2.19). We found that there were no gender differences in the combination and interaction effects (P>0.05). When fathers and mothers were jointly exposed to high levels of ACEs, children had a higher risk of developing EBPs than when they were exposed independently. Future studies should fully explore the intergenerational health effects of parental ACEs so that references for promoting the physical and mental health of preschool children can be developed.
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Affiliation(s)
- Ruoyu Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China
| | - Liyuan Jia
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China
| | - Jinhong Zha
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China
| | - Xiaoyan Wang
- Hefei Women and Children Medical Care Center, Hefei, China
| | - Yongling Huang
- Anhui Women and Children Medical Care Center, Hefei, China
| | - Xingyong Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China.
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.
- Anhui Provincial Key Laboratory of Environment and Population Health Across the Life Course, Hefei, Anhui, China.
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Loheide-Niesmann L, Riem MME, Cima M. The impact of maternal childhood maltreatment on child externalizing behaviour and the mediating factors underlying this association: a three-level meta-analysis and systematic review. Eur Child Adolesc Psychiatry 2024; 33:2445-2470. [PMID: 36463548 DOI: 10.1007/s00787-022-02117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
Child maltreatment can negatively impact not only survivors but also survivors' children. However, research on the intergenerational effect of maternal childhood maltreatment on child externalizing behaviour has yielded contradictory results and has not yet been systematically synthesised. The current three-level meta-analysis and systematic review aimed to provide a quantitative estimate of the strength of the association between maternal childhood maltreatment and child externalizing behaviour and to summarise research on potential mediating factors of this association. PsycINFO, PubMed, and Embase were searched and 39 studies with 82 effects sizes were included in the meta-analysis. Results revealed a small significant association between maternal childhood maltreatment and child externalizing behaviour (r = 0.16; 95% CI 0.12-0.19; publication bias-adjusted effect size: r = 0.12, 95% CI 0.08-0.16). Maternal mental health, particularly depressive symptoms, maternal parenting and children's maltreatment exposure were the most frequently examined mediators of this association, with relatively robust mediating effects for children's maltreatment exposure and maternal depressive symptoms, but mixed evidence for the mediating role of maternal parenting. This meta-analysis provides evidence for a small but significant association between maternal childhood maltreatment and children's externalizing behaviour, emphasizing the need to develop effective preventive and intervention strategies to minimise the effects of childhood maltreatment on the next generation.
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Affiliation(s)
- Lisa Loheide-Niesmann
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, The Netherlands.
| | - Madelon M E Riem
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, The Netherlands
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Maaike Cima
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, The Netherlands
- VIGO, Juvenile Youth Institutions (YouthCarePLUS), Nijmegen, The Netherlands
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Grafft N, Lo B, Easton SD, Pineros-Leano M, Davison KK. Maternal and Paternal Adverse Childhood Experiences (ACEs) and Offspring Health and Wellbeing: A Scoping Review. Matern Child Health J 2024; 28:52-66. [PMID: 37914980 DOI: 10.1007/s10995-023-03825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are common, often co-occur, and are associated with poor health outcomes across the life course. Emerging research has emphasized the lasting consequences of ACEs across generations, suggesting parental ACEs are associated with poor physical and mental health outcomes in children. However, the individual effects of fathers' ACEs and pathways of transmission remain unclear. A scoping review was conducted to summarize the current knowledgebase of the intergenerational consequences of parental ACEs on offspring health, clarify pathways of transmission, understand how ACEs are operationalized in the intergenerational literature, and identify gaps in knowledge. METHODS Six electronic databases were searched for articles published in English from 1995 to 2022 relating to the long-term consequences of parental ACEs on offspring physical and mental health. Articles underwent title, abstract, and full-text review by two investigators. Content analysis was performed to integrate findings across the included studies. RESULTS The search yielded 14,542 unique articles; 49 met the inclusion criteria. Thirty-six articles focused exclusively on mothers, one solely on fathers, and 12 included both mothers and fathers in their analyses. Six studies used an expanded definition of ACEs. Both direct and indirect associations between parental ACEs and poor offspring outcomes were identified, primarily through biological and psychosocial pathways. CONCLUSIONS Findings underscore the importance and oversight of fathers and the need to solidify a unified definition and measure of ACEs. This review identified modifiable protective factors (social support, father involvement) and pathways of transmission (parental mental health, parenting); both having important implications for intervention development.
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Affiliation(s)
- Natalie Grafft
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA.
| | - Brian Lo
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA
| | - Scott D Easton
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA
| | - Maria Pineros-Leano
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA
| | - Kirsten K Davison
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 20467, USA
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Zhang L, Mersky JP, Gruber AMH, Kim JY. Intergenerational Transmission of Parental Adverse Childhood Experiences and Children's Outcomes: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3251-3264. [PMID: 36205317 DOI: 10.1177/15248380221126186] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents' ACEs on children's outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children's outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children's outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018-2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children's outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children's outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.
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Bränn E, Vaina A, Daníelsdóttir HB, Thordardottir EB, Yang Q, Jakobsdóttir J, Aspelund T, Hauksdóttir A, Valdimarsdóttir UA, Lu D. Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland. Arch Womens Ment Health 2023; 26:839-849. [PMID: 37726573 PMCID: PMC10632282 DOI: 10.1007/s00737-023-01369-2] [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: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
Emerging data suggest that certain adverse childhood experiences (ACEs) are associated with perinatal depression (PND). However, few studies have comprehensively assessed the cumulative number and types of ACEs and their association to PND. We conducted a cross-sectional analysis among 16,831 female participants from the Stress-And-Gene-Analysis (SAGA) cohort in Iceland, 2018. ACEs were surveyed with the World Health Organization ACE-International questionnaire, while PND symptoms were assessed using the Edinburgh Postnatal Depression Scale (lifetime version). We, while adjusting for confounding factors, estimated the prevalence ratio (PR) of PND in relation to total number of ACEs using the Poisson quasi-likelihood model and further performed analyses for type-specific ACEs. At a mean age of 44 years (SD ± 11.1), 6,201 (36.8%) participants had experienced probable PND. Total number of ACEs was positively associated with PND (PR 1.11 per ACE, 95% CI: 1.10-1.11), also among women without any psychiatric comorbidities (PR 1.13, 95% CI: 1.11-1.14). PRs increased in a dose-response manner with the number of ACEs (P for trend < 0.001); women that endorsed 5 or more ACEs were twice as likely to have experienced PND (PR 2.24, 95% CI: 2.09-2.41). All ACE types (n = 13) were associated with PND, with most pronounced association for emotional neglect by a guardian (PR 1.53, 95% CI: 1.47-1.59). Our findings suggest a positive association between number of ACEs and PND symptoms. If our results are confirmed with prospective data, healthcare providers need to be alert of the risk of PND among expecting mothers with history of ACEs.
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Affiliation(s)
- Emma Bränn
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Alexandra Vaina
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Qian Yang
- Department of Medicine, Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
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Kim AW, Rieder AD, Cooper-Vince CE, Kakuhikire B, Baguma C, Satinsky EN, Perkins JM, Kiconco A, Namara EB, Rasmussen JD, Ashaba S, Bangsberg DR, Tsai AC, Puffer ES. Maternal adverse childhood experiences, child mental health, and the mediating effect of maternal depression: A cross-sectional, population-based study in rural, southwestern Uganda. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:19-31. [PMID: 37212482 PMCID: PMC10524293 DOI: 10.1002/ajpa.24758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/09/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health. METHODS Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis. RESULTS Among 218 mother-child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership. CONCLUSIONS Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families.
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Affiliation(s)
- Andrew Wooyoung Kim
- Department of Anthropology, University of California, Berkeley, California, USA
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amber D Rieder
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Jessica M Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Institute of Global Health, Nashville, Tennessee, USA
| | - Allen Kiconco
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, USA
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Eve S Puffer
- Duke Global Health Institute, Durham, North Carolina, USA
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Johnson SL, Kim ET, Rieder AD, Green EP, Finnegan A, Chase RM, Zayzay J, Puffer ES. Pathways from parent mental health to child outcomes in Liberia: Testing cross-sectional and longitudinal serial mediation models. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bilge Y, Yılmaz M, Hüroğlu G, Akan Tikici Z. The Effects of Adverse Childhood Experiences and Early Maladaptive Schemas on Relationship Obsessive–Compulsive Disorder. TRENDS IN PSYCHOLOGY 2022. [DOI: 10.1007/s43076-022-00245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Huang KY, Kumar M, Cheng S, Urcuyo AE, Macharia P. Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review. BMC Health Serv Res 2022; 22:1373. [PMID: 36401323 PMCID: PMC9675248 DOI: 10.1186/s12913-022-08673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
AIM Adolescents in low-and-middle-income countries (LMICs) are facing numerous developmental, sexual and reproductive health (SRH) challenges including exposure to multidimensional violence. Gender-based violence (GBV) specifically intimate partner violence (IPV) are both highly prevalent in LMICs and are strongly linked with poor SRH outcomes. However, GBV and IPV interventions have not yet been adequately integrated in SRH due to individual, social, cultural, service, and resource barriers. To promote long-term SRH, a more holistic approach that integrates GBV and IPV, and adolescent development needs is imperative. Digital health has the potential to address multiple service setup, provision, and addressing access barriers through designing and providing integrated SRH care. However, there are no guidelines for an integrated digital SRH and development promotion for adolescents in LMICs. METHODS An umbrella review was conducted to synthesize evidence in three inter-related areas of digital health intervention literature: (i) SRH, (ii) GBV specifically IPV as a subset, and (iii) adolescent development and health promotion. We first synthesize findings for each area of research, then further analyze the implications and opportunities to inform approaches to develop an integrated intervention that can holistically address multiple SRH needs of adolescents in LMICs. Articles published in English, between 2010 and 2020, and from PubMed were included. RESULTS Seventeen review articles met our review inclusion criterion. Our primary finding is that application of digital health strategies for adolescent SRH promotion is highly feasible and acceptable. Although effectiveness evidence is insufficient to make strong recommendations for interventions and best practices suggestions, some user-centered design guidelines have been proposed for web-based health information and health application design for adolescent use. Additionally, several digital health strategies have also been identified that can be used to further develop integrated GBV-IPV-SRH-informed services to improve adolescent health outcomes. We generated several recommendations and strategies to guide future digital based SRH promotion research from our review. CONCLUSIONS Rigorous research that focuses on intervention effectiveness testing using a combination of digital health strategies and standardized albeit contextualized outcome measures would be important. Methodological improvement such as adoption of longitudinal experimental design will be crucial in generating evidence-based intervention and practice guidelines for adolescents in LMICs.
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Affiliation(s)
- Keng-Yen Huang
- Department of Population Health, New York University School of Medicine, 227 East 30Th Street, 7Th Floor, New York, NY 10016 USA
| | - Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Sabrina Cheng
- Department of Population Health, New York University School of Medicine, 227 East 30Th Street, 7Th Floor, New York, NY 10016 USA
| | - Anya Elena Urcuyo
- Department of Psychology, Florida International University, Miami, USA
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Wang X, Yin G, Guo F, Hu H, Jiang Z, Li S, Shao Z, Wan Y. Associations of Maternal Adverse Childhood Experiences with Behavioral Problems in Preschool Children. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20311-NP20330. [PMID: 34652992 DOI: 10.1177/08862605211050093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Investigations have found maternal adverse childhood experiences (ACEs) cause an intergenerational danger to their children's health. However, no study has investigated the effects of maternal ACEs on behavioral problems of preschool children in China and gender differences on these effects. This paper aims to investigate the role of maternal ACEs on behavioral problems of preschool children in China and explore gender differences as related to these behavioral problems. Stratified cluster sampling method was used to select 7318 preschool children from 12 districts in Hefei city, China. A questionnaire survey was conducted to collect information on maternal exposure to ACEs and Conners' Parent Rating Scales. Logistic regression was used to analyze the relationship between maternal ACEs and children's behavioral problems. The prevalence of behavioral problems in preschool children was 16.0%, while it was higher among girls (18.4%) than boys (13.92%) (χ2 = 27.979, p < 0.001). The rate of behavioral problems in children in the group of mothers with ACEs was higher than those without ACEs (all p < 0.05). Maternal ACEs were associated with increased risk of the behavior problems in preschool children (adjusted OR 2.91, 95% CI 2.45-3.45), and no gender difference (in girls 3.01, 2.38-3.81, in boys 2.79, 2.17-3.58, respectively) was found. Maternal ACEs were associated with increased risk of each type of the behavioral problems of preschool children, except that maternal emotional neglect was not associated with psycho-physical problems, impulse-activities, and anxiety. The only gender differences found were higher conduct problems related to maternal emotional abuse and ACEs and higher anxiety related to maternal physical abuse and community violence in girls compared with boys. Mothers exposured to ACEs are more likely to have children with behavioral health problems in preschool period. Further research is needed to explore the mechanisms by which maternal ACEs influence children's behavioral problems.
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Affiliation(s)
- Xiaoyan Wang
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Gangzhu Yin
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Feng Guo
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Haili Hu
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Zhicheng Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Shuqin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Ziyu Shao
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
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Lee N, Massetti GM, Perry EW, Self-Brown S. Adverse Childhood Experiences and Associated Mental Distress and Suicide Risk: Results From the Zambia Violence Against Children Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP21244-NP21265. [PMID: 34906001 PMCID: PMC9192820 DOI: 10.1177/08862605211056726] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose: Adverse childhood experiences (ACEs) are a global public health concern. Little research exists on the prevalence and health consequences of ACEs in Zambia. The current study examined associations between individual and cumulative ACEs, mental distress, and suicide risk among Zambian youth. Methods: Data from Zambia Violence Against Children and Youth Survey were used (18-24 years old, n=1034). Bivariate and adjusted logistic models were performed with independent variables (i.e., experienced physical violence (PV), sexual violence (SV), and emotional violence (EV); witnessed intimate partner violence (IPV) and community violence (CV); orphan status; cumulative ACE exposure) and dependent variables (i.e., mental distress and suicide risk). Adjusted models controlled for demographic and social characteristics. Results: 76.8% of Zambian youth experienced one or more ACEs, and more than 30% witnessed CV (38.4%) or IPV (30.2%), or experienced PV (35.1%), prior to age 18. 27.5% were orphans, and less than 20% experienced EV (17.3%) or SV (15.4%) in childhood. 42.4% experienced mental distress in the past 30 days, and 12.5% reported lifetime suicidal thoughts or suicide attempts. PV, EV, cumulative ACE exposure, older age, being single, and stronger friendships were significantly related to experiencing mental distress. Cumulative ACEs exposure was associated with significantly higher suicide risk. Conclusions: Preventing ACEs can reduce mental distress and suicide risk among Zambian youth. Youth with cumulative ACE exposure can be prioritized for mental health intervention. More research is warranted to investigate the broad-based prevention of ACEs, especially PV and EV, and protective factors that can promote resilience among youth who have experienced ACEs.
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Affiliation(s)
- NaeHyung Lee
- Copial Business Strategists, Chamblee, GA, USA
- School of Public Health, Georgia State University, Atlanta, GA, USA
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Greta M. Massetti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth W. Perry
- School of Public Health, Georgia State University, Atlanta, GA, USA
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Shannon Self-Brown
- School of Public Health, Georgia State University, Atlanta, GA, USA
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA
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Street Children in Ghana's Golden Triangle Cities: Mental Health Needs and Associated Risks. Child Psychiatry Hum Dev 2022; 53:840-851. [PMID: 34350504 DOI: 10.1007/s10578-021-01223-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
More than 61,000 persons below the age of 18 are living on the streets in the Greater Accra region in Ghana. Street children is a hidden vulnerable population and a global public health issue in the world, but little is known about their mental health and health needs, and mechanisms that contribute to their poor health. With a lack of mental health research to guide intervention or psychoeducation programme and policy planning, this study aimed to address these research gaps by examining prevalence of mental health problems and a set of associated risk factors (i.e. Perceived quality of life, and social connection). In addition, we examined whether the associations between risk factors and mental health problems were moderated by demographic and contextual factors (i.e., gender, age, work status, reason for living on street, number of years in street). Two hundred and seven children between age 12 and 18 who lived on the street in three cities (Accra, Sekondi Takoradi, and Kumasi) were recruited. Data were gathered through adolescent survey/interviews. Multiple regression was utilized to examine risk factors and moderation effects. Results support high mental health needs among street children. Approximately 73% street children experienced moderate to severe mental health problems, and 90% experienced poor quality of life. Perceived quality/happiness of life was the strongest predictor for street children's mental health. Social connection was associated with children's mental health only in certain subgroups and contexts. This study adds new epidemiological evidence for street children, an extremely vulnerable population, in Ghana and global child and adolescent mental health.
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Psychometric properties of the ASEBA Child Behaviour Checklist and Youth Self-Report in sub-Saharan Africa - A systematic review. Acta Neuropsychiatr 2022; 34:167-190. [PMID: 35466902 DOI: 10.1017/neu.2022.5] [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] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Behavioural screening tools may be used to identify at-risk children in resource-limited settings in sub-Saharan Africa. The ASEBA forms (Child Behaviour Checklist and Youth Self-Report) are frequently translated and adapted for use in sub-Saharan African populations, but little is known about their measurement properties in these contexts. METHODS We conducted a systematic review of all published journal articles that used the ASEBA forms with sub-Saharan African samples. We evaluated the reported psychometric properties, as well as the methodological quality of the psychometric evaluations, using COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines. RESULTS Fifty-eight studies reported measurement properties of the ASEBA forms. Most studies came from Southern (n = 29, 50%) or East African (n = 25, 43%) countries. Forty-nine studies (84%) used translated versions of the tool, but details regarding the translation process, if available, were often sparse. Most studies (n = 47, 81%) only reported internal consistency (using coefficient alpha) for one or more subscale. The methodological quality of the psychometric evaluations ranged from 'very good' to 'inadequate' across all measurement properties, except for internal consistency. CONCLUSIONS There is limited good quality psychometric evidence available for the ASEBA forms in sub-Saharan Africa. We recommend (i) implementing a standardised procedure for conducting and reporting translation processes and (ii) conducting more comprehensive psychometric evaluations of the translated versions of the tools.
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Kang NR, Kwack YS, Song JK, Kim MD, Park JH, Kim BN, Moon DS. The intergenerational transmission of maternal adverse childhood experiences on offspring's psychiatric disorder and the mediating role of maternal depression: Results from a cross sectional study. Clin Child Psychol Psychiatry 2022; 27:613-629. [PMID: 34978939 DOI: 10.1177/13591045211056919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Maternal adverse childhood experiences (ACEs) may negatively affect the mental health and development of their offspring. The purpose of this study was to investigate the association of maternal ACE and offspring's psychiatric disorder and the mediating effect of maternal depression. The subjects included 463 mothers (42.78 ± 5.68 years) and their offspring aged 6-18 years (13.26 ± 3.90 years). Mothers reported their ACE before age 18 and completed the Beck Depression Inventory-II and Diagnostic Predictive Scales (DPS), a screening tool for offspring's psychiatric disorder. 35.42% of subjects had at least one ACE, and 11.0% reported three or more ACEs. Higher maternal ACE scores were associated with a significantly higher prevalence of offspring's psychiatric disorders (p < 0.001). Household dysfunction of maternal ACE (OR = 2.263, p < 0.001) is significantly associated with offspring's psychiatric disorder. In the mediation model in which the household dysfunction affects the number of offspring's psychiatric disorders, the partial mediation model through maternal depression was significant. The mother's experience of household dysfunction before the age of 18 has a significant impact on her offspring's psychiatric disorder and supported significant mediation through maternal depression. Further research is needed to determine the mechanisms of intergenerational transmission of ACE and offspring's psychopathology.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Young Sook Kwack
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Jung-Kook Song
- Department of Preventive Medicine, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Moon-Doo Kim
- Department of Psychiatry, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Joon Hyuk Park
- Department of Psychiatry, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Bung-Nyun Kim
- Department of Psychiatry, 37900Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Duk-Soo Moon
- Department of Psychiatry, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
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Pace CS, Muzi S, Rogier G, Meinero LL, Marcenaro S. The Adverse Childhood Experiences - International Questionnaire (ACE-IQ) in community samples around the world: A systematic review (part I). CHILD ABUSE & NEGLECT 2022; 129:105640. [PMID: 35662684 DOI: 10.1016/j.chiabu.2022.105640] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/01/2021] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Adverse Childhood Experiences International Questionnaire (ACE-IQ) collects additional data (e.g., witness community violence/terrorism) than the previous version. Despite ACE-IQ is widely used and validated in several languages, no reviews focus on this measure. OBJECTIVE The main goals are to: 1) synthesize the ACE-IQ prevalence rates and average means among community samples, both for total ACE and single dimensions (e.g., intrafamily abuse, bullying); 2) discuss these data in light of the characteristics of studies and samples; 3) identify main research lines of the field. PARTICIPANTS AND SETTING The search for studies using the ACE-IQ with community participants was conducted on seven academic databases, including retrieval of grey literature. The screening process led to include 63 documents. METHODS A systematic review following the PRISMA guidelines was performed. RESULTS 1) On average, 75% of community respondents experienced ACEs, with a mean of three, primarily emotional abuse and bullying. 2) Males experienced more ACEs, but they were underrepresented, as well as children and adolescents. Most studies were conducted in Asia or Africa, and different geographical areas showed different pathways of prevalence in subdimensions. 3) Most research focused on prevalence and relationships between ACE-IQ scores and respondents' mental and physical health, suicide and parenting, focusing on intrafamily ACEs more than on those outside the household. CONCLUSIONS Several issues emerged in terms of lack of reporting prevalence or means, lack of studies in Europe, America and Oceania, and no attention to collective/community/peer violence, plus a lack of consensus toward the dimensions of the ACE-IQ.
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Affiliation(s)
- Cecilia Serena Pace
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128 Genoa, Italy.
| | - Stefania Muzi
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128 Genoa, Italy
| | - Guyonne Rogier
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128 Genoa, Italy
| | - Lara Lia Meinero
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128 Genoa, Italy
| | - Sara Marcenaro
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128 Genoa, Italy
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Roberts KJ, Smith C, Cluver L, Toska E, Zhou S, Boyes M, Sherr L. Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder. AIDS Behav 2022; 26:1197-1210. [PMID: 34570313 PMCID: PMC8940800 DOI: 10.1007/s10461-021-03474-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Abstract
The mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescents living with HIV (n = 1059) and a comparison group of adolescents without HIV (n = 467) undertaken within the Eastern Cape Province, South Africa. Detailed study questionnaires included validated and study specific measures relating to HIV, adolescent motherhood, and mental health. Four self-reported measures of mental health (depressive, anxiety, posttraumatic stress, and suicidality symptomology) were used to explore the concept of likely common mental disorder and mental health comorbidities (experiencing two or more common mental disorders concurrently). Chi-square tests (Fisher’s exact test, where appropriate) and Kruskal Wallis tests were used to assess differences in sample characteristics (inclusive of mental health status) according to HIV status and motherhood status. Logistic regression models were used to explore the cross-sectional associations between combined motherhood and HIV status and, likely common mental disorder/mental health comorbidities. 70.5% of participants were living with HIV and 15.2% were mothers. 8.4% were mothers living with HIV. A tenth (10.9%) of the sample were classified as reporting a probable common mental disorder and 2.8% as experiencing likely mental health comorbidities. Three core findings emerge: (1) poor mental health was elevated among adolescent mothers compared to never pregnant adolescents (measures of likely common mental disorder, mental health comorbidities, depressive, anxiety and suicidality symptoms), (2) prevalence of probable common mental disorder was highest among mothers living with HIV (23.0%) compared to other groups (Range:8.5–12.8%; Χ2 = 12.54, p = 0.006) and, (3) prevalence of probable mental health comorbidities was higher among mothers, regardless of HIV status (HIV & motherhood = 8.2%, No HIV & motherhood = 8.2%, Χ2 = 14.5, p = 0.002). Results identify higher mental health burden among adolescent mothers compared to never-pregnant adolescents, an increased prevalence of mental health burden among adolescent mothers living with HIV compared to other groups, and an elevated prevalence of mental health comorbidities among adolescent mothers irrespective of HIV status. These findings address a critical evidence gap, highlighting the commonality of mental health burden within the context of adolescent motherhood and HIV within South Africa as well as the urgent need for support and further research to ensure effective evidence-based programming is made available for this group. Existing antenatal, postnatal, and HIV care may provide an opportunity for mental health screening, monitoring, and referral.
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Affiliation(s)
| | - Colette Smith
- Institute for Global Health, University College London, London, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Mark Boyes
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Perth, Australia
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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Cooke JE, Racine N, Pador P, Madigan S. Maternal Adverse Childhood Experiences and Child Behavior Problems: A Systematic Review. Pediatrics 2021; 148:peds.2020-044131. [PMID: 34413250 DOI: 10.1542/peds.2020-044131] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT A growing body of research has examined the role of maternal adverse childhood experiences (ACEs) on child behavior problems. OBJECTIVE To summarize the literature examining the association between maternal ACEs and child behavior problems via a systematic review. DATA SOURCES Electronic searches were conducted in Medline, PsycINFO, and Embase (1998-June 2020). Reference lists were reviewed. In total, 3048 records were screened. STUDY SELECTION Studies were included if an association between maternal ACEs and child externalizing (eg, aggression) and/or internalizing (eg, anxiety) problems was reported. In total, 139 full-text articles were reviewed for inclusion. DATA EXTRACTION Data from 16 studies met full inclusion criteria. Studies were synthesized by child externalizing and internalizing outcomes. RESULTS Maternal ACEs were significantly associated with child externalizing problems across all studies (number of studies synthesized per outcome [k] = 11). Significant associations were also found for inattention, hyperactivity, and impulsivity (k = 4), and aggression (k = 2). For internalizing problems (k = 11), significant associations were identified across 8 studies and nonsignificant associations were reported for 3 studies. Maternal ACEs were consistently associated with child anxiety and depression (k = 5). However, inconsistent findings were reported for somatization (k = 2). LIMITATIONS Results are limited to mother-child dyads and questionnaire measures of behavior problems in primarily North American countries. CONCLUSIONS Mothers' ACEs demonstrated largely consistent associations with children's behavior problems. Future research is needed to determine if specific types of maternal ACEs (eg, household dysfunction) are more strongly associated with child behavior problems.
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Affiliation(s)
- Jessica E Cooke
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Nicole Racine
- Department of Psychology, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Paolo Pador
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Canada .,Alberta Children's Hospital Research Institute, Calgary, Canada
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19
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LeMasters K, Bates LM, Chung EO, Gallis JA, Hagaman A, Scherer E, Sikander S, Staley BS, Zalla LC, Zivich PN, Maselko J. Adverse childhood experiences and depression among women in rural Pakistan. BMC Public Health 2021; 21:400. [PMID: 33632175 PMCID: PMC7905421 DOI: 10.1186/s12889-021-10409-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are a common pathway to adult depression. This pathway is particularly important during the perinatal period when women are at an elevated risk for depression. However, this relationship has not been explored in South Asia. This study estimates the association between ACEs and women's (N = 889) depression at 36 months postpartum in rural Pakistan. METHOD Data come from the Bachpan Cohort study. To capture ACEs, an adapted version of the ACE-International Questionnaire was used. Women's depression was measured using both major depressive episodes (MDE) and depressive symptom severity. To assess the relationship between ACEs and depression, log-Poisson models were used for MDE and linear regression models for symptom severity. RESULTS The majority (58%) of women experienced at least one ACE domain, most commonly home violence (38.3%), followed by neglect (20.1%). Women experiencing four or more ACEs had the most pronounced elevation of symptom severity (β = 3.90; 95% CL = 2.13, 5.67) and MDE (PR = 2.43; 95% CL = 1.37, 4.32). Symptom severity (β = 2.88; 95% CL = 1.46, 4.31), and MDE (PR = 2.01; 95% CL = 1.27, 3.18) were greater for those experiencing community violence or family distress (β = 2.04; 95%; CL = 0.83, 3.25) (PR = 1.77; 95% CL = 1.12, 2.79). CONCLUSIONS Findings suggest that ACEs are substantively distinct and have unique relationships to depression. They signal a need to address women's ACEs as part of perinatal mental health interventions and highlight women's lifelong experiences as important factors to understanding current mental health. TRIAL REGISTRATION NCT02111915 . Registered 11 April 2014. NCT02658994 . Registered 22 January 2016. Both trials were prospectively registered.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, Chapel Hill, North Carolina, USA.
| | - Lisa M Bates
- Department of Epidemiology,Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY, 10032, USA
| | - Esther O Chung
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
| | - John A Gallis
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC, 27705, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 135 College St., Suite 200, Room 230, New Haven, CT, 06510, USA
| | - Elissa Scherer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- RTI International, 3040 E Cornwallis Rd, Durham, NC, 27709, USA
| | - Siham Sikander
- Human Development Research Foundation, H 06, Street 55, Sector F-7/4, Islamabad, 44000, Pakistan
- Health Services Academy, Islamabad, Pakistan
| | - Brooke S Staley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
| | - Lauren C Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
| | - Paul N Zivich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
- Carolina Population Center, Chapel Hill, North Carolina, USA
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20
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Taha PH, Slewa-Younan S. Measures of depression, generalized anxiety, and posttraumatic stress disorders amongst Yazidi female survivors of ISIS slavery and violence. Int J Ment Health Syst 2020; 14:80. [PMID: 33292425 PMCID: PMC7654580 DOI: 10.1186/s13033-020-00412-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In 2014 the Islamic State of Iraq and Syria (ISIS) undertook a systematic and deliberate campaign against minority groups and non-Sunni Muslim communities. Amongst some of the greatest atrocities were those targeted towards Yazidi communities and in particular their women. The mental health outcomes of those women held in captivity requires investigation. This study sought to examine and compare levels of general psychological distress, depression, generalized anxiety, posttraumatic stress disorder (PTSD) and self-reported suicidal thoughts and behaviors amongst Yazidi women held in captivity compared with those without such experiences. METHOD Between January to May 2019, a total 348 Yazidi women located in internal displaced person (IDP) camps were interviewed. Of these 348, 139 females were survivors of ISIS captivity. Measures used included Kessler Psychological Distress Scale (K10), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Harvard Trauma Questionnaire part IV (HTQ part IV). RESULTS Formerly enslaved Yazidi females showed a significantly higher prevalence of severe mental distress (97.1%; P < 0.001), more severe levels of depression (36.7%; P < 0.001) and general anxiety symptoms (37.4%; P < 0.001), greater rates of PTSD (90.6%; P < 0.001) and higher reported rates of suicidal ideation (38.1%; P < 0.001). Logistic regression analysis undertaken to examine the role of sociodemographic factors as predictors of the assessed mental health conditions. Amongst the formerly enslaved group, no such significance was found, however amongst the non-enslaved group, unemployment was found to statistically determine depression, generalized anxiety and PTSD. Specifically, women from the non-enslaved group who were unemployed were 2.5 times more likely to have depression, 3 times more likely to have generalized anxiety and 3.3 times more likely to have PTSD. Finally, amongst the non-enslaved group, those women with between 5 to 8 siblings were significantly less likely to have depression than those with fewer siblings. CONCLUSION Rates of distress and trauma related symptomology were significantly higher amongst those with history of enslavement. Sociodemographic factors and duration of enslavement do not seem to predict mental disorders among enslaved females.
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Affiliation(s)
| | - Shameran Slewa-Younan
- School of Medicine, Humanitarian and Development Research Initiative, Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith South DC NSW, Sydney, 1797 Australia
- Honorary Senior Research Fellow, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Kumar M, Huang KY, Othieno C, Wamalwa D, Hoagwood K, Unutzer J, Saxena S, Petersen I, Njuguna S, Amugune B, Gachuno O, Ssewamala F, McKay M. Implementing combined WHO mhGAP and adapted group interpersonal psychotherapy to address depression and mental health needs of pregnant adolescents in Kenyan primary health care settings (INSPIRE): a study protocol for pilot feasibility trial of the integrated intervention in LMIC settings. Pilot Feasibility Stud 2020; 6:136. [PMID: 32974045 PMCID: PMC7507720 DOI: 10.1186/s40814-020-00652-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Addressing adolescent pregnancies associated health burden demands new ways of organizing maternal and child mental health services to meet multiple needs of this group. There is a need to strengthen integration of sustainable evidence-based mental health interventions in primary health care settings for pregnant adolescents. The proposed study is guided by implementation science frameworks with key objective of implementing a pilot trial testing a full IPT-G version along with IPT-G mini version under the mhGAP/IPT-G service framework and to study feasibility of the integrated mhGAP/IPT-G adolescent peripartum depression care delivery model and estimate if a low cost and compressed version of IPT-G intervention would result in similar size of effect on mental health and family functioning as the Full IPT-G. There are two sub- studies embedded which are: 1) To identify multi-level system implementation barriers and strategies guided by the Consolidated Framework for Implementation Research (CFIR) to enhance perinatal mhGAP-depression care and evidence-based intervention integration (i.e., group interpersonal psychotherapy; IPT-G) for pregnant adolescents in primary care contexts; 2) To use findings from aim 1 and observational data from Maternal and Child Health (MCH) clinics that run within primary health care facilities to develop a mental health implementation workflow plan that has buy-in from key stakeholders, as well as to develop a modified protocol and implementation training manual for building health facility staff's capacity in implementing the integrated mhGAP/IPT-G depression care. METHODS For the primary objective of studying feasibility of the integrated mhGAP/IPT-G depression care in MCH service context for adolescent perinatal depression, we will recruit 90 pregnant adolescents to a three-arm pilot intervention (unmasked) trial study (IPT-G Full, IPT-G Mini, and wait-list control in the context of mhGAP care). Pregnant adolescents ages 13-18, in their 1st-2nd trimester with a depression score of 13 and above on EPDS would be recruited. Proctor's implementation evaluation model will be used. Feasibility and acceptability of the intervention implementation and size of effects on mental health and family functioning will be estimated using mixed method data collection from caregivers of adolescents, adolescents, and health care providers. In the two sub-studies, stakeholders representing diverse perspectives will be recruited and focus group discussions data will be gathered. For aim 2, to build capacity for mhGAP-approach of adolescent depression care and research, the implementation-capacity training manual will be applied to train 20 providers, 12 IPT-G implementers/health workers and 16 Kenyan researchers. Acceptability and appropriateness of the training approach will be assessed. Additional feedback related to co-located service delivery model, task-shifting and task-sharing approach of IPT-G delivery will be gathered for further manual improvement. DISCUSSION This intervention and service design are in line with policy priority of Government of Kenya, Kenya Vision 2030, World Health Organization, and UN Sustainable Development Goals that focus on improving capacity of mental health service systems to reduce maternal, child, adolescent health and mental health disparities in LMICs. Successfully carrying out this study in Kenya will provide an evidence-based intervention service development and implementation model for adolescents in other Sub-Saharan African (SSA) countries. The study is funded by FIC/NIH under K43 grant.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Keng-Yen Huang
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Caleb Othieno
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, USA
| | - Jurgen Unutzer
- Department of Psychiatry, University of Washington, Seattle, USA
| | - Shekhar Saxena
- Department of Global Health and Population, Chan School of Public Health, Harvard University, Boston, USA
| | - Inge Petersen
- Department of Psychology, University of Kwa-Zulu Natal, Durban, South Africa
| | - Simon Njuguna
- Department of Mental Health, Ministry of Health, Nairobi, Kenya
| | | | - Onesmus Gachuno
- Department of Obstertrics and Gynacology, University of Nairobi, Nairobi, Kenya
| | - Fred Ssewamala
- Brown School at Washington University in St.Louis, St. Louis, USA
| | - Mary McKay
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
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22
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The impacts of maternal childhood adversity, stress, and mental health on child development at 6 months in Taiwan: A follow-up study. Dev Psychopathol 2020; 33:970-979. [PMID: 32684201 PMCID: PMC8374618 DOI: 10.1017/s0954579420000267] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Exposure to adverse childhood experiences (ACEs) is not only associated with one's adverse health outcomes in adulthood but also increases the risk of child developmental problems in offspring. However, the mechanisms involved in the transmission of the effects of maternal ACEs to the offspring largely remain unexplored. This study sought to identify possible psychosocial pathways of intergenerational effects of maternal ACEs on child development at 6 months. Data from a longitudinal study on maternal childhood adversity and maternal psychosocial risk during pregnancy as well as maternal mental health problems and child development at 6 months postnatal were used. Structural equation modeling with bootstrapping was used to estimate the indirect effects of maternal ACEs on child development at 6 months. The model showed that maternal ACEs indirectly influenced offspring's development via maternal stressful events during pregnancy and pre- and postnatal mental health problems. This finding highlights the possible interventions at the prenatal and postnatal periods. Early identification of women who have ACEs or who are at psychosocial risk during pre- and postnatal periods is critical to provide interventions to buffer those negative effects on offspring's development. Future studies are needed to longitudinally assess the effects of maternal ACEs on child development over time.
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23
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Kola L, Bennett IM, Bhat A, Ayinde OO, Oladeji BD, Abiona D, Abdumalik J, Faregh N, Collins PY, Gureje O. Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria. BMC Pregnancy Childbirth 2020; 20:294. [PMID: 32410586 PMCID: PMC7226964 DOI: 10.1186/s12884-020-02970-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery. METHODS Focus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis. RESULTS A total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued. CONCLUSIONS Participants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.
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Affiliation(s)
- Lola Kola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Sociology and Psychology, Faculty of Social Sciences, Lead City University, Ibadan, Nigeria
- Department of Psychiatry College of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - Ian M. Bennett
- Departments of Family Medicine, University of Washington, Seattle, USA
- Psychiatry and Behavioral Science, University of Washington, Seattle, USA
- Global Health, University of Washington, Seattle, USA
- Department of Psychology, Carleton University, Ottawa, Ontario Canada
| | - Amritha Bhat
- Departments of Family Medicine, University of Washington, Seattle, USA
| | - Olatunde O. Ayinde
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bibilola D. Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Dolapo Abiona
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jibril Abdumalik
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Neda Faregh
- Global Health, University of Washington, Seattle, USA
- Department of Psychology, Carleton University, Ottawa, Ontario Canada
| | - Pamela Y. Collins
- Psychiatry and Behavioral Science, University of Washington, Seattle, USA
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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24
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Pérez-Marfil MN, Fernández-Alcántara M, Fasfous AF, Burneo-Garcés C, Pérez-García M, Cruz-Quintana F. Influence of Socio-Economic Status on Psychopathology in Ecuadorian Children. Front Psychiatry 2020; 11:43. [PMID: 32116858 PMCID: PMC7034357 DOI: 10.3389/fpsyt.2020.00043] [Citation(s) in RCA: 6] [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: 04/11/2019] [Accepted: 01/16/2020] [Indexed: 11/13/2022] Open
Abstract
The socioeconomic status (SES) of parents has been reported to have a crucial impact on emotional competence in childhood. However, studies have largely been carried out in developed countries and in children in a specific age range, and it is not clear whether the effect of the SES of parents varies by age. The objective of this study was to investigate the psychopathological profile (including externalizing and internalizing problems) of children aged 7, 9, and 11 years old with low SES in a developing country (Ecuador). The study included 274 children (139 boys and 135 girls), who were divided between medium-SES (n = 133) and low-SES (n = 141) groups. Data were gathered on socioeconomic and anthropometric variables of the children, and the parents completed the Child Behavior Check-List (CBCL). In comparison to the medium-SES group, children in the low-SES group obtained higher scores for internalizing and externalizing symptoms and for total problems, and they obtained lower scores for social competence skills. The housing risk index and school competence were the two main predictors of internalizing and externalizing problems in this population.
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Affiliation(s)
| | - Manuel Fernández-Alcántara
- Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain.,Department of Health Psychology, University of Alicante, Alicante, Spain
| | - Ahmed F Fasfous
- Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain.,Department of Social Sciences, Bethlehem University, Bethlehem, Palestine
| | - Carlos Burneo-Garcés
- Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain.,Carrera de Derecho, Universidad de Otavalo, Otavalo, Ecuador
| | - Miguel Pérez-García
- Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain
| | - Francisco Cruz-Quintana
- Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain
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