Self-reported quality of life and self-esteem in sad and anxious school children

The Role of Emotion Regulation Strategies in the Relationship Between Temperament and Depression in Preadolescents

This study explored the relationship between temperament-i.e., negative affectivity (NA) and effortful control (EC)-and depression in preadolescents, considering emotion regulation (ER) strategies as mediating mechanisms in this relationship. We examined data from 535 children aged 8-12 years (M ± SD = 10.01 ± 1.42) who completed self-report measures related to NA, EC, ER strategies, depressive symptoms, and depressive mood. The results demonstrated that NA was significantly positively related to both depressive symptoms and depressive mood, while EC was significantly negatively related to both depressive symptoms and depressive mood. The structural equation model of latent variable analysis showed that cognitive reappraisal mediated the relationship between NA and depressive symptoms and depressive mood. Moreover, cognitive reappraisal was also identified as a mediator of the association between EC and depressive symptoms and depressive mood. However, expressive suppression only mediated the relationship between NA and depressive symptoms. Interventions aimed at ER strategies would be an effective program for preadolescents with depression and further improve preadolescents' social-emotional development.

School children's mental health during the COVID-19 pandemic

Introduction

The COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life.

Methods

Our study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations.

Results

Levels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness.

Discussion

Our study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders.Clinical trial registration: NCT04263558.

How Self-Regulation and Executive Functions Deficits Affect Quality of Life of Children/Adolescents with Emotional Regulation Disorders

BACKGROUND

Deficits in self-regulation and executive functions (EFs) frequently characterize children/adolescents with emotional regulation disorders and restrict their daily function and quality of life (QOL). These deficits are mainly manifested by neuropsychological measures in laboratory settings. This study aimed to compare self-regulation and EFs by ecological measures to reflect the implications in daily life between children with emotional regulation disorders and healthy controls and examine the relations between self-regulation, EFs and QOL in the study group.

METHODS

the participants were 49 children aged 8-18: 25 children/adolescents with emotional regulation disorders and 24 healthy children. The parents completed a socio-demographic questionnaire, the Child Behavior Checklist (CBCL), the Behavior Rating Inventory of Executive Functions (BRIEF) and the Pediatric Quality of Life Inventory (Peds-QL).

RESULTS

The study group had greater self-regulation difficulties (internalization and externalization problems), executive dysfunctions (EFdys) (including metacognition difficulties) and a lower QOL. Their internalization and externalization problems correlated with reduced EFs and QOL. Internalization predicted the physical and emotional QOLs, while metacognition predicted social and school-related QOLs.

CONCLUSIONS

Deficits in self-regulation and EFs are prevalent in children/adolescents with emotional disorders and restrict their daily function and QOL. Therefore, they should be routinely evaluated by ecological instruments to reflect daily restrictions.

The validity of transdiagnostic factors in predicting homotypic and heterotypic continuity of psychopathology symptoms over time

Studies of the continuity of psychopathology symptoms mainly involved the traditional conceptualization that mental disorders are discrete entities. However, high comorbidity rates suggest a few transdiagnostic factors that underlie individual disorders. Therefore, the present study examined the validity of transdiagnostic factors in predicting homotypic and heterotypic continuity of comorbidity classes across two waves in a nationally representative sample. We conducted a latent transition analysis to investigate how transdiagnostic factors differentially affect the transition probabilities of comorbidity classes across time. Results found a notable predictive validity of transdiagnostic factors: (a) internalizing strongly predicted the stability of the internalizing class and transition from the externalizing class to internalizing class, and (b) externalizing predicted the transition from the internalizing class to externalizing class. The study also found a more dynamic prediction pattern leading to equifinality and multifinality of psychopathology symptoms. The findings suggest that transdiagnostic factors can provide information on how individuals' symptom manifestations change over time, highlighting the potential benefits of incorporating transdiagnostic factors into assessment, treatment, and prevention.

Developing an Anxiety Screening Tool for Children in South Africa: Protocol for a Mixed Methods Study

BACKGROUND

Early childhood experiences such as trauma, exposure to violence, and poverty can significantly contribute to childhood anxiety, which is viewed as the most common mental health issue among children. In South Africa, there is no uniform tool to screen for anxiety during early childhood. This study aims to develop a tool to screen for anxiety in children aged 4 to 8 years, which could be utilized by preschool and foundation phase teachers to aid in the early identification of childhood anxiety.

OBJECTIVE

The overall objective of this study is to explore understanding and perceptions of childhood anxiety among teachers, parents, and experts and to develop a tool to screen for anxiety in children aged 4 to 8 years.

METHODS

This project will use a mixed method design that will consist of 4 stages. Stage 1 will consist of a scoping review. In Stage 2, data will be collected via semistructured interviews with 60 participants, including parents, teachers, and experts, and will be thematically analyzed. Stage 3 will consist of 20 experts and the researcher collaboratively formulating the proposed screening tool in the form of an e-Delphi component. Once the tool is refined, it will be piloted in Stage 4 with 20 teachers, and data will be analyzed with the Shapiro-Wilk test to test for normality. Additionally, factor analysis will be done to refine and restructure the tool as necessary.

RESULTS

This project was funded from April 2020 to December 2021. Data collection began in September 2022 and is projected to conclude in December 2022 for the qualitative component. The e-Delphi component is expected to be carried out from March to November 2023. Ethical approval was obtained from the Biomedical Research Ethics Committee in November 2021.

CONCLUSIONS

Anxiety in early childhood has been linked to various repercussions in adolescence and adulthood, such as school dropout, substance abuse, anxiety disorders, depression, and suicide ideation. Therefore, identifying the presence of anxiety earlier on and providing the necessary referral services could aid in reducing the negative consequences of unidentified and untreated anxiety in early childhood.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/37364.

Self-esteem and family functioning mediates the association of symptom severity and parental affiliate stigma among families with children with ASD

PURPOSE

To investigate the level of affiliate stigma among parents of children with autism spectrum disorder and to explore the mediating role of self-esteem and family functioning.

DESIGN AND METHODS

A cross-sectional study was conducted in a large regional hospital and two childhood rehabilitation centers in Guangdong, China. Data related to demographics, parental self-esteem, family functioning, and affiliate stigma were collected from 180 parents of children diagnosed with ASD. We used t-tests, analysis of variance, and correlation analysis to explore the related factors of parental affiliate stigma. Path analysis was used to determine the mediating roles of self-esteem and family functioning in the relationship between symptom severity and affiliate stigma.

RESULTS

Parents of children with autism spectrum disorder in China experienced low self-esteem, family functioning, and high affiliate stigma. Symptom severity was negatively correlated with self-esteem and family functioning. Self-esteem and family functioning were significantly negatively correlated with affiliate stigma. Symptom severity was positively correlated with affiliate stigma. Self-esteem and family functioning mediated the relationship between symptom severity and affiliate stigma.

CONCLUSIONS

Symptom severity affects parental affiliate stigma among families with children with ASD. Self-esteem and family functioning are the two mediators in the relationship. We should take steps to improve self-esteem and family functioning in order to alleviate parental affiliate stigma.

PRACTICE IMPLICATIONS

This study emphasizes the importance of the influence of ASD severity and family functioning on affiliate stigma. In clinical practice, psychological support should be provided for parents of children with ASD to improve their mental health.

An online parenting intervention to prevent affective disorders in high-risk adolescents: the PIPA trial protocol

BACKGROUND

Adolescent depression can place a young person at high risk of recurrence and a range of psychosocial and vocational impairments in adult life, highlighting the importance of early recognition and prevention. Parents/carers are well placed to notice changes in their child's emotional wellbeing which may indicate risk, and there is increasing evidence that modifiable factors exist within the family system that may help reduce the risk of depression and anxiety in an adolescent. A randomised controlled trial (RCT) of the online personalised 'Partners in Parenting' programme developed in Australia, focused on improving parenting skills, knowledge and awareness, showed that it helped reduce depressive symptoms in adolescents who had elevated symptom levels at baseline. We have adapted this programme and will conduct an RCT in a UK setting.

METHODS

In total, 433 family dyads (parents/carers and children aged 11-15) will be recruited through schools, social media and parenting/family groups in the UK. Following completion of screening measures of their adolescent's depressive symptoms, parents/carers of those with elevated scores will be randomised to receive either the online personalised parenting programme or a series of online factsheets about adolescent development and wellbeing. The primary objective will be to test whether the personalised parenting intervention reduces depressive symptoms in adolescents deemed at high risk, using the parent-reported Short Mood & Feelings Questionnaire. Follow-up assessments will be undertaken at 6 and 15 months and a process evaluation will examine context, implementation and impact of the intervention. An economic evaluation will also be incorporated with cost-effectiveness of the parenting intervention expressed in terms of incremental cost per quality-adjusted life year gained.

DISCUSSION

Half of mental health problems emerge before mid-adolescence and approximately three-quarters by mid-20s, highlighting the need for effective preventative strategies. However, few early interventions are family focused and delivered online. We aim to conduct a National Institute for Health and Care Research (NIHR) funded RCT of the online personalised 'Partners in Parenting' programme, proven effective in Australia, targeting adolescents at risk of depression to evaluate its effectiveness, cost-effectiveness and usability in a UK setting. TRIAL REGISTRATION {2A}: ISRCTN63358736 . Registered 18 September 2019.

Resilience and Regulation of Emotions in Adolescents: Serial Mediation Analysis through Self-Esteem and the Perceived Social Support

The aim of this study was to test a model that takes into account self-esteem and perceived social support as potential mediators of the relationship between resilience and emotional regulation. The study involved 251 adolescents aged between 14 and 19 years (M = 16.85). The study procedure consisted of completing paper-and-pencil questionnaires to measure resilience, self-esteem, and answer questions about perceived social support and emotional regulation. Bootstrap sampling analysis showed statistically significant serial mediation (B = 0.030; p < 0.001). As a result of the analysis, a positive direct relationship between resilience and emotional regulation was observed (B = 0.061; p < 0.001). Our results suggest that self-esteem and perception of social support may mediate the relationship between resilience and emotional regulation. The findings have an applicable value. They can be used to develop preventive and educational programs, as well as therapeutic interventions. The obtained results show that interventions aimed at resilience can improve self-assessment and perceived social support and thus favor the high level of emotional regulation skills in the adolescent group.

Neuropsychological Profiles of Athletes and Views of Parents Choosing Flag Versus Tackle Football Participation

Background:

Previous studies have found that injury rates are slightly higher in children who play flag football versus tackle football. It is unclear if this difference is due to the way each type is played or taught or whether there are intrinsic differences in attitudes or neuropsychological characteristics in children and their parents.

Purpose:

To determine whether children who play flag football score differently from those who play tackle football on validated neuropsychological tests.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Each participating athlete (aged 8-12 years) was recruited in 2018 and 2019 by email through local youth football leagues and the local university. Each athlete was administered a 1-time multidimensional assessment battery. The battery included the Wechsler Abbreviated Scale of Intelligence-2nd Edition, the children’s version of the Trail Making Test, the Integrated Digit Span and Spatial Span subtests of the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV), and the Beck Self-Concept Inventory for Youth. The parent/guardian of each athlete completed the Achenbach Child Behavior Checklist-Parent Report Form, the Behavior Rating Inventory of Executive Function (BRIEF)-Parent Form, and a custom survey. These tests were used to determine IQ estimates and standardized scores, measuring verbal comprehension, matrix reasoning, mental set-shifting, attention, cognitive processing speed, working memory, spatial processing, perception of self-concept, behavioral regulation index, metacognition index, and global executive composite. Scores were compared between flag football and tackle football groups by 2-sample t test, with the Wilcoxon rank-sum test used for nonparametric data.

Results:

A total of 64 athletes (41 tackle football, 23 flag football) were enrolled from youth football leagues (grades 4-6). Flag players scored significantly higher on the WISC-IV Spatial Span-Backward subtest (scaled mean, 12.0 vs 10.6; P = .046), while tackle players had significantly higher BRIEF-Inhibit subscores (mean t-score, 45 vs 42; P = .026). There were no significant differences in any of the other tests, including socioeconomic status and perceived concussion risks.

Conclusion:

Concerns that injury epidemiologic studies comparing flag with tackle football could be confounded by intrinsic differences in the children who choose to play each type seem to be unfounded.

Positive Child Personality Factors in Children with ADHD

OBJECTIVE

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder. While previous studies have shown substantial impact of ADHD across multiple domains, relatively little attention has been devoted to studying positive personality factors in individuals with ADHD. To address this, the current study examined strength-based factors in children with ADHD in relation to their social skills.

METHOD

Sixty-four children (aged 8-12 years) with ADHD completed questionnaires related to their social skills and strength-based factors (e.g., optimism, resilience, self-concept, and coping skills).

RESULTS

Findings indicated significant differences between different levels of social skills in children with ADHD, with children with higher social skills reporting higher levels of resiliency, greater behavioral competence, and greater prosocial attitudes than those with lower social skills.

CONCLUSIONS

The results highlight the importance of fostering strong social skills in children with ADHD, leading them to perceive themselves as competent and resilient.

The relationship between physical and mental health multimorbidity and children's health-related quality of life

Purpose

To examine the relationships between physical health problems, and borderline or clinical levels of mental health symptoms and children’s health-related quality of life (HRQoL).

Methods

Data were from the Longitudinal Study of Australian Children (2004–2018). Parents reported on their child’s HRQoL (PedsQL), physical health problems and mental health symptoms (Strengths and Difficulties Questionnaire, SDQ). A pooled cross-sectional analysis using linear regressions examined the relationships between physical health and clinical/borderline mental health symptoms, individually and when multi-morbid, and children’s HRQoL, and whether these relationships vary by a range of child, family and social factors.

Results

The sample comprised 47,567 observations of children aged 4–17 years. Borderline and clinical levels of mental health symptoms were associated with significantly lower HRQoL, equal to more than two-times (10.5 points) and more than three-times (16.8 points) the clinically meaningful difference, respectively. This was a larger difference than that associated with physical health problems (4.4 points). We found a significant interaction effect between physical health problems and clinical mental health symptoms which was associated with even poorer HRQoL after accounting for the individual relationships of both problems. Mental health problems were associated with poorer HRQoL for older versus younger children; and the interaction effect was significant for boys but not girls.

Conclusion

Findings highlight the importance of identifying and addressing mental health symptoms in children of all ages, even if these problems do not meet formal clinical criteria. Particular attention should be paid to the mental health and HRQoL of children with physical–mental multimorbidity, who are at risk of disproportionately poorer HRQoL.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-022-03095-1.

Ongoing physical and mental health problems are common in children and adolescents and, often, children can experience both problems together. Mental and physical health problems can have wide impacts for the child, including their health-related quality of life (HRQoL), which is a measure of the way the child’s health impacts their emotional, social and physical functioning during their day-to-day life. Our study shows that children with high levels of mental health symptoms have much poorer HRQoL than their peers, and we provide new evidence that even milder mental health symptoms are associated with poorer HRQoL than in children with physical health problems. When children have both physical and mental health problems, they are at even greater risk of poorer HRQoL than would be expected. Based on our findings, we recommend that clinicians should monitor and address mental health symptoms in children as young as 4–7 years old, even if these symptoms are milder, and particular attention should be given to children with physical and mental health problems, who are at greater risk of poor HRQoL.

Does a lower self-concept contribute to mental health disparities of diverse immigrant youth from middle childhood to late adolescence?

BACKGROUND

Three out of ten children in Germany have immigrant backgrounds and this proportion is expected to further increase in subsequent years. While immigrant youth have been found more vulnerable to developing symptoms of depression and anxiety, the underlying mechanisms of how such disparities unfold during youth development are still understudied. Some previous research has found that immigrant youth are at risk of experiencing a less positive self-concept compared to non-immigrant youth. We investigated whether the self-concept mediates mental health disparities and explored variability in such associations from middle childhood to late adolescence.

METHODS

Overall 1839 children and adolescents aged 6-21 years (M = 14.05 years, SD = 3.03, 49.8% female, n = 782 with immigrant status) participated in a cross-sectional self-report survey in classroom settings using scales from the Beck Youth Inventories II (Beck et al. in Beck Youth Inventories - Second Edition, Psychological Corporation, San Antonio, 2005) to assess self-concept and symptoms of depression and anxiety. Links between immigrant status, age, self-concept and symptom levels of depression as well as anxiety were examined using hierarchical regression and moderated mediation models.

RESULTS

Immigrant youth reported higher symptom levels of depression and anxiety than their non-immigrant peers but did not differ in their self-concepts. Hypothesized moderated mediation models were not fully supported and self-concept neither mediated the link between immigrant status and depression nor immigrant status and anxiety. However, self-concept was a significant predictor for symptom levels of depression as well as anxiety, with stronger associations in adolescents.

CONCLUSIONS

Our study substantiates previous findings that immigrant youth in Germany have overall increased symptom levels of depression and anxiety compared to non-immigrant youth. Our study however does not support that immigrant youth have a more negative self-concept and that the self-concept mediates such internalizing mental health disparities. Findings match previous evidence that developing a positive attitude towards the self is linked to better mental health. Beyond that, our findings suggest that mental health interventions addressing the self-concept could be especially relevant when targeting adolescents. Further research is needed to deepen the understanding of the mediating processes between migration status and mental health variables.

Co-Developmental Trajectories of Specific Anxiety Symptoms from Middle Childhood to Early Adolescence: Associations with Psychological Well-Being and Academic Achievement

Different types of specific anxiety symptoms commonly co-occur but also display distinct developmental trajectories over time in children and adolescents. Nevertheless, little is known about the co-developmental trajectories of specific anxiety symptoms among youth during the transition into adolescence and how identified trajectories are associated with important psychological and academic outcomes. This study thus aimed to determine the (a) heterogeneous co-developmental trajectories of five specific anxiety symptoms (generalized anxiety, separation anxiety, social anxiety, school anxiety, and panic disorder) from middle childhood to early adolescence, and (b) associations between the identified, distinct trajectories and youth's psychological well-being and academic achievement. A total of 715 Chinese elementary school students (45.6% girls, M_age = 8.96, SD = 0.76) completed measures on six occasions across three years, using 6-month intervals. Parallel process latent class growth modeling revealed five distinct anxiety trajectory groups: "congruent-low" (49.8%), "moderately low with predominant social anxiety" (18.5%), "moderately low with predominant school anxiety" (12.6%), "moderately high with predominant generalized and social anxiety" (8.6%), and "congruent-high" (10.5%). The lowest psychological well-being and academic achievement were observed for youth who persistently experienced the co-occurrence of two or more specific anxiety symptoms, followed by those who persistently experienced one predominant anxiety symptom, and finally, youth who persistently experienced low levels of all five specific anxiety symptoms. The identification of five heterogeneous groups with differential outcomes highlights the importance of individual differences considerations in understanding the co-developmental patterns of specific anxiety symptoms from middle childhood to early adolescence and the need for more sophisticated intervention programs tailored to members of specific groups to promote optimal psychological well-being and academic success.

Social support, resilience, and self-esteem protect against common mental health problems in early adolescence: A nonrecursive analysis from a two-year longitudinal study

The aim of this study is to examine the mutual effects of self-esteem and common mental health problems (CMHPs) as well as the mutual effects of self-esteem and resilience in early adolescence. The recruited participants were 1015 adolescents aged 12.7 years (SD = 0.5 years) from two junior high schools. Data were repeatedly collected at five time points at 6-month intervals over 2-year years. The Social Support Rating Scale (SSRS), Block and Kremen's Ego-Resiliency Scale (ER89), Rosenberg Self-esteem Scale (RSES), and Mental Health Inventory of Middle School Students (MMHI-60) were used to measure social support, resilience, self-esteem, and CMHPs, respectively. Nonrecursive structural equation modeling (SEM) was performed to analyze the data.There were bivariate partial correlations among the five-time measurements for the SSRS, ER89, RSES, and MMHI-60 scores. Self-esteem negatively predicted CMHPs with a standardized direct effect of -0.276 (95% CI: -0.425 to -0.097), and the opposite effect was -0.227 (95% CI: -0.383 to -0.072). Self-esteem positively predicted resilience with the standardized direct effect of 0.279 (95% CI: 0.093-0.425), and the opposite effect was 0.221 (95% CI: 0.063-0.376). Social support was a protective factor for mental health status.The findings of mutual effects of self-esteem and CMHPs as well as self-esteem and resilience can provide researchers and practitioners with a conceptual framework that can help them build effective intervention methods to promote adolescent mental health status.

Change in quality of life and self-esteem in a randomized controlled CBT study for anxious and sad children: can targeting anxious and depressive symptoms improve functional domains in schoolchildren?

BACKGROUND

Quality of life and self-esteem are functional domains that may suffer when having mental problems. In this study, we examined the change in quality of life and self-esteem when targeting anxious and depressive symptoms in school children (8-12 years) using a CBT-based transdiagnostic intervention called EMOTION, Kids Coping with anxiety and depression. The aim of this study was to investigate quality of life and self-esteem in children with elevated levels of anxious and depressive symptoms, and further if the EMOTION intervention could influence these important functional domains.

METHODS

The study had a clustered randomized design (cRCT), where N = 795 children recruited from 36 schools participated. The children were included based on self-reports of anxious and depressive symptoms. Schools were the unit of randomization and were assigned to intervention or control condition. Children in the intervention condition received the 10-week EMOTION intervention. Mixed effects models were used to take account of the possible clustering of data. Separate models were estimated for the dependent variables.

RESULTS

Children with elevated levels of anxious and depressive symptoms reported lower levels of quality of life and self-esteem compared to normative samples, with girls and older children reporting the lowest levels. For both genders and older children, a large and significant increase in quality of life and self-esteem was found among the children who received the intervention compared to the children in the control condition. Children in the intervention group reporting both anxious and depressive symptoms showed a significantly larger increase in both quality of life and self-esteem compared to the controls. Reductions in quality of life and self-esteem were partially mediated by reductions in symptoms of anxiety and depression.

CONCLUSIONS

Participating in an intervention targeting emotional symptoms may have a positive effect on quality of life and self-esteem in addition to reducing anxious and depressive symptoms. Improved quality of life may increase the child's satisfaction and subjective perception of wellbeing. As low self-esteem may lead to anxious and depressive symptoms, improving this functional domain in children may make them more robust dealing with future emotional challenges. Trial registration NCT02340637, retrospectively registered.

Cross-Sectional and Longitudinal Associations Between Psychosocial Well-Being and Cardiometabolic Markers in European Children and Adolescents

OBJECTIVE

Research examining aspects of positive mental health as potential predictors of cardiometabolic health in young populations is scarce. We investigated the associations between psychosocial well-being and waist circumference (WAIST), blood pressure (BP), the homeostasis model assessment for insulin resistance, triglycerides, and high-density lipoprotein cholesterol considering life-style factors as mediators.

METHODS

Data of European children and adolescents participating in the baseline (2007/2008), first follow-up (FU1; 2009/2010) and second follow-up (FU2; 2013/2014) examinations of the IDEFICS/I.Family study were used (ncross-sectional = 6519; nlongitudinal = 1393). A psychosocial well-being score was calculated from 16 items on emotional well-being, self-esteem, and social relationships (0-48 points). Cardiometabolic markers were transformed to age- and sex-specific and, in case of BP, also height-specific z scores. Life-style factors included diet, physical activity, sleep, and electronic media use. Applying path analysis, we obtained unstandardized estimates of direct and indirect effects of well-being on cardiometabolic markers.

RESULTS

Cross-sectionally, well-being score showed a negative direct and a negative indirect effect through life-style factors on WAIST z score (estimate per 4-point increase, -0.051 [p = .001] and -0.014 [p < .001], respectively). Longitudinally, positive changes in well-being score between baseline and FU1 and between FU1 and FU2, respectively, demonstrated negative indirect effects through life-style factorsFU2 on WAIST z scoreFU2. Both cross-sectionally and longitudinally, higher levels of well-being showed lowering indirect effects on homeostasis model assessment, BP, and triglyceride z scores and an increasing indirect effect on high-density lipoprotein cholesterol z score through both life-style factors and WAIST z score.

CONCLUSIONS

These results supported our hypothesis that a healthier life-style may be one mechanism through which higher well-being is linked with lower abdominal obesity and fewer other cardiometabolic disorders in young populations.

TRIAL REGISTRATION

Pan-European IDEFICS/I.Family children cohort, ISRCTN registry number: ISRCTN62310987 (http://www.isrctn.com/ISRCTN62310987).

What Can We Do to Promote Mental Health Among Individuals With Developmental Coordination Disorder?

Purpose of the Review

It is well-documented that individuals with DCD experience mental health problems, in both psychosocial and psychiatric domains. In this review, we propose a series of diverse options to improve mental health among individuals with DCD.

Recent Findings

Despite recognition of mental health problems in DCD, relatively little work has been done to develop effective interventions. There is an urgent need for action in this matter. We present and discuss options based on a societal perspective (awareness and understanding), parental perspective (access to services and resources), and child perspective (participation).

Summary

In order to improve mental health, interventions must take into account multiple levels in a complex framework that includes community, family, and the individual. While more research on intervention effectiveness is necessary, researchers, practitioners, and community advocates can use existing initiatives as a starting point to address the urgent need for improving mental health in DCD.

Self-reported symptoms of depression, anxiety and stress in Portuguese primary school-aged children

BACKGROUND

Symptoms of depression, anxiety and stress experienced during childhood might have a negative impact on development. This study explores factors associated with such symptoms among Portuguese primary school-aged children.

METHODS

A sample of children (n = 1022, mean age = 8.77 years old) was recruited in public and private schools from the cities of Coimbra, Lisbon and Porto, Portugal. The children's version of the Depression, Anxiety and Stress Scale (DASS-C) was self-administered. Multivariate logistic regression models were fitted to measure associations (expressed as Odds Ratio, OR and 95% Confidence Intervals, CI) between each DASS-C subscale, dichotomized by its 4th vs. 3rd or less quartiles (symptoms increase with scores), and covariates: child sex, age, socioeconomic status (SES), sports activity beyond school, children self-assessed health status, child and mother's body mass index and mother's DASS scores.

RESULTS

Age was negatively associated with anxiety symptoms (adjusted OR, 95% CI: 0.70, 0.57-0.87) and girls, compared to boys, presented lower odds of depressive and stress symptoms (adjusted OR, 95% CI: 0.65, 0.47-0.92 and 0.57, 0.41-0.80, respectively). A low socioeconomic status was associated with more frequent symptoms of stress (adjusted OR, 95%CI for low compared to high SES: 1.61, 1.01-2.56). Children with poorer self-assessed health status and whose mothers scored higher in the DASS also presented significantly higher odds of scoring in the 4th quartile (vs. 3rd or less) of the three DASS-C subscales.

CONCLUSIONS

These results suggest the need to tailor preventive efforts targeting childhood mental health symptoms.

Trends in childhood and adolescent internalizing symptoms: results from Swedish population based twin cohorts

Background

Previous research has noted trends of increasing internalizing problems (e.g., symptoms of depression and anxiety), particularly amongst adolescent girls. Cross-cohort comparisons using identical assessments of both anxiety and depression in youth are lacking, however.

Methods

In this large twin study, we examined trends in internalizing symptoms in samples of 9 year old children and 15 year old adolescents, gathered from successive birth cohorts from 1998 to 2008 (age 9) and 1994–2001 (age 15). Assessments at age 9 were parent-rated, and at age 15 self- and parent-rated. We examined (i) the relation between birth cohorts and internalizing symptoms using linear regressions, and (ii) whether percentages of participants exceeding scale cut-off scores changed over time, using Cochrane Armitage Trend Tests.

Results

Among 9 year old children, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off on anxiety symptoms, but not on depressive symptoms. At age 15, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off particularly on self-reported internalizing symptoms. On parent-reported internalizing symptoms, only girls demonstrated a corresponding trend.

Conclusion

In line with previous studies, we found small changes over sequential birth cohorts in frequencies of depression and anxiety symptoms in children. Further, these changes were not exclusive to girls.

Anxiety as a Common Biomarker for School Children With Additional Health and Developmental Needs Irrespective of Diagnosis

Currently very little evidence is available regarding the biological characteristics and common comorbid behaviors that are associated with children characterized by learning difficulties who require additional support at school. These children are usually referred to as having Additional Health and Developmental Needs by the Australian Government and the associated public education system more broadly though the problems may arise from academic, social and/or emotional stressors and may or may not include children with clinically diagnosed Neurodevelopmental Disorders. Thus, the aim of this study was to investigate the relationship between anxiety levels (Spence Children's Anxiety Scale- Parent Report), autism traits (Autism Spectrum Quotient - Child Version) and sleep quality (Sleep Disturbance Scale for Children) in children with Additional Health and Developmental Needs without an intellectual disability, but with either a diagnosis of Autism Spectrum Disorder (ASD) (N = 25), Speech and Language Impairment (N = 37) or Other Diagnosis (N = 22). Our results demonstrated that these children with Additional Health and Developmental Needs showed atypically high levels of anxiety and impaired sleep quality, with the ASD group reporting more impairments associated with comorbid anxiety and sleep quality than either of the other clinically diagnosed groups. In fact, greater anxiety level was associated with a greater number of autism traits and poorer sleep quality regardless of diagnostic group suggesting that anxiety is a common experience for children with Additional Health and Developmental Needs. It is suggested that assessment of anxiety, sleep behaviors and autism traits may be useful markers for early identification of children within this population, thus providing scope for early and targeted intervention.

The relationship between children's overweight and quality of life: A comparison of Sizing Me Up, PedsQL and Kid-KINDL

Background/Objective: Overweight and obese children are likely to encounter negative impact on psychological well-being and quality of life (QoL). Hence, for overweight and obese children, measuring QoL could go beyond simply assessing objective medical parameters and cover their physical health, psychological well-being, and social interaction. Generic (Kid-KINDL and Pediatric Quality of Life Inventory [PedsQL]) and weight-related (Sizing Me Up) measures are two major types of QoL measurement instruments; however, little is known about the differences between them. Method: We recruited 569 3rd to 6th graders from eleven schools in Southern Taiwan. In addition to the three QoL questionnaires, the Child Depression Inventory and Rosenberg Self-Esteem Scale were applied. Results: Depression had significantly negative associations with all three QoL questionnaires. Self-esteem was only associated with Kid-KINDL. Body mass index had a significantly stronger relationship with Sizing Me Up than its relationships with PedsQL and Kid-KINDL. In other words, the items related to body size concerns in Size Me Up significantly contributed to impaired overweight/obese children’s QoL. Conclusions: The study further identified the characters and strength of these QoL measures for better suggestions on evaluating physical and psychological issues for overweight/obese children.

Children and adolescents in institutional care versus traditional families: a quality of life comparison in Japan

BACKGROUND

A good quality of life (QOL) is important for the physical and mental well-being of all children. However, young people who live in an institutional setting may face different challenges than those who are raised in a traditional family. While a few quantitative studies of institutionalized children's QOL have been conducted, no research has investigated the QOL of young people living in Children's Homes (CHs) in Japan. This research compared the QOL of children and adolescents in Japan who live in CHs with that of children and adolescents living in traditional families.

METHODS

A cross-sectional study was conducted in July 2016 with 204 students (grades three through nine), 47 of whom lived in a CH, and 157 of whom lived in a traditional family. Ages ranged from 8 to 15 years (CH: 55.8% Female, 44.2% Male; Traditional: 54.1% Female, 45.9% Male). Participants answered the kid-Kinder Lebensqualität Fragebogen (Translated from German: Children's quality of life questionnaire; KINDL®) Japanese Version, which covers six subscales of QOL; they filled in the questionnaires at home. Analysis of variance was used to compare QOL between the two samples.

RESULTS

The total QOL score for all students (combined elementary school students and junior high school students) from CHs was statistically significantly lower than that for students from traditional families. Scores for the subscales, emotional well-being and family, were also significantly lower for CH young people than for those in traditional families. While elementary pupils in CHs reported lower QOL than those in traditional families, no significant differences in QOL were seen between junior high school students from CHs and their peers from traditional families.

CONCLUSIONS

The findings presented support previous research showing that the QOL of elementary school students living in CHs is significantly lower than that of their peers in traditional families. However, this difference was not observed among junior high school students. This contrast suggests that QOL changes with age. Future research is needed to evaluate the determinants of QOL among all generations and family contexts.