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Urbańska-Grosz J, Sitek EJ, Pakalska A, Pietraszczyk-Kędziora B, Skwarska K, Walkiewicz M. Family Functioning, Maternal Depression, and Adolescent Cognitive Flexibility and Its Associations with Adolescent Depression: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:131. [PMID: 38275441 PMCID: PMC10814122 DOI: 10.3390/children11010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND This study explores family functioning and its associations with adolescent major depressive disorder (MDD), comparing its dynamics with healthy counterparts. Family functioning (cohesion, flexibility, communication, and satisfaction), maternal depressive symptoms, postpartum depression history, parental divorce, parental alcohol abuse, and the adolescents' cognitive flexibility, are examined. The research incorporates the perspectives of both adolescents and mothers. METHODS The sample includes 63 mother-teenager dyads in the clinical group and 43 in the control group. Instruments encompass the Family Adaptability and Cohesion Evaluation Scales (FACES IV), Children's Depression Inventory (CDI-2), Beck Depression Inventory (BDI-II), The Brixton Spatial Anticipation Test, and structured interviews. RESULTS Families of adolescents with MDD exhibit lower flexibility, cohesion, communication, and overall satisfaction. Depressed adolescents display reduced cognitive flexibility. Discrepancies were observed between adolescents' and mothers' perspectives as associated with adolescents' MDD. Teenagers emphasized the severity of maternal depressive symptoms, while mothers highlighted the importance of family cohesion and flexibility. CONCLUSIONS This study emphasizes a holistic strategy in addressing adolescent depression, including family-based assessment and therapy. Screening for maternal depressive symptoms is identified as valuable. Cognitive flexibility also needs to be addressed during therapy for depression in adolescence.
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Affiliation(s)
- Justyna Urbańska-Grosz
- Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; (J.U.-G.); (E.J.S.)
- Laboratory of Clinical Neuropsychology, Neurolinguistics and Neuropsychotherapy, Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-952 Gdansk, Poland
| | - Emilia J. Sitek
- Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; (J.U.-G.); (E.J.S.)
- Laboratory of Clinical Neuropsychology, Neurolinguistics and Neuropsychotherapy, Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-952 Gdansk, Poland
- Department of Neurology, St. Adalbert Hospital, Copernicus PL, 80-462 Gdansk, Poland
| | - Anna Pakalska
- Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; (J.U.-G.); (E.J.S.)
| | - Bożena Pietraszczyk-Kędziora
- Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; (J.U.-G.); (E.J.S.)
| | - Kalina Skwarska
- Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; (J.U.-G.); (E.J.S.)
| | - Maciej Walkiewicz
- Rehabilitation Department of Child and Adolescent Psychiatry, Gdansk Health Center, 80-542 Gdansk, Poland; (J.U.-G.); (E.J.S.)
- Division of Quality of Life Research, Department of Psychology, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland
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Ramachandran J, Mayne SL, Kelly MK, Powell M, McPeak KE, Dalembert G, Jenssen BP, Fiks AG. Measures of Neighborhood Opportunity and Adherence to Recommended Pediatric Primary Care. JAMA Netw Open 2023; 6:e2330784. [PMID: 37615987 PMCID: PMC10450570 DOI: 10.1001/jamanetworkopen.2023.30784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
Importance Neighborhood conditions are known to broadly impact child health. Research to date has not examined the association of the Childhood Opportunity Index (COI), a multidimensional indicator of neighborhood environment conditions, specifically with pediatric primary care outcomes. Objective To determine the association of neighborhood opportunity measured by the COI with health metrics commonly captured clinically in pediatric primary care, reflecting both access to preventive care and child well-being. Design, Setting, and Participants This cross-sectional observational study used electronic health record data from a large pediatric primary care network in the northeastern US. Participants included patients aged 0 to 19 years who were active in the primary care network between November 2020 and November 2022. Data were analyzed in December 2022. Exposure Census tract-level COI overall score (in quintiles). Main Outcomes and Measures Outcomes included up-to-date preventive care and immunization status and presence of obesity, adolescent depression and suicidality, and maternal depression and suicidality. Multivariable mixed-effects logistic regressions estimated associations of these outcomes with COI quintiles, adjusted for age, sex, race and ethnicity, and insurance type. Results Among 338 277 patients (mean [SD] age, 9.8 [5.9] years; 165 223 female [48.8%]; 158 054 [46.7%] non-Hispanic White, 209 482 [61.9%] commercially insured), 81 739 (24.2%) and 130 361 (38.5%) lived in neighborhoods of very low and very high COI, respectively. Living in very high COI neighborhoods (vs very low COI) was associated with higher odds of being up-to-date on preventive visits (odds ratio [OR], 1.40; 95% CI, 1.32-1.48) and immunizations (OR, 1.77; 95% CI, 1.58-2.00), and with lower odds of obesity (OR, 0.55; 95% CI, 0.52-0.58), adolescent depression (OR, 0.78; 95% CI, 0.72-0.84) and suicidality (OR, 0.79; 95% CI, 0.73-0.85), and maternal depression (OR, 0.78; 95% CI, 0.72-0.86) and suicidality (OR, 0.71; 95% CI, 0.61-0.83). Conclusions and Relevance This cross-sectional study of electronic health record data found that neighborhood opportunity was associated with multiple pediatric primary care outcomes. Understanding these associations can help health systems identify neighborhoods that need additional support and advocate for and develop partnerships with community groups to promote child well-being. The findings underscore the importance of improving access to preventive care in low COI communities.
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Affiliation(s)
- Janani Ramachandran
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie L. Mayne
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Mary Kate Kelly
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maura Powell
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katie E. McPeak
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - George Dalembert
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Brian P. Jenssen
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Alexander G. Fiks
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
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