Prevention of Mental Health Difficulties for Children Aged 0-3 Years: A Review

Executive Functions and Social-Emotional Problems in Toddlerhood: Nature, Persistence, and Direction of Associations

Social-emotional problems can emerge as early as the first years of life and are associated with a broad range of negative outcomes throughout the lifespan. There is convincing evidence that poorer executive functions (EF) are associated with more social-emotional problems during childhood and adolescence. However, the nature, persistence, and direction of the associations between different components of EF and social-emotional problems in toddlerhood remain unclear. Using two complementary statistical approaches, the present study aimed to (a) identify the role of EF components (inhibitory control, cognitive flexibility, and working memory) in the emergence and maintenance of social-emotional problems during toddlerhood, and (b) explore potential bidirectional associations between toddlers' EF and social-emotional problems. EF and social-emotional problems were assessed around 13, 19, and 28 months of age in a sample of 133 typically developing toddlers (51% boys) from mostly White middle-class families. At each time point, EF were measured with three behavioral tasks and social-emotional problems with a well-validated questionnaire completed by mothers. Multilevel growth models revealed a significant increase in social-emotional problems across toddlerhood and a negative association between inhibitory control and social-emotional problems that persisted across time. Controlling for stability across time, cross-lagged panel models indicated that child inhibitory control at 19 months negatively predicted child social-emotional problems at 28 months, but not the reverse. This study highlights that toddlerhood is a period of significant increase in social-emotional problems and provides evidence for the protective role of early inhibitory control skills against the development of social-emotional problems during toddlerhood.

Paternal and Maternal Depressive Symptoms and Sensitivity: Links with Trajectories of Socioemotional Problems in Toddlerhood

Parental depressive symptoms and sensitivity have well-documented consequences for children; however, studies considering both parents are still scarce. This longitudinal study aimed to investigate the respective roles of paternal and maternal depressive symptoms and sensitivity in predicting the development of child socioemotional problems during toddlerhood. We also investigated the buffering role of each parent's sensitivity in the associations between the other parent's depressive symptoms and toddlers' socioemotional problems. The sample consisted of 140 Canadian families who were visited in their homes when children were around 13 (T1), 19 (T2), and 27 (T3) months of age. At T1, both parents' sensitivity was assessed from observations of parent-child interactions at home and each parent reported on his or her own depressive symptoms. At T1, T2, and T3, maternal and paternal perceptions of their toddler's socioemotional problems were assessed and aggregated. Growth curve analyses revealed that paternal and maternal depressive symptoms as well as paternal sensitivity were unique and persistent predictors of child socioemotional problems and that sensitive fathering acted as a buffer in the context of maternal depressive symptoms. This study highlights the importance of considering both parents when studying risk and protective factors for young children's socioemotional problems.

Epidemiological Screening for the Risk of Mental, Behavioral and Developmental Disorders, Including Autism, in Early Childhood: Data for Russia 2017-2019

We aimed to screen children aged 18-48 months in the general population of nine Russian regions for risk of mental, behavioral and developmental disorders (MBDDs) including autism spectrum disorders (ASD) using an original screening tool. The prevalence of the risk for MBDDs is 1307:10,000 (13.07%), the prevalence of clinically verified cases of MBDDs is 151:10,000 (1.51%), whereas the prevalence of ASD among them is 18:10,000 (0.18%). Basing on our results, the screening procedures are already integrated into the Russian primary care system since the end of 2019. Screening of the risk for MBDDs including ASD in Russia among children in the general pediatric population is a promising area of preventive medicine.

Relationship focused mother-infant groups: Preliminary evaluation of improvements in maternal mental health, parenting confidence, and parental reflective functioning

We report on two preliminary evaluations of a group intervention, targeting vulnerable infants and their mothers within the first 6-months postpartum. The Mother-Baby Nurture® program aims to strengthen the developing infant-mother attachment relationship by increasing maternal mentalizing. These studies were undertaken with pre-post evaluations with the mothers of infants under 10-months of age. The mother-infant dyads participated in ten 2-h group sessions. Study one (N = 69 dyads) included self-reported maternal depression, anxiety, and parenting confidence. In study two (N = 27 dyads), parenting stress and reflective functioning were measured by self-report, and reflective functioning coded on the 5 min speech sample (completed by N = 22). Results from study one confirmed a decrease in depression (p < .001, d = .79) and anxiety (p < .001, d = .72) symptoms, and an increase in mothers' scores for parenting confidence (p < .001, d = -.98). Results from Study Two demonstrated a significant decrease in parenting stress (p < .001, d = .94) and significant improvement in measures of self-report reflective functioning (p = .007, .024; d = .56, .61). These findings are preliminary yet promising indications that this program could be effective in alleviating parenting stress, depression, and anxiety, and improving mother's reflective functioning and parenting confidence. Further research is needed, with a control group and long-term follow-up assessments.

Early triadic interactions in the first year of life: a systematic review on object-mediated shared encounters

Infants' early interactions with adults and everyday objects are key to socio-communicative development, but their emergence and development are still under debate. Aiming at describing the diversity of theoretical and methodological approaches on triadicity during the first year of life, we conducted a systematic and qualitative review of recent literature. Following PRISMA 2020 guidelines, we explored the scientific production of recent decades on triadic interactions up to 12 months of age. We initially screened 1943 items from which we obtained a final sample of 51 publications. Studies are usually conducted in laboratory settings, while ecological research is becoming increasingly common, especially in home settings. According to a thematic analysis of the data, we discussed the different perspectives on the origin and conceptualization of triadic interactions, and how they contribute to structuring and facilitating other developmental phenomena, such as the children's communicative gestures and uses of objects. Prior to the origin of intentional communication, adults facilitate early forms of triadicity based on fostering opportunities for infants' communication and engagement with both adults and materiality. However, there is a need for further research that explore the potential of early triadic interactions for parenting and early childhood education practises.

Thinking about the next generation: The case for a mentalization-informed approach to perinatal and intergenerational mental health

BACKGROUND

There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the 'First 1000 Days' from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches.

AIMS AND METHODS

In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health.

RESULTS

We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health.

DISCUSSION

Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.

Prevention of mental illness within public health: An analysis of progress via systematic literature review and a pathway forward

Primary prevention is the cornerstone of public health. Prevention is especially important for chronic diseases of significant burden such as mental illnesses because many of them have limited treatment options, an onset in childhood or in adolescence, and are linked to adverse childhood experiences requiring a focus on early childhood and maternal-child health (MCH). Despite this need, there appears to be a paucity of research into prevention of mental illnesses within public health. To confirm this, we performed a systematic literature review to quantify the proportion of articles in public health that focus on prevention of mental illness versus intervention for these illnesses after their onset, and the proportion of published articles within MCH that focus on mental health. Between November 2019 and August 2021, we reviewed 211,794 published articles from 147 Scimago-ranked English public health journals with no limit on year of publication. As hypothesized, a very small portion (2.2%) of mental health articles included primary prevention and a small portion of MCH articles (7.8%) included mental health. These results are consistent with the existence of a research gap in mental illness prevention within the public health field. Given the early onset of mental illness, the importance of early childhood experiences in the later development of mental illness, and the importance of the social-emotional connection between mother and child for building resilience, public health professionals must incorporate evidence from the field of MCH to develop and assess more primary prevention programs for mental illness.

Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants

Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.

Parenting Styles, Family Characteristics, and Teacher-Reported Behavioral Outcomes in Kindergarten

It is well established that parenting influences child behavior at home, but less is known about the associations between parenting and teacher reports of child behavior at school, an environment more distal from the home context. This study investigated the presence of authoritarian, authoritative, permissive, and uninvolved parenting styles (PS) in a community sample of 321 parents with kindergarteners (M_age = 5.45 years) in the Northwestern United States. This study analyzed (1) which PS were present, (2) if PS was associated with family characteristics, (3) if teacher reported behavior problems in spring of children's kindergarten year varied by PS, and (4) whether associations between PS and child behaviors were moderated by parenting stress. Study hypotheses were that PS would be associated with family characteristics, that teacher reported child behaviors would differ by PS, and that parenting stress would moderate the relationship between PS and behavior problems at school. Results indicated all PS were present. Chi-squares and ANOVA's identified that PS were significantly associated with parenting stress and child problem behaviors. ANOVAs determined differences in parenting stress and problem behaviors depending on PS. ANOVAs revealed parenting stress moderated the relation between PS and child problem behavior. Few studies to date have analyzed the presence of all four PS among kindergarteners and the relationship this has with teacher-reported classroom behavioral concerns. This study sought to fill this gap as results have implications for targeted parenting prevention interventions to promote children's social and behavioral adjustment during the transition to elementary school.

Holistic community-based group parenting programs for mothers with maternal mental health issues help address a growing public health need for a diversity of vulnerable mothers, children and families: Findings from an action research study

Background

Maternal mental illness is a major growing global concern which can affect parenting with serious negative implications for offspring. Group-based parenting programs for mothers which both enhance the parent-child relationship and address mental health symptoms in a supportive social setting may optimise better outcomes for mothers and children. The Acorn program in South Australia draws on attachment theory to integrate dance play, reflective diary keeping and therapeutic letters in a holistic program for a diversity of vulnerable mothers and children aged 1-36 months. The program seeks to nurture and enhance parental wellbeing and the quality of the parent-child relationship for mothers experiencing identified mental health illnesses that impinge upon their parenting. This study presents the evaluation of the program and its effectiveness.

Methods

Action research approach for continuous monitoring and program improvement engaging Acorn program staff in evaluation data collection and interpretation of pre and post self-completion measures and standardized observations. Additional data was collected through a telephone interview of attending mothers 6-8 months after program completion to address sustainable impacts on parenting and wellbeing.

Results

The program engaged 353 diverse vulnerable mothers with their children. Many had profound overlapping mental health issues including borderline personality disorder (BPD) and depression. The quality of the parent-child interaction, parental confidence, competence and enjoyment were enhanced; mothers' wellbeing, ability to cope and lasting social supports were augmented. This occurred for a number of "most vulnerable" subgroups including single mothers, mothers with BPD, mothers from non-English speaking households and those with lower levels of education or household income. Mothers reported sustained improvements in their wellbeing, parenting, social and family lives, and feeling closer to their child as a result of participating in the program.

Conclusions

Given the high prevalence of maternal mental health issues and substantial potential negative consequences for mothers and offspring, the Acorn parenting program offers an effective means of addressing this pressing public health issue potentially helping large numbers of vulnerable mothers and their children. This has additional gravitas in the shadow of COVID-19 due to expanded numbers of those experiencing greater parental stress, isolation and mental illness.

Epidemiological Study on the Early Detection of Mental Disorders in Young Children in Russia

BACKGROUND

Assessing the risk of children developing mental, behavioral, and developmental disorders (MBDDs), including autism spectrum disorders (ASDs), as well as achieving early detection of such disorders, has become one of the most important undertakings for public mental health professionals worldwide.

AIM

This study aims to evaluate the risk of developing MBDDs and the prevalence of MBDDs among young children (18-48 months old) in Russia.

METHODS

A two-level epidemiological screening approach was developed and adopted for the purposes of this study. At the first level, the parents of all children between 18 and 48 months old were questioned using Russian national validated Screening Checklist for Parents for Identification of the Risk of Mental, Behavioral, and Developmental Disorders in Early Childhood in nine regions of Russia (Volgograd, Kirov, Moscow, Novosibirsk, Orenburg, Tver, Chelyabinsk, Yaroslavl, and Stavropol). At the second level, children identified at the first level of screening as being at risk of developing MBDDs were assessed by a child psychiatrist on a voluntary basis and diagnosed according to the International Classification of Diseases, Tenth Revision criteria.

RESULTS

The present study revealed that the risk of developing MBDDs stands at 13.07% or 1,307 cases per 10,000 child population aged 18-48 months, whereas the prevalence of confirmed MBDDs is 1.51% or 151 cases per 10,000 among a Russian child population aged 18-48 months.

CONCLUSION

Screening for the risk of developing MBDDs, including ASDs, in Russia among very young children is a promising area of preventive medicine. This initiative allows us to develop optimal algorithms for specialized care measures that could help prevent the development and aggravation of children mental health issues.

Neurodegenerative Diseases: Implications of Environmental and Climatic Influences on Neurotransmitters and Neuronal Hormones Activities

Neurodegenerative and neuronal-related diseases are major public health concerns. Human vulnerability to neurodegenerative diseases (NDDs) increases with age. Neuronal hormones and neurotransmitters are major determinant factors regulating brain structure and functions. The implications of environmental and climatic changes emerged recently as influence factors on numerous diseases. However, the complex interaction of neurotransmitters and neuronal hormones and their depletion under environmental and climatic influences on NDDs are not well established in the literature. In this review, we aim to explore the connection between the environmental and climatic factors to NDDs and to highlight the available and potential therapeutic interventions that could use to improve the quality of life and reduce susceptibility to NDDs.

High, in Contrast to Low Levels of Acute Stress Induce Depressive-like Behavior by Involving Astrocytic, in Addition to Microglial P2X7 Receptors in the Rodent Hippocampus

Extracellular adenosine 5'-triphosphate (ATP) in the brain is suggested to be an etiological factor of major depressive disorder (MDD). It has been assumed that stress-released ATP stimulates P2X7 receptors (Rs) at the microglia, thereby causing neuroinflammation; however, other central nervous system (CNS) cell types such as astrocytes also possess P2X7Rs. In order to elucidate the possible involvement of the MDD-relevant hippocampal astrocytes in the development of a depressive-like state, we used various behavioral tests (tail suspension test [TST], forced swim test [FST], restraint stress, inescapable foot shock, unpredictable chronic mild stress [UCMS]), as well as fluorescence immunohistochemistry, and patch-clamp electrophysiology in wild-type (WT) and genetically manipulated rodents. The TST and FST resulted in learned helplessness manifested as a prolongation of the immobility time, while inescapable foot shock caused lower sucrose consumption as a sign of anhedonia. We confirmed the participation of P2X7Rs in the development of the depressive-like behaviors in all forms of acute (TST, FST, foot shock) and chronic stress (UCMS) in the rodent models used. Further, pharmacological agonists and antagonists acted in a different manner in rats and mice due to their diverse potencies at the respective receptor orthologs. In hippocampal slices of mice and rats, only foot shock increased the current responses to locally applied dibenzoyl-ATP (Bz-ATP) in CA1 astrocytes; in contrast, TST and restraint depressed these responses. Following stressful stimuli, immunohistochemistry demonstrated an increased co-localization of P2X7Rs with a microglial marker, but no change in co-localization with an astroglial marker. Pharmacological damage to the microglia and astroglia has proven the significance of the microglia for mediating all types of depression-like behavioral reactions, while the astroglia participated only in reactions induced by strong stressors, such as foot shock. Because, in addition to acute stressors, their chronic counterparts induce a depressive-like state in rodents via P2X7R activation, we suggest that our data may have relevance for the etiology of MDD in humans.