Health and Self-Regulation among School-Age Children Experiencing Family Homelessness

Initial characterization of print awareness in unhoused children

This study provides an initial understanding of print awareness, a foundational literacy skill, in a group of 12 unhoused children at two shelters in a large urban setting. Children ranged in age from 4;1 to 8;0, representing grades associated with learning to read (i.e., pre-kindergarten to second grade). Findings indicate that the majority of children in this sample were significantly delayed in their acquisition of print awareness skills. Caregivers were surveyed regarding their beliefs about supporting literacy development and what would be beneficial for helping them in this area. Responses indicated that almost all caregivers believed that some literacy development should occur outside of the school setting and that it would be helpful if they (the caregivers) were taught both what skills to teach and how to teach them.

The Role of Qi-Stagnation Constitution and Emotion Regulation in the Association Between Childhood Maltreatment and Depression in Chinese College Students

Background

Childhood maltreatment is known as a significant risk factor for later depression. However, there remains a lack of understanding about the mechanisms through which childhood maltreatment confers risk for depression. This study explores how Qi-stagnation constitution (QSC) and emotion regulation affect the link between childhood maltreatment and depressive symptoms in Chinese college students.

Methods

We recruited 2,108 college students aged 18-25 years between November 2020 and December 2021. Participants were required to complete four self-report questionnaires, including the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Qi-Stagnation Constitution (QSC) subscale of the simplified Chinese Medicine Constitution Questionnaire, Difficulties in Emotion Regulation Scale (DERS), and the Beck Depression Inventory-II (BDI-II). Moderated mediation analyses were conducted.

Results

There was a positive correlation between childhood maltreatment and QSC, while the QSC partially mediated the effect of childhood maltreatment on depressive scores in college students. In addition, emotion dysregulation moderated the association between QSC and depressive scores.

Conclusion

These results enhance understanding of key factors influencing the link between childhood maltreatment and depressive symptoms among college students by combining the theory of TCM constitution with psychological processes. The development of strategies to prevent biased Qi-stagnation constitution and emotion dysregulation may help to improve college students' mental health and strengthen the resilience of individuals to depression.

Relationship of parent-rated and objectively evaluated executive function to symptoms of posttraumatic stress and attention-deficit/hyperactivity disorder in homeless youth

Compared to their stably housed peers, homeless, and highly mobile (HHM) youth experience disproportionately greater adversity and risk leading to a wide variety of poor developmental outcomes, and targeted interventions have the potential to mitigate such outcomes. A growing literature highlights the need for accurate diagnosis in high-risk populations given the considerable overlap between posttraumatic symptomology and behaviorally based disorders such as ADHD. Objective testing inferring neurobiological and circuit-based abnormalities in posttraumatic stress disorder (PTSD) and ADHD may provide a useful clinical tool to aid accurate diagnosis and treatment recommendations. This novel, exploratory study examined the relation between executive function (EF) as measured by objective testing and parent ratings with symptoms of posttraumatic stress and ADHD in 86 children (age 9 to 11) living in emergency homeless shelters. Parent-rated EF problems suggested broad impairment associated with ADHD symptoms but specific impairment in emotional/behavioral function associated with posttraumatic stress symptoms. While measures of inhibition and shifting EF were strongly associated with symptomology in bivariate correlations, they explained minimal variance in regression models. Internalizing behavior problems were associated with posttraumatic stress symptoms, while externalizing behavior problems were associated with ADHD symptoms. Implications for clinical practice and future research are discussed.

Self-Regulation in Pediatric Nursing Literature: An Evolutionary Concept Exploration

The concept of self-regulation appears frequently in nursing literature. Although the concept is well developed in nonnursing theories, its application in nursing has not been explored adequately. Most nursing authors address self-regulation in one of two ways. Some publish findings without a strong theoretical understanding of self-regulation. Others publish studies using a conglomeration of theorists' self-regulatory explanations without properly contextualizing the theoretical elements for nursing practice. For this concept exploration, the authors used Rodgers, B. L. (2005). Developing nursing knowledge: Philosophical traditions and influences Lippincott, Williams & Wilkins, evolutionary concept analysis method to determine the current use of self-regulation in pediatric nursing literature and trace the concept's recent development, changes, and expansion. This work provides a representation of self-regulation based on existing healthcare studies and suggests steps for concept clarification that could promote accurate use of the concept in future research.

Health and adverse childhood experiences among homeless youth

BACKGROUND

Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health.

METHODS

Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates.

RESULTS

The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p < 0.001), such that ACE-related health risks were moderated by housing status.

CONCLUSIONS

ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Experiencing homelessness, whether unaccomapnied or with family, is associated with increased health risk, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

Protective factors for youth confronting economic hardship: Current challenges and future avenues in resilience research

Economic hardship during childhood is associated with worse mental and physical health across the life span. Over the past decade, interdisciplinary research has started to elucidate the behavioral and biological pathways that underlie these disparities and identify protective factors that mitigate against their occurrence. In this integrative review we describe these advances, highlight remaining gaps in knowledge, and outline a research agenda for psychologists. This article has 3 aims. First, we consider the evolving psychobiological literature on protective factors and conclude that supportive relationships can mitigate against the physical health problems often associated with economic hardship. Second, we discuss recent empirical developments in health psychology, public health, and the biological sciences, which reveal trade-offs associated with adaptation and challenge the conception of what it means to be resilient. Finally, we outline a research agenda that attempts to integrate existing knowledge on health disparities with these newer challenges to inform both policy and practice for youth experiencing economic hardship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The psychological impact of childhood homelessness-a literature review

In August 2019, 3848 children in Ireland were faced with emergency homelessness [1]. In recent years, lack of affordable housing, unemployment and shortage of rental properties have been the primary driving factors for the potentially devastating impact of familial homelessness in our society [1]. Our aim was to evaluate current knowledge on the psychological impact of homelessness in children. Using the PRISMA model, we performed a review of the currently available literature on the psychological impact of homelessness on children. This concept was explored under two different categories-'transgenerational' and 'new-onset homelessness'. Hidden homelessness was also explored. Our literature review revealed several psychological morbidities which were unique to children. This includes developmental and learning delays, behavioural difficulties and increased levels of anxiety and depression [66, 77, 40, 81, 42]. This has been demonstrated by poorer performance in school testing and increased levels of aggression. Anxiety in children within this cohort has been shown to peak at time of dispersion from their stable home environment [67]. Our study highlights violence, aggression and poor academic learning outcomes to be just some of the key findings in our review of homelessness in childhood, worldwide. Unfortunately, there has been minimum research to date on paediatric homelessness within the context of the Irish population. We anticipate this review to be the first chapter in a multipart series investigation to evaluate the psychological morbidity of paediatric homelessness within the Irish Society.

Physical illnesses associated with childhood homelessness: a literature review

BACKGROUND

Childhood homelessness is a growing concern in Ireland [1] creating a paediatric subpopulation at increased risk of physical illnesses, many with life-long consequences [2].

AIM

Our aim was to identify and categorize the physical morbidities prevalent in homeless children.

METHODS

A review of the English-language literature on physical morbidities affecting homeless children (defined as ≤ 18 years of age) published from 1999 to 2019 was conducted.

RESULTS

Respiratory issues were the most commonly cited illnesses affecting homeless children, including asthma, upper respiratory tract infections, and chronic cough [3]. Homeless children were described as being at increased risk for contracting infectious diseases, with many studies placing emphasis on the risks of sexually transmitted infections (STIs) and HIV/AIDS transmission [4, 5]. Dermatologic concerns for this population comprised of scabies and head lice infestation, dermatitis, and abrasions [3, 6]. Malnutrition manifested as a range of physical morbidities, including childhood obesity [7], iron deficiency anemia [4], and stunted growth [8]. Studies demonstrated a higher prevalence of poor dental [7] and ocular health [9] in this population as well. Many articles also commented on the risk factors predisposing homeless children to these physical health concerns, which can broadly be categorized as limited access to health care, poor living conditions, and lack of education [3, 10].

CONCLUSION

This literature review summarized the physical illnesses prevalent among homeless children and the contributing factors leading to them. Gaps in the literature were also identified and included a dearth of studies focusing on younger children compared with adolescents. Further research into prevention and intervention programs for this vulnerable population is urgently needed.

Neurobiological Markers of Resilience to Depression Following Childhood Maltreatment: The Role of Neural Circuits Supporting the Cognitive Control of Emotion

BACKGROUND

Childhood adversity is strongly linked to negative mental health outcomes, including depression and anxiety. Leveraging cognitive neuroscience to identify mechanisms that contribute to resilience in children with a history of maltreatment may provide viable intervention targets for the treatment or prevention of psychopathology. We present a conceptual model of a potential neurobiological mechanism of resilience to depression and anxiety following childhood adversity. Specifically, we argue that neural circuits underlying the cognitive control of emotion may promote resilience, wherein a child's ability to recruit the frontoparietal control network to modulate amygdala reactivity to negative emotional cues-such as during cognitive reappraisal-buffers risk for internalizing symptoms following exposure to adversity.

METHODS

We provide preliminary support for this model of resilience in a longitudinal sample of 151 participants 8 to 17 years of age with (n = 79) and without (n = 72) a history of childhood maltreatment who completed a cognitive reappraisal task while undergoing functional magnetic resonance imaging.

RESULTS

Among maltreated youths, those who were better able to recruit prefrontal control regions and modulate amygdala reactivity during reappraisal exhibited lower risk for depression over time. By contrast, no association was observed between neural functioning during reappraisal and depression among youths without a history of maltreatment.

CONCLUSIONS

These preliminary findings support the hypothesis that children who are better able to regulate emotion through recruitment of the frontoparietal network exhibit greater resilience to depression following childhood maltreatment. Interventions targeting cognitive reappraisal and other cognitive emotion regulation strategies may have potential for reducing vulnerability to depression among children exposed to adversity.

Health Risks and Outcomes of Homelessness in School-Age Children and Youth: A Scoping Review of the Literature

Despite reports that over 1.3 million school-age children (ages 5-18) were homeless in 2019, little is known about the effects of homelessness on their overall health and well-being. To better understand where gaps exist, a scoping review of the literature was conducted to identify studies of the physical, mental, and behavioral health risks and outcomes of school-age children experiencing homelessness or housing instability. Following the Joanna Briggs Institute framework and Preferred Reporting Items (PRISMA) guidelines, seven electronic databases were searched using key words: homelessness, children, health, and well-being. Of the 4,372 records, 23 articles met inclusion criteria. Most examined mental health and high-risk activities or behavioral risks related to school achievement. Few studies tracked the long-term health outcomes of homeless school-age children. Findings have implications for school nurses who have contact with children experiencing homelessness and are in position to intervene to prevent negative health sequelae in this vulnerable population.