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Bayer JK, Prendergast LA, Brown A, Bretherton L, Hiscock H, Nelson-Lowe M, Gilbertson T, Noone K, Bischof N, Beechey C, Muliadi F, Mihalopoulos C, Rapee RM. Prediction of clinical anxious and depressive problems in mid childhood amongst temperamentally inhibited preschool children: a population study. Eur Child Adolesc Psychiatry 2023; 32:267-281. [PMID: 34368891 DOI: 10.1007/s00787-021-01857-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. Amongst inhibited preschool children, we aimed to predict each of clinical child anxiety and depressive problems in mid childhood from a broad range of potential risks (demographics, traumatic events and broader recent stressors, parents' well-being, and parenting practices). This study is based on data from a wider population trial of Cool Little Kids that recruited a representative sample of inhibited preschool children enrolled in their year before starting school. In 2011-2012, an inhibition screen was universally distributed to parents of children in their year before school (age 4 years) across eight diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited preschoolers (78% uptake, 545/703) who were followed to mid childhood (three annual waves 2015-2017, age 7-10 years) with 84% retention (456/545). Parents completed questionnaires spanning child ages 4-10 years, along with diagnostic interviews for child anxiety. Children also completed questionnaires in mid childhood. The questionnaires encompassed a variety of potential risks including sociodemographics, traumatic events, recent life stressors, parent wellbeing and parenting practices. In mid childhood, 57% (246/430) of inhibited preschoolers had a clinical level of anxiety problems while 22% (95/432) had depressive problems (by one or more sources). The aetiology analyses highlighted parent distress and parenting practices (overinvolved/protective, harsh discipline) as key predictors of inhibited preschoolers' internalising problems by mid childhood. Some high-risk families may not have participated. Child depression was not assessed with a diagnostic interview. The measures did not include every possible risk factor. The findings lend support to parenting programs for shy/inhibited young children that aim to prevent the development of anxiety and depression as they grow.
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Affiliation(s)
- Jordana K Bayer
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Amy Brown
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Margaret Nelson-Lowe
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Tamsyn Gilbertson
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Kate Noone
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Natalie Bischof
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Cassima Beechey
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Fenny Muliadi
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
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Bayer JK, Brown A, Prendergast LA, Bretherton L, Hiscock H, Mihalopoulos C, Nelson-Lowe M, Gilbertson T, Noone K, Bischof N, Beechey C, Muliadi F, Rapee RM. Follow-up of the Cool Little Kids translational trial into middle childhood. J Child Psychol Psychiatry 2022; 63:88-98. [PMID: 34128236 DOI: 10.1111/jcpp.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Public health advocates have highlighted internalising problems as a leading cause of global burden of disease. Internalising problems (anxiety/depression) affect up to 20% of school-age children and can impact peer relations, school engagement and later employment and mortality. This translational trial aimed to determine whether a selective/indicated parenting group programme to prevent internalising distress in shy/inhibited preschool children had sustained effects in middle childhood. Translational design aspects were a brief parent-report screening tool for child inhibition offered universally across the population via preschools in the year before school, followed by an invitation to parents of all inhibited children to attend the parenting programme at venues in their local community. METHODS Design of the study was a randomised controlled trial. The setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited four-year-old children of which 456 (84%) were retained during middle childhood (age of seven to 10 years). Early intervention was the Cool Little Kids parenting group programme, and control was 'usual care' access to available support services in the community. Primary outcomes were child anxiety and depression symptoms (parent and child report) and DSM-IV anxiety disorders (assessor masked). Secondary outcomes were parenting practices and parent mental health. RESULTS There was no significant difference in anxiety disorders between the intervention and control group during the three annual follow-ups of the cohort in middle childhood (2015 43% vs. 41%, 2016 40% vs. 36%, 2017 27% vs. 30%, respectively; p's > .05). There were also no significant differences in child anxiety or depression symptoms (by child or parent report), parenting practices or parent mental health, between the intervention and control group during middle childhood. However, a priori interaction tests suggested that for children with anxious parents, early intervention attenuated risk for middle childhood internalising problems. CONCLUSIONS An issue for population translation is low levels of parent engagement in preventive interventions. Initial effects of the Cool Little Kids parenting group programme in reducing shy/inhibited preschool children's internalising distress at school entry dissipated over time, perhaps due to low engagement. Future translational research on early prevention of internalising problems could benefit from screening preschool children in the population at higher risk (combining temperamental inhibition and parent distress) and incorporating motivational techniques to facilitate family engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662.
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Affiliation(s)
- Jordana K Bayer
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Amy Brown
- Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Vic, Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.,Royal Children's Hospital, Melbourne, Vic, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Vic, Australia
| | | | | | - Kate Noone
- Royal Children's Hospital, Melbourne, Vic, Australia
| | - Natalie Bischof
- Eastern Health Child and Youth Mental Health Service, Melbourne, Vic, Australia
| | | | | | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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Savvas S, Goh AMY, Batchelor F, Doyle C, Wise E, Tan E, Panayiotou A, Malta S, Winbolt M, Clarke P, Burton J, Low LF, Loi SM, Fairhall A, Polacsek M, Stiles J, Muliadi F, Chau N, Scherer S, Ames D, Sousa TV, Dow B. Promoting Independence Through quality dementia Care at Home (PITCH): a research protocol for a stepped-wedge cluster-randomised controlled trial. Trials 2021; 22:949. [PMID: 34930422 PMCID: PMC8687633 DOI: 10.1186/s13063-021-05906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Home care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home. Methods This study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs’ sense of competence in dementia care provision. Discussion Upskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs. Trial registration anzctr.org.au; ACTRN12619000251123. Registered on 20 February 2019.
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Affiliation(s)
- Steven Savvas
- The National Ageing Research Institute, Parkville, VIC, Australia.
| | - Anita M Y Goh
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Colleen Doyle
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Erica Wise
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Esther Tan
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Anita Panayiotou
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Sue Malta
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | | | | | | | - Lee-Fay Low
- University of Sydney, Sydney, NSW, Australia
| | - Samantha M Loi
- The University of Melbourne, Parkville, VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Meg Polacsek
- The National Ageing Research Institute, Parkville, VIC, Australia.,Benetas, Melbourne, VIC, Australia
| | - Jay Stiles
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Fenny Muliadi
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Nadia Chau
- The National Ageing Research Institute, Parkville, VIC, Australia
| | | | - David Ames
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | | | - Briony Dow
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
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