Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying

Infant carrying may have beneficial effects on the parent-infant relationship but only limited research has been conducted in this area. Therefore, the main aim of the current study was to investigate whether infant carrying is associated with parental reflective functioning, parental bonding, and parental (emotional) and behavioral responses to infant crying, key elements within the parent-infant relationship, promoting infant development. Parents reporting high levels (N = 389) of infant carrying (six times a week or daily) and parents reporting low levels (N = 128) of infant carrying (less than once a week or not at all) who participated in an online survey about the developing parent-infant relationship in Germany were included in the present study. Standardized questionnaires were used to assess parental reflective functioning, parental bonding impairments, and emotional responses to infant crying. Further insensitive (non-responsive and hostile) behaviors in response to infant crying were assessed. Parents with high levels of infant carrying showed better parental reflective functioning, lower parental bonding problems, less negative emotions, and less insensitive behaviors in response to infant crying.

The impact of social connectedness on mental health in LGBTQ + identifying individuals during the COVID-19 pandemic in Germany

BACKGROUND

Recent studies report that LGBTQ + people have experienced high levels of mental health problems during COVID-19-related social distancing. Given the well-established association between social isolation and mental health, the main aim of the current study was to investigate differences in mental health and (perceived) social isolation and social support in LGBTQ + individuals compared to heterosexual, cisgender people and to explore whether the hypothesized higher mental health burden in LGBTQ + individuals is (partly) mediated by (perceived) social isolation or social support.

METHODS

N = 531 participants indicating belonging to the LGBTQ + community and N = 1826 not identifying as LGBTQ + participated in a cross-sectional online survey during the initial COVID-19-related lockdown in Germany. Standardized questionnaires were used to assess depression, anxiety, suicidality, loneliness and social support. Further, perceived social isolation and face-to-face communication during the lockdown were assessed.

RESULTS

LGBTQ + people had higher levels of depression, anxiety and suicidal thought, were lonelier and experienced less social support than non-LGBTQ + identifying individuals. Mediation analysis showed that the higher levels of mental health burden in LGBTQ + people were (partly) mediated by reduced social connectedness. Further face-to-face contact positively affected mental health by reducing feelings of loneliness.

CONCLUSION

Given the high impact of loneliness on mental health, governmental actions should be taken to promote social connectedness particularly among LGBTQ + identifying individuals to ensure that the COVID-19 pandemic does not exacerbate the health inequalities that already exist between LGBTQ+-identifying and heterosexual, cisgender people.

Physical Activity for the Treatment of Adolescent Depression: A Systematic Review and Meta-Analysis

Background: A noticeable proportion of adolescents with depression do not respond to guideline recommended treatment options. This systematic review and meta-analysis investigated the effectiveness of physical activity interventions as an alternative or complementary treatment for adolescents (12-18 years) with depression. The characteristics of the physical activity treatment that were most effective in reducing symptoms in adolescents with depression and the impact of methodological shortcomings in the existing research were also examined. Methods: Medline, PsycINFO, SPORTDiscus, ProQuest, and CENTRAL were searched for eligible records. Effect size estimates were pooled based on the application of a random-effects model. Potential moderation by physical activity characteristics (i.e., intensity, type, context, and time frame) and methodological features (i.e., type of control group and diagnostic tool to identify depression at baseline) was investigated by means of subgroup analyses and meta-regressions. The certainty of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was the antidepressant effect of physical activity at postintervention measurement time point. As secondary outcomes, the sustainability of effects after the end of physical activity treatment and the acceptability of physical activity treatments were assessed. Overall, 10 studies were included in the qualitative synthesis and 9 studies involving 431 patients were included in the quantitative synthesis. Results: A moderate, significant antidepressant effect of physical activity was found (Hedges' g = -0.47, 95% CI = -0.71 to -0.24). Heterogeneity was small (T2 = 0.0313, I 2 = 27%, p = 0.18). However, the certainty of evidence was downgraded to low because the included studies contained serious methodological limitations. Moderator analyses revealed that session intensity significantly moderated the antidepressant effect of physical activity. Moreover, noticeably smaller effect sizes were found in studies that used non-physical activity sham treatments as control treatments (e.g., playing board games), compared to studies that used no control group treatments. Only three studies assessed the sustainability of effects after the end of physical activity treatment. The results suggest that the antidepressant effects further increase after the end of physical activity interventions. There was no significant difference in dropout risk between the physical activity and control groups. Conclusions: This review suggests that physical activity is effective in treating depression in adolescents. Physical activity sessions should be at least moderately intense [rate of perceived exertion (RPE) between 11 and 13] to be effective. Furthermore, our results suggest that physical activity treatments are well accepted. However, the low methodological quality in included studies might have led to effect overestimation. Therefore, more studies with higher methodological quality are needed to confirm the recommendation for physical activity treatments in adolescents with depression.

Neural Correlates of Empathy in Boys With Early Onset Conduct Disorder

Background: A deficit in empathy has repeatedly been described in individuals with conduct disorder (CD), and in particular in those with callous unemotional traits. Until now, little is known about the neural basis of empathy in children and adolescents with early onset conduct disorder. The aim of this study was to examine neural responses during empathizing in children and adolescents with CD with a task that allowed to differentiate between the judgment of the emotional states of other people and the own emotional response to other people's emotional state. Moreover, we investigated associations of callous-unemotional traits and neural activations during empathizing. Methods: Using functional magnetic resonance imaging (fMRI) we investigated 14 boys with early onset CD and 15 typically developing (TDC) age matched controls between 8 and 16 years of age. Happy and sad faces were presented, and participants were asked to either infer the emotional state from the face (other-task) or to judge their own emotional response (self-task). A perceptual decision on faces was used as a control task. Individual empathic abilities and callous unemotional traits were assessed. Results: During the other task, TDC boys showed significantly larger right amygdala responses than CD boys. Higher empathic abilities (as assessed with the Bryant Index of Empathy) were associated with higher responses in the right amygdala within the CD boys and across the entire sample. Moreover, across the entire sample, callous-unemotional traits were negatively related to the BOLD-response in the right amygdala. CD boys showed larger responses in the dorsal and ventral medial prefrontal cortex across tasks and increased activation in dorsal medial prefrontal cortex specifically during the self-conditions, which were also related to empathic abilities within the CD boys. Conclusions: The data emphasize the important role of the amygdala in empathy related emotional processing. Diminished amygdala responses and their association with low empathy suggest a pivotal influence of impaired amygdala processing in early-onset CD, in particular for deficits in empathic behavior and related callous-unemotional-traits. Elevated response in the medial prefrontal cortex in boys with CD point toward increased involvement of brain areas related to self-referential processing and cognitive empathy during empathizing.

[Attachment Styles in Adult Children of Mentally Ill Parents]

This paper presents the results of an online survey in Germany in which 296 adult children of mentally ill parents were interviewed. The aim of the study was to record the respondents' attachment-related experiences and to investigate possible predictors of reported childhood experiences on adult attachment patterns. The German version of the revised Adult Attachment Scales (AAS-R) was used to record basic adult attachment dimensions. Data analysis yielded lower values in the dimension "intimacy/trust" compared to the general population, whereas very high values were found in the dimension "anxiety". A clinical relevant anxious-avoiding attachment style could be assigned to 39 % of the respondents. In regression analyses, the safety experienced in childhood, communication deficits in the family and stigmatisation experiences proved to be significant predictors of adult attachment styles. In the concluding discussion of the research findings, we consider possible help offers for adult children of mentally ill parents.

Neural modulation of social reinforcement learning by intranasal oxytocin in male adults with high-functioning autism spectrum disorder: a randomized trial

Reduced social motivation is a hallmark of individuals with autism spectrum disorders (ASDs). Although the exact neural mechanisms are unclear, oxytocin has been shown to enhance motivation and attention to social stimuli, suggesting a potential to augment social reinforcement learning as the central mechanism of behavioral interventions in ASD. We tested how reinforcement learning in social contexts and associated reward prediction error (RPE) signals in the nucleus accumbens (NAcc) were modulated by intranasal oxytocin. Male adults with a childhood diagnosis of ASD (n = 15) and healthy controls (n = 24; aged 18-26 years) performed a probabilistic reinforcement learning task during functional magnetic resonance imaging in a single-center (research center in Germany), randomized double-blind, placebo-controlled cross-over trial. The interventions were intranasal oxytocin (Syntocinon^®, Novartis; 10 puffs = 20 international units (IUs) per treatment) and placebo spray. Using computational modeling of behavioral data, trial-by-trial RPE signals were assessed and related to brain activation in NAcc during reinforcing feedback in social and non-social contexts. The order of oxytocin/placebo was randomized for 60 participants. Twenty-one participants were excluded from analyses, leaving 39 for the final analysis. Behaviorally, individuals with ASD showed enhanced learning under oxytocin when the learning target as well as feedback was social as compared to non-social (social vs. non-social target: 87.09% vs. 71.29%, 95% confidence interval (CI): 7.28-24.33, p = .003; social vs. non-social feedback: 81.00% vs. 71.29%, 95% CI: 2.81-16.61, p = .027). Correspondingly, oxytocin enhanced the correlation of the RPE signal with NAcc activation during social (vs. non-social) feedback in ASD (3.48 vs. -1.12, respectively, 95% CI: 2.98-6.22, p = .000), whereas in controls, this effect was found in the placebo condition (2.90 vs. -1.14, respectively, 95% CI: 1.07-7.01, p = .010). In ASD, a similar pattern emerged when the learning target was social (3.00 vs. -0.64, respectively, 95% CI: -0.13 to 7.41, p = .057), whereas controls showed a reduced correlation for social learning targets under oxytocin (-0.70 vs. 2.72, respectively, 95% CI: -5.86 to 0.98, p = .008). The current data suggest that intranasal oxytocin has the potential to enhance social reinforcement learning in ASD. Future studies are warranted that investigate whether oxytocin can potentiate social learning when combined with behavioral therapies, resulting in greater treatment benefits than traditional behavior-only approaches.

Effects of a 6-week, whole-body vibration strength-training on depression symptoms, endocrinological and neurobiological parameters in adolescent inpatients experiencing a major depressive episode (the "Balancing Vibrations Study"): study protocol for a randomized placebo-controlled trial

BACKGROUND

Moderate to vigorous endurance and strength-training exercise was suggested as a treatment option for major depression. However, there is little evidence to support this suggestion in adolescent patients. The present study investigates the effects of a whole-body vibration strength-training intervention on symptoms in medication-naïve adolescent inpatients experiencing a major depressive episode. Potential underlying endocrinological and neurobiological mechanisms are explored.

METHODS/DESIGN

A double-blinded randomized controlled trial is conducted at the University Hospital of Cologne in Germany, comparing a 6-week, whole-body vibration strength-training with a 6-week placebo-intervention, as add-on therapy to inpatient treatment as usual. Forty-one subjects (13-18 years of age) will be included in each of the two groups. The study is powered to detect (α = .05, β = .2) a medium effect size difference between the two groups (d = .5) in terms of patients' change in the Children's Depression Rating Scale raw-score, from baseline until the end of the intervention. As secondary endpoints, the effects of exercise treatment on patients' cortisol awakening response as well as on brain-derived neurotrophic factor, insulin-like growth factor 1 and inflammatory markers (tumor necrosis factor-alpha, interleukin-6 and C-reactive protein) serum levels will be assessed.

DISCUSSION

This study will provide evidence on the effectiveness of whole-body vibration strength-training as an add-on therapy in adolescent inpatients experiencing a major depressive episode. After completion of data collection, the present study will be the largest randomized controlled trial so far to investigate the effectiveness of an exercise intervention in inpatient adolescents suffering from a major depressive episode. Moreover, the present study may help to determine the underlying mechanisms of potential anti-depressant effects of exercise in depressed adolescent inpatients.

TRIAL REGISTRATION

DRKS.de, German Clinical Trials Register (DRKS), Identifier: DRKS00011772 . Registered on 20 March 2017.

[Female conduct disorders]

The last few years have seen much research on girls with conduct disorder (CD). This article summarizes the gender-specific data regarding prevalence, differences with respect to symptomatology (e.g., subtypes of aggression, callous-unemotional (cu)-traits), and it presents data on the autonomic and neuroendocrine stress system as well as genetic, neurocognitive, and neuroimaging data. Differences in the impact of environmental factors on boys and girls for the development of CD are discussed. Taken together, the data indicate that there is great overlap in symptomatology, personality traits, and neurobiological aberrations in girls and boys with CD. Since fewer girls than boys exhibit CD symptomatology, further investigations on CD in girls might help to identify resilience factors that could improve future therapeutic interventions.