1
|
Johns-Mead R, Vijayakumar N, Mulraney M, Melvin G, Anderson VA, Efron D, Silk TJ. The longitudinal relationship between socioemotional difficulties and irritability in ADHD. J Affect Disord 2024; 350:573-581. [PMID: 38244802 DOI: 10.1016/j.jad.2024.01.151] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Despite higher rates of irritability and socioemotional symptoms in ADHD, consensus is lacking regarding their developmental relationship and whether it differs by ADHD status. This longitudinal study sought to evaluate how peer and emotional difficulties relate to irritability in ADHD and control groups. METHODS A community sample of 336 participants (45 % ADHD) were recruited for the Children's Attention Project. Participants completed the Affective Reactivity Index and the Strengths and Difficulties Questionnaire's emotional and peer difficulties scales at baseline (mean age 10.5 years) and 18-month follow-up. Latent Change Score models assessed how emotional and peer difficulties related to irritability at baseline and longitudinally. RESULTS For both groups, more severe baseline difficulties were associated with higher concurrent irritability, and reductions in emotional and peer difficulties were associated with declining irritability. Baseline emotional difficulties predicted change in irritability for the ADHD group, while baseline peer difficulties predicted change in irritability for both groups. Baseline irritability did not predict change in emotional or peer difficulties for either. The ADHD group showed elevated irritability, emotional, and peer difficulties, and stronger baseline correlation between peer difficulties and irritability. LIMITATIONS Only two timepoints were captured, and associations with ADHD symptom severity and presentation were not investigated. Doing so may facilitate additional insights. CONCLUSIONS Change in irritability corresponded to change in socioemotional difficulties, and was driven by earlier levels of socioemotional difficulties. ADHD exacerbated aspects of the relationship between socioemotional difficulties and irritability. Socioemotional difficulties drive irritability, so may represent targets for clinical interventions.
Collapse
Affiliation(s)
- Rania Johns-Mead
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Nandita Vijayakumar
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Glenn Melvin
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tim J Silk
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| |
Collapse
|
2
|
Jia H, Min Z, Yiyun C, Zhiguo W, Yousong S, Feng J, Na Z, Yiru F, Daihui P. Association between social withdrawal and suicidal ideation in patients with major depressive disorder: The mediational role of emotional symptoms. J Affect Disord 2024; 347:69-76. [PMID: 37992770 DOI: 10.1016/j.jad.2023.11.051] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The study was designed to investigate the associations between social withdrawal, emotional symptoms, and suicide ideation in patients with major depressive disorder (MDD). METHODS This cross-sectional study included 2678 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, suicide ideation, and emotional symptoms were compared in patients with different frequencies of social withdrawal. Pearson correlation, multiple linear regression analysis, and mediation analysis were employed to assess the contribution of social withdrawal to suicide ideation. RESULTS MDD patients with a higher frequency of social withdrawal were prone to have a higher frequency of suicide ideation (p for trend <0.001) and history of suicide behavior (p for trend <0.001). Multiple linear regression analysis showed that there was a dose-response relationship between social withdrawal and suicide ideation in MDD patients, but this association became insignificant after adjusting for emotional symptoms. Mediation analysis suggested that all of the emotional symptoms had significant mediating effects on the association between social withdrawal and suicide ideation in MDD patients (p < 0.05). The magnitude of mediation varied between 4.3 % and 64.3 %, with the largest mediating effect in the feeling of despair (64.3 %), helplessness (41.2 %), and loneliness (40.0 %). CONCLUSION Our study provides evidence that social withdrawal was a common clinical presentation and it may increase the risk for suicide through emotional symptoms in MDD patients. LIMITATIONS Causal conclusions could not be drawn between social withdrawal, emotional symptoms, and suicide ideation because of the cross-sectional design of the study.
Collapse
Affiliation(s)
- Huang Jia
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Zhang Min
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Cai Yiyun
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, PR China
| | - Wu Zhiguo
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Su Yousong
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Jin Feng
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Zhu Na
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Shanghai Pudong New Area Mental Health Center, Shanghai 200122, PR China
| | - Fang Yiru
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
| | - Peng Daihui
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
| |
Collapse
|
3
|
Caceres GA, Scambray KA, Malee K, Smith R, Williams PL, Wang L, Jenkins LM. Relationship between brain structural network integrity and emotional symptoms in youth with perinatally-acquired HIV. Brain Behav Immun 2024; 116:101-113. [PMID: 38043871 PMCID: PMC10842701 DOI: 10.1016/j.bbi.2023.11.026] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023] Open
Abstract
Perinatally acquired HIV infection (PHIV) currently affects approximately 1.7 million children worldwide. Youth with PHIV (YPHIV) are at increased risk for emotional and behavioral symptoms, yet few studies have examined relationships between these symptoms and brain structure. Previous neuroimaging studies in YPHIV report alterations within the salience network (SN), cognitive control network (CCN), and default mode network (DMN). These areas have been associated with social and emotional processing, emotion regulation, and executive function. We examined structural brain network integrity from MRI using morphometric similarity networks and graph theoretical measures of segregation (transitivity), resilience (assortativity), and integration (global efficiency). We examined brain network integrity of 40 YPHIV compared to 214 youths without HIV exposure or infection. Amongst YPHIV, we related structural brain network metrics to the Emotional Symptoms Index of the Behavioral Assessment System for Children, 2nd edition. We also examined the relationship of inflammatory biomarkers in YPHIV to brain network integrity. YPHIV had significantly lower global efficiency in the SN, DMN, and the whole brain network compared to controls. YPHIV also demonstrated lower assortativity or resilience (i.e., network robustness) compared to controls in the DMN and whole brain network. Further, higher emotional symptom score was associated with higher global efficiency in the SN and lower global efficiency in the DMN, signaling more emotional challenges. A significant association was also found between several inflammatory and cardiac markers with structural network integrity. These findings suggest an impact of HIV on developing brain networks, and potential dysfunction of the SN and DMN in relation to network efficiency.
Collapse
Affiliation(s)
- Gabriella A Caceres
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kiana A Scambray
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kathleen Malee
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Renee Smith
- University of Illinois, Chicago, IL, United States
| | - Paige L Williams
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lei Wang
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Lisanne M Jenkins
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| |
Collapse
|
4
|
Barrio-Martínez S, Cano-Vindel A, Priede A, Medrano LA, Muñoz-Navarro R, Moriana JA, Carpallo-González M, Prieto-Vila M, Ruiz-Rodríguez P, González-Blanch C. Worry, rumination and negative metacognitive beliefs as moderators of outcomes of Transdiagnostic group cognitive-behavioural therapy in emotional disorders. J Affect Disord 2023; 338:349-357. [PMID: 37336250 DOI: 10.1016/j.jad.2023.06.032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Despite the relevance of cognitive processes such as rumination, worry, negative metacognitive beliefs in emotional disorders, the existing literature about how these cognitive processes moderate the effect of treatment in treatment outcomes is limited. The aim of the present study was to explore the potential moderator effect of baseline cognitive processes-worry, rumination and negative metacognitive beliefs-on the relationship between treatment allocation (transdiagnostic cognitive-behavioural therapy -TD-CBT plus treatment as usual-TAU vs. TAU alone) and treatment outcomes (anxiety and depressive symptoms, quality of life [QoL], and functioning) in primary care patients with emotional disorders. METHODS A total of 631 participants completed scales to evaluate worry, rumination, negative metacognitive beliefs, QoL, functioning, and anxiety and depressive symptoms. RESULTS Worry and rumination acted as moderators on the effect of treatment for anxiety (b = -1.25, p = .003; b = -0.98, p = .048 respectively) and depressive symptoms (b = -1.21, p = .017; b = -1.34, p = .024 respectively). Individuals with higher baseline levels of worry and rumination obtained a greater reduction in emotional symptoms from the addition TD-CBT to TAU. Negative metacognitive beliefs were not a significant moderator of any treatment outcome. LIMITATIONS The study assesses cognitive processes over a relatively short period of time and uses self-reported instruments. In addition, it only includes individuals with mild or moderate anxiety or depressive disorders, which limits generalization to other populations. CONCLUSIONS These results underscore the generalization of the TD-CBT to individuals with emotional disorders in primary care with different cognitive profiles, especially those with high levels of worry and rumination.
Collapse
Affiliation(s)
- Sara Barrio-Martínez
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain.
| | | | - Amador Priede
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain; Mental Health Centre, Hospital de Laredo, Laredo, Spain
| | | | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Spain
| | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba, Córdoba, Spain; Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
| | - María Carpallo-González
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Spain
| | | | - Paloma Ruiz-Rodríguez
- Embarcaciones Primary Care Centre, Health Service of Madrid, Tres Cantos, Madrid, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Spain; Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
| |
Collapse
|
5
|
Kumar SGP, Ranpise D, Vishwakarma P, Gend PB, Chavan S, Kurian E. Social-emotional issues among children with strabismus higher than among non-strabismus children in Western India. Indian J Ophthalmol 2023; 71:2827-2834. [PMID: 37417129 PMCID: PMC10491034 DOI: 10.4103/ijo.ijo_2646_22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/27/2023] [Accepted: 03/28/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose Data on social-emotional aspects among children with strabismus in India are scanty. We compared the emotional symptoms (ES), loneliness and social dissatisfaction (LSD), and self-esteem (SE) and their associated risk factors among children with and without strabismus in India. Methods A cross-sectional case-control study design was used to recruit 101 children with strabismus aged 8 to 18 years and a control group of 101 children that were age- and gender-matched. Interviews were performed using standardized scales to assess ES, LSD, and SE. Variations in the intensity of ES, LSD, and SE were assessed using multiple classification analysis (MCA). Results A total of 202 children participated in the study. The mean ES, LSD, and SE scores were 3.4 (standard deviation [SD] 1.9), 48.4 (SD 3.2), and 22.1 (SD 3.8) for the strabismus group and 1.8 (SD 1.5), 33.3 (SD 3), and 31.3 (SD 2) for the non-strabismus group, respectively. Among the strabismus group, the highest levels of mean ES, LSD, and SE scores were observed among children facing problems in performing daily tasks. Amongst the non-strabismus group, children studying at the primary level and those facing neglect had the highest mean scores. In MCA, being affected with strabismus had the highest effect on the intensity of ES, LSD, and SE with a beta (β) value of 0.223 (P = 0.016), 0.922 (P < 0.001), and 0.853 (P < 0.001). Conclusion A significantly high proportion of children with strabismus deal with elevated levels of ES, LSD problems, and low SE as compared with non-strabismus children, highlighting the need to address the poor social-emotional health of children.
Collapse
|
6
|
Gandhi K, Shy ME, Ray M, Fridman M, Vaghela S, Mostaghimi A. The Association of Alopecia Areata-Related Emotional Symptoms with Work Productivity and Daily Activity Among Patients with Alopecia Areata. Dermatol Ther (Heidelb) 2023; 13:285-98. [PMID: 36484916 DOI: 10.1007/s13555-022-00864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Patients with alopecia areata (AA) experience psychological and psychosocial symptoms including depression, anxiety, anger, social withdrawal, embarrassment, and low self-esteem. While multiple studies have measured the detrimental emotional impact of AA on patient quality of life, evidence of its effect on work productivity loss (WPL) and daily activities is limited. This study aimed to assess the extent of AA-related emotional symptom (ES) burden on work productivity and activity impairment. METHODS A cross-sectional survey of dermatologists and their adult patients with AA was conducted in the USA in 2019. Dermatologists provided assessments of patients' clinical characteristics, while patients completed sociodemographic questionnaires along with two validated patient-reported outcome measures of the Work Productivity and Activity Impairment (WPAI) and the AA Patient Priority Outcomes (AAPPO) ES subscale. The WPAI assessed AA-related WPL (employed respondents) and activity impairment (all respondents), and the AAPPO-ES assessed AA-related frequency of feeling self-conscious, embarrassed, sad, or frustrated. Multiple linear regression models were fitted to both WPAI scores with the AAPPO ES as an independent variable. RESULTS A total of 242 patients with a mean (SD) age of 39.2 (13.3) years, treated by 59 dermatologists, were evaluated. Mean (SD) ES score was 2.0 (1.1). Mean (SD) work productivity loss [n = 170] and activity impairment [n = 242] were 12.2% (17.4%) and 13.3% (18.3%), respectively. After adjusting for covariates, WPL increased by 4.1% [95% confidence interval (CI) 1.6-6.7%; p = 0.002] and activity impairment increased by 3.1% (95% CI 0.7-5.4%; p = 0.010) for every 1-point increase in ES. For an average patient, a 1-SD decrease (about 1 point) on the ES scale substantially reduced WPL and activity impairment (by at least 25%). CONCLUSIONS Patients with AA reported significant increases in WPL and activity impairment associated with worsening AA-related ES. These findings underscore the substantial emotional and psychosocial burden among patients with AA and a need for improved treatment options.
Collapse
|
7
|
Ecija C, Catala P, Velasco L, Pastor-Mira MA, Peñacoba C. When It Hurts, a Positive Attitude May Help. The Moderating Effect of Positive Affect on the Relationship Between Walking, Depression, and Symptoms in Women with Fibromyalgia. Pain Manag Nurs 2022; 23:767-775. [PMID: 35840530 DOI: 10.1016/j.pmn.2022.05.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/17/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increased exercise is a marker of health in fibromyalgia (FM). However, patients frequently avoid physical activity as a way of minimizing the pain they feel. This deprives them of opportunities to obtain positive reinforcement, increasing functional impact. AIMS This study examines the mediating role of depressive symptoms between walking (as physical exercise), functional impact, and pain, at different levels of positive affect (PA) among women with fibromyalgia. DESIGN Cross-sectional correlational study. SETTINGS Mutual aid associations for fibromyalgia in Spain. PARTICIPANTS 231 women diagnosed with FM. METHODS Moderate mediation analyses were conducted using PROCESS. RESULTS First, a simple mediation model showed that depression mediated the effect of walking on functional impact, but not on pain. Additionally, the moderated mediated model showed that this effect was significant at medium and high levels of PA, but not when levels of PA were low. CONCLUSIONS Provision of resources focused on positive affect seem to increase the positive effects of walking on functional impact through the reduction of depressive symptoms. Nurses can improve adherence of patients with FM to walking behavior through increasing positive affect.
Collapse
Affiliation(s)
- Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lilian Velasco
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Mª Angeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain.
| |
Collapse
|
8
|
Yue X, Liu L, Chen W, Preece DA, Liu Q, Li H, Wang Y, Qian Q. Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating "ADHD-simplex" and "ADHD-complex" syndromes? J Affect Disord 2022; 307:133-141. [PMID: 35367500 DOI: 10.1016/j.jad.2022.03.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 01/29/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative "ADHD+ED" subphenotypes. METHOD 4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments. RESULTS Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes. LIMITATIONS The data for our LCA were cross-sectional and based primarily on parent ratings. CONCLUSION Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential "ADHD-complex" syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.
Collapse
Affiliation(s)
- Xinxin Yue
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Wai Chen
- Mental Health Service, Fiona Stanley Hospital, Perth, Australia; Graduate School of Education, University of Western Australia, Australia; School of Medicine, University of Notre Dame Australia, Fremantle, Australia; School of Psychology, Murdoch University, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia; The enAble Institute, Curtin University, Perth, Australia.
| | - David A Preece
- The enAble Institute, Curtin University, Perth, Australia; School of Psychology, Curtin University, Perth, Australia; School of Psychological Science, University of Western Australia, Perth, Australia
| | - Qianrong Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Haimei Li
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China.
| |
Collapse
|
9
|
Pisinger VSC, Tolstrup JS. Are emotional symptoms and depression among young people with parental alcohol problems modified by socioeconomic position? Eur Child Adolesc Psychiatry 2022; 31:747-755. [PMID: 33432403 DOI: 10.1007/s00787-020-01716-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 04/16/2020] [Accepted: 12/25/2020] [Indexed: 12/20/2022]
Abstract
The aim was to test the hypothesis that parental alcohol problems and low socioeconomic position would be associated with higher odds ratio of emotional symptoms and depression as compared to high socioeconomic position and parental alcohol problems. Data came from Danish National Youth Study 2014, a web-based national survey with 75,853 high school and vocational school students participating, merged with register-data on family socioeconomic position. Multi-level logistic regression models (nesting participants within schools) were used to assess the association between perceived parental alcohol problems and frequent emotional symptoms and depression and effect modification by financial strains in the family, family income, or parental educational level. All analyses were adjusted for age, sex, education, immigration status, and cohabitation with parents. Young people with parental alcohol problems had higher odds ratio of experiencing frequent emotional symptoms (OR = 1.56 [1.46-1.66]) and depression (OR = 2.07 [1.88-2.28]), compared to young people without parental alcohol problems. There was no effect modification between severity of parental alcohol problems and the measures of socioeconomic position on the odds ratio of frequent emotional symptoms and depression. This study found that young people with parental alcohol problems in all social strata had higher odds ratios of frequent emotional symptoms and depression compared to young people without parental alcohol problems; the more severely they had been affected by parent's alcohol problems, the higher the odds ratios of frequent emotional symptoms and depression.
Collapse
Affiliation(s)
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
| |
Collapse
|
10
|
Humphrey N, Panayiotou M. Bounce Back: randomised trial of a brief, school-based group intervention for children with emergent mental health difficulties. Eur Child Adolesc Psychiatry 2022; 31:205-10. [PMID: 32770409 DOI: 10.1007/s00787-020-01612-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
We report the findings of the first randomised trial of Bounce Back, a brief, school-based group intervention for children with emergent mental health difficulties, whose aim is to improve their understanding of resilience and well-being, support them to build their confidence and friendships, and provide practical skills to make positive behaviour changes. 24 primary schools (N = 326 children) were randomly allocated to deliver the intervention or continue practice as usual in a waitlist design. Children in the intervention arm of the trial worked in groups of up to 15, supported by a trained youth practitioner, over ten weekly sessions that were delivered during the school day for up to an hour. Measures of emotional symptoms, behavioural difficulties, problem-solving, and self-esteem were recorded at baseline and post-intervention follow-up. Routinely collected session attendance data were used as a proxy for intervention compliance. Intent to treat analyses revealed that Bounce Back produced significant reductions in emotional symptoms (d = - 0.21). Furthermore, complier average causal effect analyses established that intervention compliance modified this treatment effect, such that children who attended more sessions accrued greater reductions in symptoms (moderate compliance d = - 0.54; high compliance d = - 0.61). There were no intervention effects for any of the other outcomes. Collectively, these findings provide robust preliminary evidence of the efficacy of Bounce Back.Trial registration: ISRCTN11162672.
Collapse
|
11
|
Chambi-Martínez CAA, Moraga-Escobar EI, Peralta-Jiménez GA, Vera-Calzaretta A, Barrientos J, Pihán R, Klaassen G, Páez D. Social Support, Stress and Emotional Symptoms Among LGBTQ+ College Students in Chile. Int J Sex Health 2021; 34:277-290. [PMID: 38596522 PMCID: PMC10903570 DOI: 10.1080/19317611.2021.2014014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 10/13/2021] [Accepted: 11/25/2021] [Indexed: 04/11/2024]
Abstract
Objective to compare the relationships between emotional symptomatology and perceived social support according to gender identity and sexual orientation in LGBTQ+ university students. Methods 322 Chilean LGBTQ+ college students answered an online survey based on sociodemographic information and validated instruments. Analysis of variance and linear regressions were made. Results Transgender people have more emotional symptoms and stress and less perceived social support from family than the rest of LGBTQ+ students. Depression and anxiety are negatively associated with perceived social support from friends and family. Conclusions Perceived social support decreases emotional symptomatology even when controlling for current stress in LGBTQ+ students.
Collapse
Affiliation(s)
| | - Esteban Iván Moraga-Escobar
- Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes, Imhay, Chile
| | | | - Aldo Vera-Calzaretta
- Unidad Docente Administrativa Higueras, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile
| | - Jaime Barrientos
- Facultad de Psicología, Universidad Alberto Hurtado, Santiago, Chile
| | - Rolando Pihán
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Gonzalo Klaassen
- Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Darío Páez
- Departamento de Psicología Social y Metodología, Facultad de Psicología, Universidad del País Vasco, San Sebastián, España
- Facultad de Educación y Ciencias Sociales, Universidad Andrés Bello, Santiago, Chile
| |
Collapse
|
12
|
Wyrwich KW, Winnette R, Bender R, Gandhi K, Williams N, Harris N, Nelson L. Validation of the Alopecia Areata Patient Priority Outcomes (AAPPO) Questionnaire in Adults and Adolescents with Alopecia Areata. Dermatol Ther (Heidelb) 2021; 12:149-166. [PMID: 34846634 PMCID: PMC8776917 DOI: 10.1007/s13555-021-00648-z] [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: 09/28/2021] [Accepted: 11/13/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Individuals with alopecia areata (AA) may experience significant impacts on their health-related quality of life. The novel Alopecia Areata Patient Priority Outcomes (AAPPO) questionnaire has been developed to assess hair loss signs, emotional symptoms, and activity limitations associated with AA. The objective of this study was to evaluate psychometric properties and establish scoring of the AAPPO in adults and adolescents with AA. Methods Scoring and measurement properties of the AAPPO were examined using baseline and 2-week follow-up data from a prospective, noninterventional, web-based study of 121 patients with AA (85 adults aged ≥ 18 years, 36 adolescents aged 12–17 years) with Severity of Alopecia Tool (SALT) ≥ 25% scalp hair loss. Results Exploratory and confirmatory factor analysis supported four single Hair Loss (HL) items, an Emotional Symptoms domain (ES; 4 items), and an Activity Limitations domain (AL; 3 items). Among all patients, the multi-item ES and AL domains had strong internal consistency (α ≥ 0.87); all HL items and domain scores had strong test-retest reliability (weighted kappa or intraclass correlation coefficients ≥ 0.78). All HL item scores demonstrated strong construct validity (r ≥ 0.52) compared with the patient-reported Alopecia Areata Symptom and Impact Scale (AASIS) hair loss subscale score; ES and AL domain scores exhibited strong construct validity (r ≥ 0.66) compared with the SF-36 Mental Component Summary (MCS) score. Using SALT scores, HL mean item scores were better (lower) in the 25–49% SALT subgroup versus those with highest SALT scores (76–100%); however, ES mean domain scores were better in the SALT 76–100% subgroup in the same comparison (p < 0.0001). Using AASIS and MCS score–created subgroups, ES and AL mean domain scores demonstrated hypothesized differences across subgroups (all p values < 0.0001). Conclusion The AAPPO questionnaire is a reliable, valid disease-specific measure of hair loss severity and impact in individuals with AA. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00648-z.
Collapse
Affiliation(s)
| | | | - Randall Bender
- Patient-Centered Outcomes Assessment, RTI Health Solutions (RTI-HS), 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Kavita Gandhi
- Patient and Health Impact, Pfizer, Collegeville, PA, USA
| | - Nicole Williams
- Patient-Centered Outcomes Assessment, RTI Health Solutions (RTI-HS), 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Nimanee Harris
- Patient-Centered Outcomes Assessment, RTI Health Solutions (RTI-HS), 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Lauren Nelson
- Patient-Centered Outcomes Assessment, RTI Health Solutions (RTI-HS), 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| |
Collapse
|
13
|
Demkowicz O, Panayiotou M, Humphrey N. Cumulative risk exposure and emotional symptoms among early adolescent girls. BMC Womens Health 2021; 21:388. [PMID: 34740341 PMCID: PMC8569965 DOI: 10.1186/s12905-021-01527-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/28/2021] [Indexed: 12/05/2022]
Abstract
Background From early adolescence, girls and women report the highest rates of emotional symptoms, and there is evidence of increased prevalence in recent years. We investigate risk factors and cumulative risk exposure (CRE) in relation to emotional symptoms among early adolescent girls.
Methods We used secondary data analysis, drawing on data capturing demographic information and self-reported emotional symptoms from 8327 girls aged 11–12 years from the 2017 baseline data collection phase of the HeadStart evaluation. We used structural equation modelling to identify risk factors in relation to self-reported emotional symptoms, and collated this into a CRE index to investigate associations between CRE and emotional symptoms. Results Four risk factors were found to have a statistically significant relationship with emotional symptoms among early adolescent girls: low academic attainment, special educational needs, low family income, and caregiving responsibilities. CRE was positively associated with emotional symptoms, with a small effect size. Conclusions Results identify risk factors (outlined above) that are associated with emotional symptoms among early adolescent girls, and highlight that early adolescent girls experiencing a greater number of risk factors in their lives are likely to also experience greater emotional distress. Findings highlight the need for identification and targeted mental health intervention (e.g., individual or group counselling, approaches targeting specific symptoms), for those facing greater risk and/or with emergent symptoms.
Collapse
Affiliation(s)
- Ola Demkowicz
- Manchester Institute of Education, The University of Manchester, Manchester, UK.
| | | | - Neil Humphrey
- Manchester Institute of Education, The University of Manchester, Manchester, UK
| |
Collapse
|
14
|
Kamalumpundi V, Saeidzadeh S, Chi NC, Nair R, Gilbertson-White S. The efficacy of web or mobile-based interventions to alleviate emotional symptoms in people with advanced cancer: a systematic review and meta-analysis. Support Care Cancer 2021. [PMID: 34735601 DOI: 10.1007/s00520-021-06496-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This review aims to critically evaluate the efficacy of web or mobile-based (WMB) interventions impacting emotional symptoms in patients with advanced cancer. METHOD Articles published from 1991 to 2019 were identified using PubMed, PsycINFO, CINAHL, and Scopus. Only interventions involving adults with advanced cancer using a WMB intervention to manage emotional symptoms were included. Risk of bias was assessed using ROBINS-I and ROB2 tools. Studies that reported mean symptom scores were pooled using a random-effects model, and standardized mean difference (SMD) and 95% CIs were calculated. RESULTS Twenty-three of the 1177 screened studies met the inclusion criteria, and a total sample of 2558 patients were included. The sample was 57% female, and 33% had advanced cancer with mean age of 57.15 years. Thirteen studies evaluated anxiety, nineteen evaluated depression, and eleven evaluated distress. Intervention components included general information, tracking, communication, multimedia choice, interactive online activities, tailoring/feedback, symptom management support content, and self-monitoring. Overall pooled results showed that WMB interventions' effects on decreasing anxiety (SMD - 0.20, - 0.45 to 0.05, I2 = 72%), depression (SMD - 0.10, - 0.30 to 0.11, I2 = 73%), and distress (SMD - 0.20, - 0.47 to 0.06, I2 = 60%) were not significant for randomized controlled trials (RCTs). In contrast, WMB interventions significantly decreased symptoms of anxiety (p = .002) in a sub-group analysis of non-RCTs. CONCLUSION This meta-analysis demonstrated that WMB interventions were not efficacious in alleviating emotional symptoms in adults with advanced cancer. Considering the diversity of interventions, the efficacy of WMB interventions and its impacts on emotional symptoms should be further explored.
Collapse
|
15
|
David OA, Predatu R, Cardoș RA. Effectiveness of the REThink therapeutic online video game in promoting mental health in children and adolescents. Internet Interv 2021; 25:100391. [PMID: 33996508 PMCID: PMC8099491 DOI: 10.1016/j.invent.2021.100391] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 12/22/2022] Open
Abstract
Although evidence-based interventions exist, estimates suggest that about 60% percent of children and adolescents with mental health disorders do not receive the treatment they need. In this context, one expanding strategy for increasing access to mental health care for children and adolescents is the use therapeutic, or serious, games. REThink is one such therapeutic game, developed to offer a CBT-based prevention that was documented in a controlled trial to develop psychological resilience in children and adolescents, aged between 10 and 16, helping them learn healthy strategies for coping with dysfunctional negative emotions such as anxiety, anger and depression. This study aims to test the effectiveness of the REThink therapeutic online video game in promoting emotional health in children and adolescents in a pilot study. Participants (N = 31), aged between 10 and 16 years, were recruited on a volunteer basis from a school. Emotional problems, irrational beliefs, negative automatic thoughts, rational beliefs, and problem solving abilities were assessed pre- and post-using the therapeutic game. We also measured participants' satisfaction with the game. Results obtained show improvements in terms of emotional problems of the youths, their irrational beliefs, negative automatic thoughts and high levels of intervention satisfaction. of this study are in support of the previous findings suggesting that the REThink online game can be a valuable tool for large-scale mental health efforts aimed at the prevention of emotional disorders in children and adolescents, in accordance with evidence-based prevention protocols.
Collapse
Affiliation(s)
- Oana A. David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Romania,DATA Lab, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University Cluj-Napoca, Romania,Corresponding authors at: Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, 37 Republicii St., 400015 Cluj-Napoca, Romania.
| | - Răzvan Predatu
- DATA Lab, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University Cluj-Napoca, Romania,Doctoral School “Evidence-based assessment and psychological interventions”, Babeș-Bolyai University, Romania
| | - Roxana A.I. Cardoș
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Romania,DATA Lab, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University Cluj-Napoca, Romania
| |
Collapse
|
16
|
Xu H, Sheng J, Wu X, Zhan K, Tao S, Wen X, Liu W, Cudjoe O, Tao F. Moderating effects of plastic packaged food on association of urinary phthalate metabolites with emotional symptoms in Chinese adolescents. Ecotoxicol Environ Saf 2021; 216:112171. [PMID: 33812210 DOI: 10.1016/j.ecoenv.2021.112171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/02/2021] [Accepted: 03/17/2021] [Indexed: 05/26/2023]
Abstract
Previous research reports that diet is the main source of phthalate exposure to adolescents, and phthalate is associated with adolescent mental and behavioral problems. However, no study has explored the moderating effects of eating behavior in this association. This study aimed to analyze the moderating effects of plastic packaged food consumption in the longitudinal association between phthalate metabolite concentration and emotional symptoms in adolescents. This school-based survey was carried out among adolescents in two Chinese provinces. We conducted a baseline and follow-up surveys for 893 freshmen using the purposive sampling method from December 2018 to November 2019. We used food frequency questionnaire to assess eating behavior. The Chinese version of 21-item Depression Anxiety Stress Scales was used to assess emotional symptoms, and high-performance liquid chromatography-tandem mass spectrometry was used to analyze the concentration of six urine phthalate metabolites. The results of latent moderation model indicated that plastic packaged food consumption moderated the association of low molecular weight phthalate (LMWP) with depressive symptoms (β = 0.27, P = 0.002), anxiety symptoms (β = 0.89, P < 0.01), and stress symptoms (β = 0.23, P = 0.019). The moderating effects were significant at the higher scores (β = 0.14-0.35, P < 0.05) and/or the lower scores (β = -0.35 to -0.12, P < 0.05) of plastic packaged food consumption. The results suggest that plastic packaged food consumption to some extent moderates the longitudinal association of phthalate exposure with emotional symptoms in adolescents.
Collapse
Affiliation(s)
- Honglv Xu
- School of Medicine, Kunming University, 2 Puxin Road, Kunming 650214, Yunnan, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Jie Sheng
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Kai Zhan
- Anhui Key Laboratory of Livestock and Poultry Product Safety Engineering, Institute of Animal Husbandry and Veterinary Medicine, Anhui Academy of Agricultural Science, Hefei 230031, Anhui, PR China
| | - Shuman Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Xing Wen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Wenwen Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Obed Cudjoe
- University of Cape Coast, Department of Microbiology and Immunology, School of Medical Sciences, Cape Coast, Ghana; Department and the Key Laboratory of Microbiology and Parasitology, Anhui, School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei 230032, Anhui, PR China.
| |
Collapse
|
17
|
Kovács-Tóth B, Oláh B, Papp G, Szabó IK. Assessing adverse childhood experiences, social, emotional, and behavioral symptoms, and subjective health complaints among Hungarian adolescents. Child Adolesc Psychiatry Ment Health 2021; 15:12. [PMID: 33618739 PMCID: PMC7901200 DOI: 10.1186/s13034-021-00365-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) can have lifelong adverse impacts; they can play a role in the development of subsequent emotional, cognitive, and social impairments leading to somatic and mental difficulties, as well as health damaging behaviours. Unfortunately, there are currently no research data available in Hungary regarding the frequency of ACEs among adolescents. AIMS A cross sectional questionnaire survey was conducted in a community sample of Hungarian adolescents to assess the frequency of ACEs and analyse their association with current social, emotional, and behavioural symptoms (SEB), and subjective health complaints (SHC). METHODS Demographic data, ACEs, SEB and SHC status of 516 adolescents aged 12 to 17 were collected. ACEs were assessed using the ACE Score Calculator; for SEB the Strengths and Difficulties Questionnaire, and for SHC some specific items from the Health Behaviour of School Children questionnaire were employed. To analyse the relationship of ACEs to SEB and SHC logistic regression was performed. RESULTS Our results showed that the frequency of ACEs, SEB and SHC is high among adolescents. One-fourth of the students reported ≥ 2 categories of childhood exposures, and 7.4% reported having experienced ≥ 4 types of ACEs. The most prevalent forms of child maltreatment were emotional neglect (15.5%) and emotional abuse (14.5%). The most frequent dysfunctional household condition was parental divorce or separation (23.8%), followed by household substance abuse (8.9%) and household mental illness (8.1%). Almost one-fifth of students (17.5%) reported SEB symptoms (peer relationship problems in 21.7%, emotional symptoms in 14.6%, conduct problems in 18.3%, hyperactivity in 15%). The prevalence of SHC was also high: more than half of the students experienced at least one subjective health complaint multiple times a week. Significant associations were found between ACEs and the SEB/SHC reported by students. CONCLUSIONS Adverse childhood experiences, social, emotional, and behavioural symptoms, and SHC are common among Hungarian adolescents. The cumulation of ACEs is associated with a higher number of SEB and SHC symptoms. Therefore, prevention programmes, early recognition, risk reduction, and therapy are needed.
Collapse
Affiliation(s)
- Beáta Kovács-Tóth
- Department of Behavioural Sciences, University of Debrecen Faculty of Medicine, Nagyerdei krt. 98, POB. 45, Debrecen, 4032, Hungary. .,Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
| | - Barnabás Oláh
- grid.7122.60000 0001 1088 8582Department of Behavioural Sciences, University of Debrecen Faculty of Medicine, Nagyerdei krt. 98, POB. 45, Debrecen, 4032 Hungary ,grid.7122.60000 0001 1088 8582Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Gábor Papp
- grid.7122.60000 0001 1088 8582Institute of Psychology, University of Debrecen, Debrecen, Hungary
| | - Ildikó Kuritárné Szabó
- grid.7122.60000 0001 1088 8582Department of Behavioural Sciences, University of Debrecen Faculty of Medicine, Nagyerdei krt. 98, POB. 45, Debrecen, 4032 Hungary ,grid.7122.60000 0001 1088 8582Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
18
|
Weigend Vargas E, Hemenway D. Emotional and physical symptoms after gun victimization in the United States, 2009-2019. Prev Med 2021; 143:106374. [PMID: 33326829 DOI: 10.1016/j.ypmed.2020.106374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 08/24/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023]
Abstract
Interpersonal firearm violence is a major public health problem in the United States. The objective of this study was to determine the effects of gun victimization on the likelihood of post emotional and physical symptoms as reported by victims. We focused on non-fatal violent crimes reported to the National Crime Victimization Surveys for 2009-2019 and ran a set of binary logistic regressions. For outcome measures, we used two dichotomous variables, whether the victim reported feeling at least one of the seven emotional symptoms included in the survey (i.e., anxious, angry, sad/depressed, vulnerable, violated, distrustful, unsafe) and whether they reported having at least one of the seven physical symptoms (i.e., headaches, sleep eating/drinking disorders, upset stomach, fatigue, high blood pressure, muscle tension). Our key independent variable was the type of weapons used by the offender: guns, other weapons, and no weapon. We controlled for demographics of the victim, as well as other aspects of the crime (e.g., age, race, sex of victim, multiple offenders, type of violent crime). Victims of crimes in which the offender used a gun were most likely to report both emotional and physical symptoms, followed by victims of crimes in which the offender used other weapons, and lastly by victims of unarmed offenders. Our findings suggest that the presence of a firearm during a violent crime results in an increased likelihood of subsequent emotional and physical repercussions.
Collapse
Affiliation(s)
| | - David Hemenway
- Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| |
Collapse
|
19
|
Xu H, Wu X, Liang C, Shen J, Tao S, Wen X, Liu W, Zou L, Yang Y, Xie Y, Jin Z, Li T, Tao F. Association of urinary phthalates metabolites concentration with emotional symptoms in Chinese university students. Environ Pollut 2020; 262:114279. [PMID: 32443185 DOI: 10.1016/j.envpol.2020.114279] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/30/2020] [Accepted: 02/25/2020] [Indexed: 06/11/2023]
Abstract
Previous studies have shown the associations between phthalates exposure and psychological behavior problems in children and adolescents, but such associations have not been fully elucidated in university students, especially among Chinese university students. This study aims to examine the association between urinary phthalates metabolites concentration and emotional symptoms in Chinese university students. A school-based cross-sectional survey was carried out among 990 university students aged 17-24 years from two universities in Anhui and Jiangxi provinces of China. Concentration of six phthalate metabolites in urine was determined by high-performance liquid chromatography-tandem mass spectrometry and the emotional symptoms were assessed by the 21-item Depression, Anxiety, and Stress Scale. The detection rate of six phthalate metabolites in urine ranged from 79.6% to 99.7%. The median concentration of six phthalate metabolites ranged from 2.90 to 119.64 ng/mL. The positive rates of depressive symptoms, anxiety symptoms, and stress were 17.4%, 24.8%, and 9.5%, respectively. After adjusting for the confounding variables, mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) was found to be associated with depressive symptoms (β = 8.84, P = 0.017), anxiety symptoms (β = 8.46, P = 0.015), and stress symptoms (β = 9.95, P = 0.012) in males; whereas, monobutyl phthalate (MBP) was found to be associated with depressive symptoms (β = 1.86, P = 0.002), anxiety symptoms (β = 1.81, P = 0.005), and stress symptoms (β = 1.48, P = 0.047) in females. Our study demonstrates that Chinese university students are widely exposed to phthalates; and high- and low-molecular weight phthalates are associated with emotional symptoms in males and females, respectively.
Collapse
Affiliation(s)
- Honglv Xu
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Xiaoyan Wu
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Chunmei Liang
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Jie Shen
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Shuman Tao
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Xing Wen
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Wenwen Liu
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Liwei Zou
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Yajuan Yang
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Yang Xie
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Zhongxiu Jin
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Tingting Li
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, PR China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, PR China.
| |
Collapse
|
20
|
Fabris MA, Marengo D, Longobardi C, Settanni M. Investigating the links between fear of missing out, social media addiction, and emotional symptoms in adolescence: The role of stress associated with neglect and negative reactions on social media. Addict Behav 2020; 106:106364. [PMID: 32145495 DOI: 10.1016/j.addbeh.2020.106364] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/11/2020] [Accepted: 02/22/2020] [Indexed: 12/21/2022]
Abstract
Fear of missing out (FoMO) is known to be associated with a decrease in emotional well-being in adolescents. However, few studies have investigated the possible mediating factors between FoMO and emotional symptoms. In this study, we studied the relationship between FoMO and emotional symptoms in a sample of 472 Italian adolescents aged 11-19. In particular, the study investigated the possible mediating role of perceived stress associated with experiences of neglect and negative reactions by other social media users, and social media addiction. Self-report measures were used. Results show that FoMO directly and indirectly predicts emotional symptoms. Additionally, FoMO is associated with increased sensitivity to stress associated with experiences of neglect and negative reactions by online peers, and social media addiction. Sensitivity to stress associated with neglect (but not to negative reactions) by online peers is found to mediate the relationship between FoMO and social media addiction, which, in turn, mediates the relationship with emotional symptoms. In general, the study shows that FoMO is a factor in experiencing higher sensitivity to stress associated with neglect by online peers, which in turn my act as a trigger for social media addiction, and ultimately showing a negative impact on emotional well-being of adolescents. Limits and future directions for research are discussed.
Collapse
Affiliation(s)
- M A Fabris
- Department of Psychology, University of Turin, Italy.
| | - D Marengo
- Department of Psychology, University of Turin, Italy.
| | - C Longobardi
- Department of Psychology, University of Turin, Italy.
| | - M Settanni
- Department of Psychology, University of Turin, Italy.
| |
Collapse
|
21
|
Chan RCH, Yi H, Siu QKY. Polymorbidity of developmental disabilities: Additive effects on child psychosocial functioning and parental distress. Res Dev Disabil 2020; 99:103579. [PMID: 32078912 DOI: 10.1016/j.ridd.2020.103579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 12/18/2019] [Accepted: 01/16/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND While parents of children with developmental disabilities show greater parenting burden and distress compared with their counterparts, little is known about to what extent developmental polymorbidity in children escalates and magnifies the risk of parental distress. AIMS This study investigated the co-occurrence of developmental disabilities among a sample of elementary school children and examined its additive effects on child psychosocial functioning and parental distress. METHODS AND PROCEDURES A cross-sectional survey among 710 parents of elementary school children in Hong Kong included measures of child psychosocial functioning and parental stress. Structural equation modeling was used to test a hypothesized model in which child psychosocial functioning mediates the effect of developmental polymorbidity on parental distress. OUTCOMES AND RESULTS About one-fourth of the participants reported their children having two or more developmental disabilities. The number of developmental disabilities was positively related to the severity of emotional and behavioral problems in children, which in turn explained general and parenting distress in parents. CONCLUSIONS AND IMPLICATIONS Given the heightened vulnerability to distress among parents of children with multiple developmental disabilities, psychological care should particularly target this population. Early identification and intervention strategies are also needed to detect children with multiple co-occurring developmental disabilities, which could potentially alleviate their emotional and behavioral problems and lessen the parenting burden.
Collapse
Affiliation(s)
- Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong Special Administrative Region.
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - Queenie K Y Siu
- Department of Clinical Psychology, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong Special Administrative Region.
| |
Collapse
|
22
|
Whitten T, Laurens KR, Tzoumakis S, Kaggodaarachchi S, Green MJ, Harris F, Carr VJ, Dean K. The influence of parental offending on the continuity and discontinuity of children's internalizing and externalizing difficulties from early to middle childhood. Soc Psychiatry Psychiatr Epidemiol 2019; 54:965-975. [PMID: 30756149 DOI: 10.1007/s00127-019-01670-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/15/2018] [Accepted: 02/04/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Although parental criminal offending is a recognized risk factor for conduct problems among offspring, its impact on the continuity and discontinuity of children's behavioural and emotional difficulties during the early development is less well known. We used data from a large, population-based record-linkage project to examine the relationship between parental offending and the continuity and discontinuity of children's conduct, attentional, and emotional difficulties from early to middle childhood while also considering the role of timing of the parental offending exposure. METHOD Data for 19,208 children and their parents were drawn from the New South Wales Child Development Study. Multinomial regression analyses tested associations between mother's and father's history and timing of any and violent offending, and patterns of continuity or discontinuity in offspring emotional, conduct, and attentional difficulties between ages 5 and 11 years. RESULTS Maternal and paternal offending each conferred a significantly increased risk of all the patterns of developmental difficulties, including those limited to age 5 only (remitting problems), to age 11 only (incident problems), and to difficulties present at both ages 5 and 11 years (persisting problems). Greatest odds were observed for persisting conduct problems. Paternal offending that continued through early and middle childhood had the greatest association with child difficulties, while the timing of maternal offending had a less prominent effect on child developmental difficulties. CONCLUSION Parental offending is a strong risk factor for early and pervasive behavioural and emotional problems in offspring, and may be a key indicator of high risk for later antisocial behaviour.
Collapse
Affiliation(s)
- Tyson Whitten
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Stacy Tzoumakis
- School of Social Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| |
Collapse
|
23
|
Golub Y, Kuitunen-Paul S, Panaseth K, Stonawski V, Frey S, Steigleder R, Grimm J, Goecke TW, Fasching PA, Beckmann MW, Kornhuber J, Kratz O, Heinrich H, Moll GH, Eichler A. Salivary and hair cortisol as biomarkers of emotional and behavioral symptoms in 6-9 year old children. Physiol Behav 2019; 209:112584. [PMID: 31228497 DOI: 10.1016/j.physbeh.2019.112584] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 01/09/2023]
Abstract
The aim of the present work is to investigate the association of salivary and cumulative cortisol levels with emotional and behavioral symptoms in a Franconian Cognition and Emotion Studies (FRANCES) general population cohort of 158 6- to 9 year old children. Salivary cortisol values were measured by one-day diurnal cortisol profile, whereas cumulative cortisol was estimated via one-month hair cortisol concentrations (rHCC). Nearly all significant associations of clinical symptoms with child cortisol indices were age dependent: We report emotional symptoms being associated with lower rHCC in younger children (6.06-7.54 years). In older children (7.55-9.41 years) behavioral problems were further associated with higher rHCC and lower salivary cortisol awakening responses. In summary, child clinical symptoms were stronger associated with markers of hair cortisol compared to salivary cortisol. To picture developmental mechanisms, we suggest longitudinal designs for cortisol measures of stress systems in children and adolescents.
Collapse
Affiliation(s)
- Yulia Golub
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany; University Hospital Dresden, Department of Child and Adolescent Psychiatry and Psychotherapy, Fetscherstraße 74, 01307 Dresden, Germany.
| | - Sören Kuitunen-Paul
- University Hospital Dresden, Department of Child and Adolescent Psychiatry and Psychotherapy, Fetscherstraße 74, 01307 Dresden, Germany.
| | - Kerstin Panaseth
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany.
| | - Valeska Stonawski
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany.
| | - Stefan Frey
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany.
| | - Ruth Steigleder
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany.
| | - Jennifer Grimm
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany.
| | - Tamme W Goecke
- University Hospital Erlangen, Department of Obstetrics and Gynecology, Universitätsstraße 21-23, 91054 Erlangen, Germany; Department of Perinatal Medicine and Obstetrics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Peter A Fasching
- University Hospital Erlangen, Department of Obstetrics and Gynecology, Universitätsstraße 21-23, 91054 Erlangen, Germany.
| | - Matthias W Beckmann
- University Hospital Erlangen, Department of Obstetrics and Gynecology, Universitätsstraße 21-23, 91054 Erlangen, Germany.
| | - Johannes Kornhuber
- University Hospital Erlangen, Department of Psychiatry and Psychotherapy, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Oliver Kratz
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany.
| | - Hartmut Heinrich
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany; kbo-Heckscher-Klinikum, Deisenhofener Str. 28, 81539 München, Germany.
| | - Gunter H Moll
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany.
| | - Anna Eichler
- University Hospital Erlangen, Department of Child and Adolescent Mental Health, Schwabachanlage 6 & 10, 91054 Erlangen, Germany.
| |
Collapse
|
24
|
Alcántara-Canabal L, Fernández-Baizán C, Solís-Sánchez G, Arias JL, Méndez M. [Identification of behavioural and emotional problems in premature children in the primary care setting]. Aten Primaria 2019; 52:104-111. [PMID: 30638698 PMCID: PMC7025995 DOI: 10.1016/j.aprim.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/26/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
Objetivos Evidenciar la utilidad, para su uso por el pediatra de atención primaria, del cuestionario BASC (Behavior Assessment System for Children) para la detección precoz de los problemas psicológicos y comportamentales en los prematuros. Diseño Estudio transversal y descriptivo. Emplazamiento Centro de atención primaria (Área Sanitaria IV del Principado de Asturias) y centro hospitalario (Hospital Universitario Central de Asturias), España. Participantes Padres de 87 niños prematuros con peso menor de 1.500 g al nacimiento y de 43 controles nacidos a término, ambos grupos con edad de 5 a 7 años. Mediciones principales Se aplicó el cuestionario BASC (versión para padres). Resultados Los niños prematuros presentan diferencias respecto a los controles, muestran mayores niveles de inatención (Z = −4,125; p < 0,001), ansiedad (Z = −2,801; p = 0,005) e interiorización de conductas (Z = −2,148; p = 0,032), conductas que son más evidentes a los 5 años. Los niños prematuros presentan mayores niveles de hiperactividad (Z = −2,082; p = 0,037) y problemas de conducta (Z = −2.354; p = 0,019) que las niñas, que destacan en problemas de atención (Z = −2.345; p = 0,019). Conclusiones El BASC permite la detección y diagnóstico precoz en atención primaria de los problemas de conducta y emocionales de los niños prematuros.
Collapse
Affiliation(s)
| | - Cristina Fernández-Baizán
- Departamento de Psicología, Instituto de Neurociencias del Principado de Asturias (INEUROPA), Universidad de Oviedo, Oviedo (Asturias), España
| | - Gonzalo Solís-Sánchez
- Área de Gestión Clínica de Pediatría, Neonatología, Hospital Universitario Central de Asturias, Oviedo (Asturias), España
| | - Jorge L Arias
- Departamento de Psicología, Instituto de Neurociencias del Principado de Asturias (INEUROPA), Universidad de Oviedo, Oviedo (Asturias), España
| | - Marta Méndez
- Departamento de Psicología, Instituto de Neurociencias del Principado de Asturias (INEUROPA), Universidad de Oviedo, Oviedo (Asturias), España
| |
Collapse
|
25
|
Gin K, Banerjea P, Abbott C, Browning S, Bracegirdle K, Corrigall R, Jolley S. Childhood unusual experiences in community Child and Adolescent Mental Health Services in South East London: Prevalence and impact. Schizophr Res 2018; 195:93-96. [PMID: 28874319 DOI: 10.1016/j.schres.2017.08.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Received: 01/17/2017] [Revised: 05/03/2017] [Accepted: 08/22/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Distressing 'psychotic-like' or unusual experiences (UEDs) signify increased mental health risk in the general population, including greater likelihood and severity of co-occurring non-psychotic mental health problems, and, from fourteen years of age, increased risk of a future psychotic illness. Healthcare guidelines for under eighteens recommend psychological intervention for UEDs, to reduce current distress and adverse functional impact, and, potentially, future mental health risk. Children tend not to report UEDs unless directly asked, indicating a need for routine screening. We report on the feasibility of a routine screening methodology, and screening outcomes, in Child and Adolescent Mental Health Services (CAMHS) in South East London, United Kingdom. METHOD Four general community CAMHS teams were invited to screen, by adding a nine-item self-report UED measure to their routine assessment battery. Screening data were collected over 18months from 02/2015 to 07/2016. RESULTS All but one team agreed to screen. Each team saw around 300 accepted referrals during the audit period (total: 900); 768 of these (85%) were successfully screened; of those screened, 68% (n=524) self-reported UEs, 60% (n=461) with associated distress/adverse functional impact. Screening was acceptable to clinicians, children and families. CONCLUSIONS Assessing UEDs routinely in CAMHS is feasible, and suggests that around two thirds of assessed referrals could potentially benefit from interventions targeting UEDs. Additional training may be required for the CAMHS workforce to address this need.
Collapse
Affiliation(s)
- Kimberley Gin
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
| | - Partha Banerjea
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Chris Abbott
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Sophie Browning
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | | | | | - Suzanne Jolley
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London SE5 8AF, UK
| |
Collapse
|
26
|
Crane L, Sumner E, Hill EL. Emotional and behavioural problems in children with Developmental Coordination Disorder: Exploring parent and teacher reports. Res Dev Disabil 2017; 70:67-74. [PMID: 28915470 DOI: 10.1016/j.ridd.2017.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Although characterised by motor impairments, children with Developmental Coordination Disorder (DCD) also show high rates of psychopathology (anxiety, depression, low self-esteem). Such findings have led to calls for the screening of mental health problems in this group. AIMS To investigate patterns and profiles of emotional and behavioural problems in children with and without DCD, using the Strengths and Difficulties Questionnaire (SDQ). METHODS AND PROCEDURES Teachers and parents completed SDQs for 30 children with DCD (7-10 years). Teacher ratings on the SDQ were also obtained from two typically-developing (TD) groups: 35 children matched for chronological age, and 29 younger children (4-7 years) matched by motor ability. OUTCOMES AND RESULTS Group and individual analyses compared parent and teacher SDQ scores for children with DCD. Teacher reports showed that children with DCD displayed higher rates of emotional and behavioural problems (overall, and on each subscale of the SDQ) relative to their TD peers. No differences were observed between the two TD groups. Inspection of individual data points highlighted variability in the SDQ scores of the DCD group (across both teacher and parent ratings), with suggestions of elevated hyperactivity but comparably lower levels of conduct problems across this sample. Modest agreement was found between teacher and parent ratings of children with DCD on the SDQ. CONCLUSIONS AND IMPLICATIONS There is a need to monitor levels of emotional and behavioural problems in children with DCD, from multiple informants.
Collapse
Affiliation(s)
- Laura Crane
- Department of Psychology, Goldsmiths, University of London, United Kingdom; Department of Psychology and Human Development, UCL Institute of Education, United Kingdom
| | - Emma Sumner
- Department of Psychology and Human Development, UCL Institute of Education, United Kingdom.
| | - Elisabeth L Hill
- Department of Psychology, Goldsmiths, University of London, United Kingdom
| |
Collapse
|
27
|
Abstract
The General Health Questionnaire - 12 (GHQ-12) is a widely used screening self-report for emotional disorders among adults. However, there is little evidence concerning the validity of the GHQ-12 in Colombia and its factorial invariance between nonclinical and clinical samples. Accordingly, the current study aims to explore the GHQ-12 validity in Colombian nonclinical and clinical samples. The GHQ-12 was administered to a total of 1641 participants, including a sample of undergraduates, one of general population, and a clinical sample. The internal consistency of the GHQ-12 across samples was good (overall alpha of .90). The one-factor model showed a good fit to the data and was considered theoretically more coherent than the two-factor model with positive and negative items loading in separate factors. Metric and scalar invariance were observed across nonclinical and clinical samples. The GHQ-12 scores were strongly and positively related to emotional symptoms and experiential avoidance, and negatively related to life satisfaction. According to the receiver operating characteristic (ROC) curves, a threshold score of 11/12 was optimal to identify emotional disorders. In conclusion, the GHQ-12 is a valid screening self-report in Colombia that provides scores that can be compared across clinical and nonclinical participants.
Collapse
Affiliation(s)
- Francisco J Ruiz
- Facultad de Psicología, Fundación Universitaria Konrad Lorenz, Bogotá, Colombia.
| | | | - Juan C Suárez-Falcón
- Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| |
Collapse
|
28
|
Mörstedt B, Corbisiero S, Bitto H, Stieglitz RD. Emotional symptoms and their contribution to functional impairment in adults with attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2016; 8:21-33. [PMID: 26254914 DOI: 10.1007/s12402-015-0181-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/31/2015] [Indexed: 12/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a severe neurodevelopmental disorder beginning in childhood and consisting of the core symptoms of inattention, hyperactivity, and impulsivity. The disorder is often accompanied by functional impairment in daily life. Research showed that severe impairment cannot be fully explained by the core symptoms of ADHD. Accordingly, emotional symptoms in ADHD and their influence on functional impairment have increasingly become the focus of research in recent years. The aim of the current study was to investigate the relationship between ADHD core symptoms, emotional symptoms, and functional impairment. We assumed that emotional symptoms might form part of adult ADHD and that the connection between ADHD core symptoms and functional impairment may be partly mediated by emotional symptoms. Data of 176 participants from an ADHD Special Consultations Unit were included. Of these participants, 146 were diagnosed with ADHD, while 30 received no such diagnosis. We developed a structural equation model which included core symptoms, emotional symptoms, and four domains of daily impairment (family life, social life, work, and organization). As predicted, results indicate that emotional symptoms are directly linked to adult ADHD and bear a strong negative influence on different domains of daily life. The results of different analyses showed a mediation of the relationship between ADHD core symptoms and impairment through emotional symptoms: While the connection between inattention and work and organization was partly mediated, the connections between impulsivity and family life and between inattention and social life were shown to be fully mediated through emotional symptoms.
Collapse
|
29
|
Nielsen L, Koushede V, Vinther-Larsen M, Bendtsen P, Ersbøll AK, Due P, Holstein BE. Does school social capital modify socioeconomic inequality in mental health? A multi-level analysis in Danish schools. Soc Sci Med 2015; 140:35-43. [PMID: 26189012 DOI: 10.1016/j.socscimed.2015.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/18/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
It seems that social capital in the neighbourhood has the potential to reduce socioeconomic differences in mental health among adolescents. Whether school social capital is a buffer in the association between socioeconomic position and mental health among adolescents remains uncertain. The aim of this study is therefore to examine if the association between socioeconomic position and emotional symptoms among adolescents is modified by school social capital. The Health Behaviour in School-aged Children Methodology Development Study 2012 provided data on 3549 adolescents aged 11-15 in two municipalities in Denmark. Trust in the school class was used as an indicator of school social capital. Prevalence of daily emotional symptoms in each socioeconomic group measured by parents' occupational class was calculated for each of the three categories of school classes: school classes with high trust, moderate trust and low trust. Multilevel logistic regression analyses with parents' occupational class as the independent variable and daily emotional symptoms as the dependent variable were conducted stratified by level of trust in the school class. The prevalence of emotional symptoms was higher among students in school classes with low trust (12.9%) compared to school classes with high trust (7.2%) (p < 0.01). In school classes with low level of trust, the odds ratio for daily emotional symptoms was 1.89 (95% CI 1.25-2.86) in the low socioeconomic group compared to the high socioeconomic group. In school classes characterised by high and moderate trust, there were no statistically significant differences in emotional symptoms between high and low socioeconomic groups. Although further studies are needed, this cross-sectional study suggests that school social capital may reduce mental health problems and diminish socioeconomic inequality in mental health among adolescents.
Collapse
Affiliation(s)
- Line Nielsen
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, DK-1353 Copenhagen K, Denmark.
| | - Vibeke Koushede
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, DK-1353 Copenhagen K, Denmark.
| | - Mathilde Vinther-Larsen
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, DK-1353 Copenhagen K, Denmark.
| | - Pernille Bendtsen
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, DK-1353 Copenhagen K, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, DK-1353 Copenhagen K, Denmark.
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, DK-1353 Copenhagen K, Denmark.
| | - Bjørn E Holstein
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, DK-1353 Copenhagen K, Denmark.
| |
Collapse
|
30
|
Plenty S, Ostberg V, Almquist YB, Augustine L, Modin B. Psychosocial working conditions: an analysis of emotional symptoms and conduct problems amongst adolescent students. J Adolesc 2014; 37:407-17. [PMID: 24793388 DOI: 10.1016/j.adolescence.2014.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/03/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
Abstract
This study explored how psychosocial features of the schoolwork environment are associated with students' mental health. Data was drawn from 3699 ninth grade (15 year-old) Swedish students participating in the Health Behaviour in School-Aged Children survey. Using Structural Equation Modelling, perceived school demands, decision control and social support from teachers, classmates and parents were examined in relation to students' emotional and conduct problems. Higher demands were associated with greater emotional symptoms and conduct problems. Although weaker social support predicted emotional symptoms and conduct problems, the relative influence of teachers, classmates and parents differed. Teacher support was more closely associated with conduct problems, particularly for girls, while classmate support was more strongly related to emotional symptoms. The findings indicate that while excessive school pressure is associated with poorer mental health, social support can assist in optimising adolescents' emotional health and adaptive behaviour, as well as shaping perceptions of demands.
Collapse
Affiliation(s)
- Stephanie Plenty
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden.
| | - Viveca Ostberg
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden
| | - Ylva B Almquist
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden
| | - Lilly Augustine
- Swedish National Institute of Public Health (FHI), SE-831 40 Östersund, Sweden
| | - Bitte Modin
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden
| |
Collapse
|
31
|
Moser DK, Lee KS, Wu JR, Mudd-Martin G, Jaarsma T, Huang TY, Fan XZ, Strömberg A, Lennie TA, Riegel B. Identification of symptom clusters among patients with heart failure: an international observational study. Int J Nurs Stud 2014; 51:1366-72. [PMID: 24636665 DOI: 10.1016/j.ijnurstu.2014.02.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 01/17/2014] [Accepted: 02/09/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Virtually all patients with heart failure experience multiple symptoms simultaneously, yet clinicians and researchers usually consider symptoms in isolation. Recognizing and responding early to escalating symptoms is essential to preventing hospitalizations in heart failure, yet patients have considerable difficulty recognizing symptoms. Identification of symptom clusters could improve symptom recognition, but cultural differences may be present that must be considered. OBJECTIVES To identify and compare symptom clusters in heart failure patients from the United States, Europe and Asia. DESIGN Cross-sectional, observational study. SETTINGS In- and out-patient settings in three regions of the world: Asia (i.e., China and Taiwan); Europe (i.e., the Netherlands and Sweden); and the United States. PARTICIPANTS A total of 720 patients with confirmed heart failure. Propensity scoring using New York Heart Association Classification was used to match participants from each of the three regions. METHODS Symptoms were identified using the Minnesota Living with Heart Failure Questionnaire. To identify symptom clusters we used cluster analysis with the hierarchical cluster agglomerative approach. We used the Euclidean distance to measure the similarity of variables. Proximity between groups of variables was measured using Ward's method. The resulting clusters were displayed with dendrograms, which show the proximity of variables to each other on the basis of semi-partial R-squared scores. RESULTS There was a core group of symptoms that formed two comparable clusters across the countries. Dyspnea, difficulty in walking or climbing, fatigue/increased need to rest, and fatigue/low energy were grouped into a cluster, which was labeled as a physical capacity symptom cluster. Worrying, feeling depressed, and cognitive problems were grouped into a cluster, which was labeled as an emotional/cognitive symptom cluster. The symptoms of edema and trouble sleeping were variable among the countries and fell into different clusters. CONCLUSION Despite the diversity in cultures studied, we found that symptoms clustered similarly among the cultural groups. Identification of similar symptoms clusters among patients with heart failure may improve symptom recognition in both patients and healthcare providers.
Collapse
|
32
|
Conti-Ramsden G, Mok PL, Pickles A, Durkin K. Adolescents with a history of specific language impairment (SLI): strengths and difficulties in social, emotional and behavioral functioning. Res Dev Disabil 2013; 34:4161-9. [PMID: 24077068 PMCID: PMC3830176 DOI: 10.1016/j.ridd.2013.08.043] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 05/22/2023]
Abstract
Adolescents with specific language impairment (SLI) are at a greater risk of emotional and behavioral problems compared to their typically developing (TD) peers, but little is known about their self-perceived strengths and difficulties. In this study, the self-reported social, emotional and behavioral functioning of 139 adolescents with a history of SLI and 124 TD individuals at age 16 was examined. The self-report version of the Strengths and Difficulties Questionnaire (SDQ) was used to assess their prosocial behavior and levels of peer, emotional and behavioral difficulties. Associations of these areas of functioning with gender, verbal and non-verbal skills were also investigated. Adolescents with a history of SLI were more likely than their TD peers to report higher levels of peer problems, emotional symptoms, hyperactivity and conduct problems. The majority of adolescents in both groups (87% SLI and 96% TD), however, reported prosocial behavior within the typical range. Difficulty with peer relations was the strongest differentiator between the groups, with the odds of reporting borderline or abnormally high levels of peer problems being 12 times higher for individuals with a history of SLI. Adolescents with poorer receptive language skills were also more likely to report higher levels of emotional and behavioral difficulties. The findings of this study identify likely traits that may lead to referral to services.
Collapse
Affiliation(s)
- Gina Conti-Ramsden
- School of Psychological Sciences, Communication and Deafness, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Corresponding author. Tel.: +44 0 161 275 3514.
| | - Pearl L.H. Mok
- School of Psychological Sciences, Communication and Deafness, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Andrew Pickles
- Institute of Psychiatry, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Kevin Durkin
- School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK
| |
Collapse
|