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Weissman MM, Wickramaratne P, Pilowsky DJ, Poh E, Hernandez M, Batten LA, Flament MF, Stewart JW, Blier P. The effects on children of depressed mothers' remission and relapse over 9 months. Psychol Med 2014; 44:2811-2824. [PMID: 25065614 PMCID: PMC4174338 DOI: 10.1017/s003329171400021x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND The high rate of depression among children of depressed mothers is well known. Suggestions that improvement in maternal acute depression has a positive effect on the child have emerged. However, data on the mechanisms of change have been sparse. The aim was to understand how remission and relapse in the mother might explain the changes in the child's outcome. METHOD Participants were 76 depressed mothers who entered into a medication clinical trial for depression and 135 of their eligible offspring ages 7-17 years. The mothers and children were assessed at baseline and periodically over 9 months by independent teams to understand the relationship between changes in children's symptoms and functioning and maternal remission or relapse. The main outcome measures were, for mothers, the Hamilton Depression Rating Scale (HAMD), the Social Adjustment Scale (SAS) and the Parental Bonding Instrument (PBI) and, for children, the Children's Depression Inventory (CDI), the Columbia Impairment Scale (CIS), the Multidimensional Anxiety Scale for Children (MASC) and the Children's Global Assessment Scale (CGAS). RESULTS Maternal remission was associated with a decrease in the child's depressive symptoms. The mother's subsequent relapse was associated with an increase in the child's symptoms over 9 months. The effect of maternal remission on the child's improvement was partially explained by an improvement in the mother's parenting, particularly the change in the mother's ability to listen and talk to her child, but also reflected in her improvement in parental bonding. These findings could not be explained by the child's treatment. CONCLUSIONS A depressed mother's remission is associated with her improvement in parenting and a decrease in her child's symptoms. Her relapse is associated with an increase in her child's symptoms.
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Affiliation(s)
- M. M. Weissman
- Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology at the Mailman School of Public Health at Columbia University, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - P. Wickramaratne
- Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - D. J. Pilowsky
- Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology at the Mailman School of Public Health at Columbia University, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - E. Poh
- Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - M. Hernandez
- Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - L. A. Batten
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
- Carleton University, Ottawa, ON, Canada
| | - M. F. Flament
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - J. W. Stewart
- Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - P. Blier
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
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Berkman A, Pilowsky DJ, Zybert PA, Herman DB, Conover S, Lemelle S, Cournos F, Hoepner LA, Susser E. HIV prevention with severely mentally ill men: A randomised controlled trial. AIDS Care 2007; 19:579-88. [PMID: 17505917 DOI: 10.1080/09540120701213989] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We conducted a randomised clinical trial to test the efficacy of an enhanced version of an intervention previously shown to reduce HIV sexual risk behaviours among men with severe mental illness. One-hundred-and-forty-nine subjects aged 18-59 years were randomly assigned to the experimental or control conditions. Sexual risk behaviours were assessed every three months for 12-months. The primary analysis compared experimental and control groups with respect to sexual risk behaviours with casual partners as measured by the Vaginal Episodes Equivalent (VEE) score. Additional analyses included comparison of VEE scores of those men sexually active in the three months prior to baseline and the proportion of condom-protected sexual acts with casual partners. There were no significant differences in sexual risk behaviours with casual partners between experimental and control subjects. Additional analyses demonstrated a trend toward sexual risk reduction at six months post-intervention (p=0.06) but not at 12 months. These results may reflect a lack of efficacy or a true reduction in risk that the trial was underpowered to detect at the 0.05-level. If there was a true reduction in risk, it was not maintained after the initial six months.
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Affiliation(s)
- A Berkman
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Berkman A, Pilowsky DJ, Zybert PA, Leu CS, Sohler N, Susser E. The impact of substance dependence on HIV sexual risk-reduction among men with severe mental illness. AIDS Care 2007; 17:635-9. [PMID: 16036249 DOI: 10.1080/09540120412331291797] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We explored the impact of substance dependence on the efficacy of an HIV sexual risk reduction intervention previously shown to be effective among men with severe mental illness by comparing rates of high-risk sexual behaviors among men with (n = 26) and without (n = 31) a lifetime history of substance dependence. We sub-divided subjects by alcohol and drug dependence status, comparing each intervention sub-group to the corresponding control sub-group. At each follow-up interval (six, 12 and 18 months), the intervention group as a whole and the non-substance dependent participants showed a significant reduction in risk; the substance-dependent men showed no difference from controls. These data suggest that among men with severe mental illness, substance dependence may be a further impediment to HIV risk reduction.
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Affiliation(s)
- A Berkman
- Mailman School of Public Health at Columbia, Columbia University, New York, NY 10032, USA
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Abstract
The objective of this article is to examine the relationship between panic attacks, panic disorder, and suicidal ideation among primary care patients. A probability sample of 1,007 primary care attenders from a large urban university practice was assessed for current mental disorders and suicidal ideation (past 2 week prevalence) with the PRIME-MD Patient Health Questionnaire. Controlling for major depression, substance use disorders, and sociodemographic variables simultaneously, patients with either panic attacks or panic disorder had significantly increased risks of suicidal ideation. Suicidal ideation was highly associated with major depression and comorbid panic disorder (OR = 15.4) or panic attacks (OR = 7.9). There is need for detection and possible treatment of patients with panic attacks or disorder in primary care, especially among those with co-occurring major depression.
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Affiliation(s)
- R Goodwin
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, and The Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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Abstract
We investigated the association between parental factors (including infection with human immunodeficiency virus [HIV], acquired immunodeficiency syndrome [AIDS] diagnosis, parental medical illness, and depression) and children's behavioral and emotional problems among children of injection drug users (IDUs). IDUs were recruited through community outreach. The sample included 73 parents of 73 children, aged 4 to 12 years. Parental depression (odds ratio [OR] = 4.61) and medical illness (OR = 4.70) were found to be significantly associated with internalizing (depressive and anxiety-related symptoms), but not with externalizing (aggressive and disruptive behaviors) symptoms in the children of IDUs. The clinical implications are that children of IDUs are known to be at high risk for psychiatric symptoms and disorders; these data suggest that children of depressed and/or medically ill IDU parents may be at even higher risk of internalizing symptoms (depression and anxiety symptoms) than children of IDUs who do not suffer from these conditions.
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Affiliation(s)
- D J Pilowsky
- Department of Epidemiology, Mailman School of Public Health at Columbia University, Columbia College of Physicians and Surgeons, New York City, NY 10032, USA.
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Abstract
While it is known that injection drug users (IDUs) often have their children removed or place them voluntarily, little is known about factors associated with whether IDU parents live with their children. We identified a community sample of 391 IDU parents with at least one child under age 14 (index IDU parents). For these IDU parents, 62% did not have any of their children under age 14 living with them. We assessed whether certain health factors, risk related behaviors, social indicators, and active drug use were related to whether children of IDUs were living with the index IDU parent. IDU parents who were living with their children were overwhelmingly more likely to be female, more likely to have health insurance, and engage in no-risk or low-risk drug practices, as compared to moderate/high-risk practices. Additionally, HIV negative and HIV positive asymptomatic parents were about three times more likely to be living with their children than HIV positive parents with clinical symptoms commonly seen among those suffering from HIV-related illnesses. HIV-related clinical symptoms, rather than HIV status per se, seem to be associated with retention of children.
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Affiliation(s)
- D J Pilowsky
- Department of Psychiatry, Columbia College of Physicians and Surgeons at Columbia University, Suite 32, 601 West 168th St., New York, NY 10032, USA.
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Abstract
The purpose of this investigation was to ascertain the reasons given by mothers diagnosed with AIDS (acquired immunodeficiency syndrome) for disclosing or not disclosing their HIV (human immunodeficiency virus) status to their children, a dilemma faced by most HIV-infected parents and those who counsel them. We interviewed 29 mothers residing in one of two New York City facilities that provide housing and medical treatment for adults with AIDS. The majority of these mothers do not live with their children, but all had recent face-to-face contact with them. The two reasons most frequently considered important for disclosing to children were that disclosure was the "right thing to do" and the need to make arrangements for children's future in case of maternal death or incapacity. The reason most frequently considered important for not disclosing was maternal concern about discussing death and dying with children. These findings have significant implications for counseling of HIV-positive parents.
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Pilowsky DJ, Wissow L, Hutton N. Children affected by HIV. Clinical experience and research findings. Child Adolesc Psychiatr Clin N Am 2000; 9:451-64, viii. [PMID: 10768077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This article describes the plight of HIV affected children, and the work of mental health professionals with HIV affected children and their families, and presents pertinent research findings on the topics. The concepts of prevention, resilience, and family and child development are applied to the organizing of mental health care for HIV affected children.
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Affiliation(s)
- D J Pilowsky
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
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Abstract
OBJECTIVE The aim of this study was to investigate the association of panic attacks and suicide attempts in a community-based sample of 13-14-year-old adolescents. METHOD The data are from a survey of 1,580 students in an urban public school system located in the mid-Atlantic region of the United States. Logistic regression methods were used to estimate associations between panic attacks and suicidal ideation and suicide attempts. RESULTS Controlling for demographic factors, major depression, the use of alcohol, and the use of illicit drugs, the authors found that adolescents with panic attacks were three times more likely to have expressed suicidal ideation and approximately two times more likely to have made suicide attempts than were adolescents without panic attacks. CONCLUSIONS This new epidemiologic research adds to the evidence of an association between panic attacks and suicide attempts during the middle years of adolescence.
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Abstract
As the number of HIV-infected women and children in the USA has increased, clinicians and researchers have debated the benefits and risks of disclosure of parental HIV status to children. Disclosure is usually ascertained through interviews of unknown reliability. Given the need to advance knowledge regarding the benefits and risks of disclosure of parental HIV status to children, a reliable and comprehensive disclosure interview is needed. The Parent Disclosure Interview (PDI) was developed for this purpose. In order to study its reliability, 29 HIV-infected mothers were administered the PDI twice, on average one week apart, by two different female interviewers. Kappa statistics indicate that the PDI is highly reliable in most content areas. Researchers may use the interview for comparing the prevalence of disclosure among different groups of HIV-infected parents. Practitioners who assist parents in making decisions about disclosure of HIV status to children may use the interview to obtain a baseline assessment of the clients' disclosure history and attitudes towards disclosure.
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Affiliation(s)
- D J Pilowsky
- Department of Psychiatry, Johns Hopkins University School of Medicine & Kennedy-Krieger Institute, Baltimore, MD, USA.
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Rosenfeld A, Wasserman S, Pilowsky DJ. Psychiatry and children in the child welfare system. Child Adolesc Psychiatr Clin N Am 1998; 7:515-36, viii. [PMID: 9894053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The child welfare system is, for better or worse, an unavoidable associate of the child and adolescent psychiatrist. Although the child psychiatrist rarely plays an integral role in decision making about the children who are involved with the system, the authors point out that a large percentage of children maintained in and involved with the system have psychiatric and developmental disorders. When these children's difficulties are either minimized or unrecognized by child welfare workers, the interventions and treatment that the children receive may be inappropriate. Worse still, when the children's difficulties are improperly addressed, the vicissitudes of the system may further harm them. The authors propose several ways in which the child and adolescent psychiatrist can have an important reparative role and voice in child welfare systems.
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Affiliation(s)
- A Rosenfeld
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Rosenfeld AA, Pilowsky DJ, Fine P, Thorpe M, Fein E, Simms MD, Halfon N, Irwin M, Alfaro J, Saletsky R, Nickman S. Foster care: an update. J Am Acad Child Adolesc Psychiatry 1997; 36:448-57. [PMID: 9100418 DOI: 10.1097/00004583-199704000-00006] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To inform child and adolescent psychiatrists about the almost 500,000 children now residing in the American foster care system. This overview surveys the pediatric, developmental, and psychiatric needs of these children. METHOD Child and adolescent psychiatrists, pediatricians, a child welfare researcher, a social worker, and a psychologist developed a consensus paper from their experience with child welfare and a review of the literature in their respective fields. RESULTS Being in foster care is a defining experience in these children's lives. They are at risk in myriad ways: for instance, being poor, having chronic health deficits, experiencing the trauma of abuse and neglect, and suffering from a gamut of emotional challenges. Evolutionary developments in foster care such as therapeutic foster homes, kinship care, and changes in Medicaid funding will continue to alter the system. CONCLUSIONS Foster children are a huge reservoir of unmet pediatric and psychiatric needs; research on them is spotty at best. It is hoped that child and adolescent psychiatrists will meet the challenges these youngsters present and will advocate for them.
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Affiliation(s)
- A A Rosenfeld
- Johns Hopkins University Medical School, Baltimore, USA
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Affiliation(s)
- S Fennig
- Shelvata Hospital, Tel Aviv, Israel
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Affiliation(s)
- D J Pilowsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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