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Punamäki RL, Diab SY, Drosos K, Qouta SR, Vänskä M. The role of acoustic features of maternal infant-directed singing in enhancing infant sensorimotor, language and socioemotional development. Infant Behav Dev 2024; 74:101908. [PMID: 37992456 DOI: 10.1016/j.infbeh.2023.101908] [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: 02/21/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
The quality of infant-directed speech (IDS) and infant-directed singing (IDSi) are considered vital to children, but empirical studies on protomusical qualities of the IDSi influencing infant development are rare. The current prospective study examines the role of IDSi acoustic features, such as pitch variability, shape and movement, and vocal amplitude vibration, timbre, and resonance, in associating with infant sensorimotor, language, and socioemotional development at six and 18 months. The sample consists of 236 Palestinian mothers from Gaza Strip singing to their six-month-olds a song by their own choice. Maternal IDSi was recorded and analyzed by the OpenSMILE- tool to depict main acoustic features of pitch frequencies, variations, and contours, vocal intensity, resonance formants, and power. The results are based on completed 219 maternal IDSi. Mothers reported about their infants' sensorimotor, language-vocalization, and socioemotional skills at six months, and psychologists tested these skills by Bayley Scales for Infant Development at 18 months. Results show that maternal IDSi characterized by wide pitch variability and rich and high vocal amplitude and vibration were associated with infants' optimal sensorimotor, language vocalization, and socioemotional skills at six months, and rich and high vocal amplitude and vibration predicted these optimal developmental skills also at 18 months. High resonance and rhythmicity formants were associated with optimal language and vocalization skills at six months. To conclude, the IDSi is considered important in enhancing newborn and risk infants' wellbeing, and the current findings argue that favorable acoustic singing qualities are crucial for optimal multidomain development across infancy.
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Affiliation(s)
- Raija-Leena Punamäki
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland.
| | - Safwat Y Diab
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland
| | - Konstantinos Drosos
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland; Nokia Research Center, Espoo, Finland
| | - Samir R Qouta
- Doha Institute for Graduate Studies, School of Social Sciences and Humanities, Qatar
| | - Mervi Vänskä
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland
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2
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Kankaanpää R, Töttö P, Punamäki RL, Peltonen K. Is it time to revise the SDQ? The psychometric evaluation of the Strengths and Difficulties Questionnaire. Psychol Assess 2023; 35:1069-1084. [PMID: 37768636 DOI: 10.1037/pas0001265] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Despite the wide use of the Strengths and Difficulties Questionnaire (SDQ) to assess adolescent mental health, its psychometric functionality is still under debate. This study investigated the structural validity and reliability of the SDQ scores, and the resemblance of the SDQ sum scores and factor scores. Factor one-dimensionality and competing multifactor structures were tested against data. With the best acceptable models, measurement invariance was tested between genders and over time. Subscale reliability and correspondence between subscale sum scores and factor scores were estimated. The nationally representative self-report data from 23,980 Finnish early (12-13 years) and mid- (15-16 years) adolescents (50.4% girls) were collected from two cohorts in 2008 and 2013. The results showed that among early adolescents, the revised SDQ with a controlled method effect had an excellent fit. In contrast, none of the tested models had an acceptable fit among the mid-adolescents. Among early adolescents, strong measurement invariance was achieved between genders and over time. Three of the five subscales were one-dimensional, and all subscales had low reliability. The resemblance between the subscale sum scores and factor scores was alarmingly low. Researchers should be cautious when using the SDQ Total Difficulties sum score or the subscale scores as they may be substantially biased, and practitioners should desist from using the SDQ as a screening tool in its current form. This study strongly supports the revision of the SDQ. In line with the previous findings, we suggest rewording the worst functioning items and revising the reverse-worded difficulties items. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Pertti Töttö
- Faculty of Social Sciences and Business Studies, University of Eastern Finland
| | | | - Kirsi Peltonen
- Inequalities, Interventions, and New Welfare State Research Flagship Center, University of Turku
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3
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Ilomäki M, Lindblom J, Salmela V, Flykt M, Vänskä M, Salmi J, Tolonen T, Alho K, Punamäki RL, Wikman P. Early life stress is associated with the default mode and fronto-limbic network connectivity among young adults. Front Behav Neurosci 2022; 16:958580. [PMID: 36212193 PMCID: PMC9537946 DOI: 10.3389/fnbeh.2022.958580] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Exposure to early life stress (ELS) is associated with a variety of detrimental psychological and neurodevelopmental effects. Importantly, ELS has been associated with regional alterations and aberrant connectivity in the structure and functioning of brain regions involved in emotion processing and self-regulation, creating vulnerability to mental health problems. However, longitudinal research regarding the impact of ELS on functional connectivity between brain regions in the default mode network (DMN) and fronto-limbic network (FLN), both implicated in emotion-related processes, is relatively scarce. Neuroimaging research on ELS has mostly focused on single nodes or bi-nodal connectivity instead of functional networks. We examined how ELS is associated with connectivity patterns within the DMN and FLN during rest in early adulthood. The participants (n = 86; 47 females) in the current functional magnetic resonance imaging (fMRI) study were young adults (18–21 years old) whose families had participated in a longitudinal study since pregnancy. ELS was assessed both prospectively (parental reports of family relationship problems and mental health problems during pregnancy and infancy) and retrospectively (self-reported adverse childhood experiences). Inter-subject representational similarity analysis (IS-RSA) and multivariate distance matrix regression (MDMR) were used to analyze the association between ELS and the chosen networks. The IS-RSA results suggested that prospective ELS was associated with complex alterations within the DMN, and that retrospective ELS was associated with alterations in the FLN. MDMR results, in turn, suggested that that retrospective ELS was associated with DMN connectivity. Mean connectivity of the DMN was also associated with retrospective ELS. Analyses further showed that ELS-related alterations in the FLN were associated with increased connectivity between the prefrontal and limbic regions, and between different prefrontal regions. These results suggest that exposure to ELS in infancy might have long-lasting influences on functional brain connectivity that persist until early adulthood. Our results also speak for the importance of differentiating prospective and retrospective assessment methods to understand the specific neurodevelopmental effects of ELS.
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Affiliation(s)
- Miro Ilomäki
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- *Correspondence: Miro Ilomäki,
| | - Jallu Lindblom
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
- Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Viljami Salmela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marjo Flykt
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Mervi Vänskä
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Juha Salmi
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
| | - Tuija Tolonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kimmo Alho
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Advanced Magnetic Imaging Centre, Aalto NeuroImaging, Aalto University, Espoo, Finland
| | | | - Patrik Wikman
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Flykt M, Belt R, Salo S, Pajulo M, Punamäki RL. Prenatal Reflective Functioning as a Predictor of Substance-Using Mothers' Treatment Outcome: Comparing Results From Two Different RF Measures. Front Psychol 2022; 13:909414. [PMID: 35959038 PMCID: PMC9359121 DOI: 10.3389/fpsyg.2022.909414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Mothers with prenatal substance use disorder (SUD) often show broad deficits in their reflective functioning (RF), implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF (AAI-RF), regarding parent's own childhood experiences, and parenting-focused RF (PRF) regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview (during pregnancy/pre-intervention), and with Parent Development Interview at 4 months (during intervention). Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months (post-intervention), and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions.
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Affiliation(s)
- Marjo Flykt
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, Department of Psychology, Tampere University, Tampere, Finland
- *Correspondence: Marjo Flykt
| | - Ritva Belt
- Department of Social Services, Tampere, Finland
| | - Saara Salo
- Faculty of Education, University of Helsinki, Helsinki, Finland
| | - Marjukka Pajulo
- Faculty of Medicine, Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Raija-Leena Punamäki
- Faculty of Social Sciences, Department of Psychology, Tampere University, Tampere, Finland
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Peltonen K, Aalto S, Vänskä M, Lepistö R, Punamäki RL, Soye E, Watters C, de Wal Pastoor L, Derluyn I, Kankaanpää R. Effectiveness of Promotive and Preventive Psychosocial Interventions on Improving the Mental Health of Finnish-Born and Immigrant Adolescents. IJERPH 2022; 19:ijerph19063686. [PMID: 35329374 PMCID: PMC8955200 DOI: 10.3390/ijerph19063686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 01/27/2023]
Abstract
Background: Schools are considered natural environments in which to enhance students’ social–emotional skills and mental health in general, but they can be especially important for students with refugee and immigrant backgrounds. The current study tested the effectiveness of two school-based interventions in enhancing the mental health and wellbeing of adolescents of native, refugee, and immigrant backgrounds. It further analyzed the role of age, gender, daily stressors, and discrimination in affecting the interventions’ effectiveness. Methods: A three-arm cluster RCT with parallel assignment was applied among the 16 schools. Schools were randomized to three conditions of two active interventions and a waiting-list control condition. Students (n = 1974) filled in an online questionnaire at baseline before the interventions, after the interventions, and at follow-up an average of 9 months after the interventions. The effectiveness criteria were internalizing and externalizing problems, resilience, and prosocial behavior. Results: Interventions were generally not effective in decreasing mental health problems and increasing psychosocial resources. The expected positive intervention effects were dependent on students’ age and gender and exposure to socioeconomic daily stressors. Conclusion: Interventions enhancing teacher awareness and peer relationships at school should be carefully tailored according to the strengths and vulnerabilities of participating students, especially their daily stress exposure, but also age and gender.
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Affiliation(s)
- Kirsi Peltonen
- Department of Child Psychiatry, University of Turku, 20014 Turku, Finland
- INVEST Research Flagship Center, University of Turku, 20014 Turku, Finland
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
- Correspondence:
| | - Sanni Aalto
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
| | - Mervi Vänskä
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
| | - Riina Lepistö
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
| | - Raija-Leena Punamäki
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
| | - Emma Soye
- School of Education and Social Work, University of Sussex, Falmer Brighton BN1 9RH, UK; (E.S.); (C.W.)
| | - Charles Watters
- School of Education and Social Work, University of Sussex, Falmer Brighton BN1 9RH, UK; (E.S.); (C.W.)
| | - Lutine de Wal Pastoor
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, 1353 Copenhagen, Denmark;
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, 9000 Gent, Belgium;
| | - Reeta Kankaanpää
- Faculty of Social Sciences/Psychology, Tampere University, 33100 Tampere, Finland; (S.A.); (M.V.); (R.L.); (R.-L.P.); (R.K.)
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Kankaanpää R, Aalto S, Vänskä M, Lepistö R, Punamäki RL, Soye E, Watters C, Andersen A, Hilden PK, Derluyn I, Verelst A, Peltonen K. Effectiveness of psychosocial school interventions in Finnish schools for refugee and immigrant children, "Refugees Well School" in Finland (RWS-FI): a protocol for a cluster randomized controlled trial. Trials 2022; 23:79. [PMID: 35086535 PMCID: PMC8793091 DOI: 10.1186/s13063-021-05715-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schools are natural environments in which to enhance young people's social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to. METHODS A three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ). DISCUSSION The current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group. TRIAL REGISTRATION ISRCTN ISRCTN64245549 . Retrospectively registered on 10 June 2020.
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Affiliation(s)
- Reeta Kankaanpää
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Sanni Aalto
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Mervi Vänskä
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Riina Lepistö
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | | | - Emma Soye
- School of Education and Social Work, University of Sussex, FIN-33014 Tampere, Finland
| | - Charles Watters
- School of Education and Social Work, University of Sussex, FIN-33014 Tampere, Finland
| | - Arnfinn Andersen
- Section for Trauma, Catastrophes and Forced Migration - Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Per Kristian Hilden
- Section for Trauma, Catastrophes and Forced Migration - Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Ilse Derluyn
- Department of Social Pedagogy, Ghent University, Ghent, Belgium
| | - An Verelst
- Department of Social Pedagogy, Ghent University, Ghent, Belgium
| | - Kirsi Peltonen
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
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Flykt M, Vänskä M, Punamäki RL, Heikkilä L, Tiitinen A, Poikkeus P, Lindblom J. Adolescent Attachment Profiles Are Associated With Mental Health and Risk-Taking Behavior. Front Psychol 2021; 12:761864. [PMID: 34925164 PMCID: PMC8674949 DOI: 10.3389/fpsyg.2021.761864] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/20/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
This person-oriented study aimed to identify adolescents' hierarchical attachment profiles with parents and peers, and to analyze associations between the profiles and adolescent psychosocial adjustment. Participants were 449 Finnish 17-19-year-olds reporting their attachments to mother, father, best friend, and romantic partner and details on mental health (internalizing symptoms, inattention/hyperactivity, and anger control problems) and risk-taking behavior (substance use and sexual risk-taking). Attachment was measured with Experiences in Close Relationships - Relationship Structures (ECR-RS); internalizing, inattention/hyperactivity, and anger control problems with Self-Report of Personality - Adolescent (SRP-A) of the Behavior Assessment System for Children, third edition (BASC-3); substance use with the Consumption scale of the Alcohol Use Disorders Identification Test (AUDIT-C) and items from the Finnish School Health Promotion Study; and sexual risk-taking behavior with the Cognitive Appraisal of Risky Events (CARE). Latent profile analysis identified five attachment profiles: "All secure" (39%), "All insecure" (11%), "Parents insecure - Peers secure" (21%), "Parents secure - Friend insecure" (10%), and "Parents secure - Partner insecure" (19%). "All insecure" adolescents showed the highest and "All secure" adolescents the lowest levels of mental health problems and substance use. Further, parental attachment security seemed to specifically prevent substance use and anger control problems, while peer attachment security prevented internalizing problems. Our findings help both understand the organization of attachment hierarchies in adolescence and refine the role of specific attachment relationships in psychosocial adjustment, which can be important for clinical interventions in adolescence.
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Affiliation(s)
- Marjo Flykt
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Mervi Vänskä
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | | | - Lotta Heikkilä
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Aila Tiitinen
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Piia Poikkeus
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Jallu Lindblom
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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Durbeej N, McDiarmid S, Sarkadi A, Feldman I, Punamäki RL, Kankaanpää R, Andersen A, Hilden PK, Verelst A, Derluyn I, Osman F. Correction to: Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial): study protocol for a cluster randomized controlled trial. Trials 2021; 22:861. [PMID: 34844640 PMCID: PMC8628432 DOI: 10.1186/s13063-021-05840-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27, Uppsala, Sweden.
| | - Serena McDiarmid
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27, Uppsala, Sweden
| | - Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27, Uppsala, Sweden
| | - Inna Feldman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27, Uppsala, Sweden
| | - Raija-Leena Punamäki
- Faculty of Social Sciences, Psychology, FI- 30014, University of Tampere, Tampere, Finland
| | - Reeta Kankaanpää
- Faculty of Social Sciences, Psychology, FI- 30014, University of Tampere, Tampere, Finland
| | - Arnfinn Andersen
- Norwegian Centre for Violence and Traumatic Stress Studies, NO-0409, Oslo, Norway
| | - Per Kristian Hilden
- Norwegian Centre for Violence and Traumatic Stress Studies, NO-0409, Oslo, Norway
| | - An Verelst
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Ilse Derluyn
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Fatumo Osman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27, Uppsala, Sweden.,School of Education, Health and Social Studies, Dalarna University, 791 88, Falun, Sweden
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9
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Sezgin AU, Punamäki RL. Type of Traumatic Events, Mental Health Problems, and Posttraumatic Cognitions Among Eastern Anatolian Women. J Interpers Violence 2021; 36:NP9501-NP9525. [PMID: 31271098 DOI: 10.1177/0886260519858385] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Both severity and type of trauma play a role in mental health consequences. Interpersonal trauma, especially sexual abuse and intentional assaultive violence, form a risk for posttraumatic stress disorder (PTSD). However, few studies have factually compared the impact of trauma types on mental health. This study examined whether interpersonal violence (IPV), natural disasters and accidents (NDA), and life-threat and war (LTW) are differently associated with mental health problems among women. It further examined the mediating role of posttraumatic cognitions (PTCs) among the abovementioned three types of traumatic events and mental health problems. The participants were 1,569 Eastern Anatolian women (16-72 years of age). Traumatic events were assessed with the Life Events Checklist (LEC), mental health with the Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5) diagnostic criteria for PTSD, psychiatric distress symptoms with the GHQ-28 (General Health Questionnaire) scales, and PTCs with the self-related and other-related scales of the Posttraumatic Cognitions Inventory (PTCI). As hypothesized, IPV was more significantly associated with PTSD, anxiety, and somatization symptoms than with NDA. The LTW was significantly associated with all symptoms. Both self-related and other-related PTCs partially mediated the association of both IPV and NDA with mental health problems. The findings are discussed from the perspectives of women and human rights, emphasizing also the importance of cognitive processing of traumatic experiences in enhancing good mental health.
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Tammilehto J, Punamäki RL, Flykt M, Vänskä M, Heikkilä LM, Lipsanen J, Poikkeus P, Tiitinen A, Lindblom J. Developmental Stage-Specific Effects of Parenting on Adolescents' Emotion Regulation: A Longitudinal Study From Infancy to Late Adolescence. Front Psychol 2021; 12:582770. [PMID: 34149494 PMCID: PMC8211896 DOI: 10.3389/fpsyg.2021.582770] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
The quality of parenting shapes the development of children's emotion regulation. However, the relative importance of parenting in different developmental stages, indicative of sensitive periods, has rarely been studied. Therefore, we formulated four hypothetical developmental timing models to test the stage-specific effects of mothering and fathering in terms of parental autonomy and intimacy in infancy, middle childhood, and late adolescence on adolescents' emotion regulation. The emotion regulation included reappraisal, suppression, and rumination. We hypothesized that both mothering and fathering in each developmental stage contribute unique effects to adolescents' emotion regulation patterns. The participants were 885 families followed from pregnancy to late adolescence. This preregistered study used data at the children's ages of 1 year, 7 to 8 years, and 18 years. At each measurement point, maternal and paternal autonomy and intimacy were assessed with self- and partner reports using the Subjective Family Picture Test. At the age of 18 years, adolescents' reappraisal and suppression were assessed using the Emotion Regulation Questionnaire and rumination using the Cognitive Emotion Regulation Questionnaire. Stage-specific effects were tested comparing structural equation models. Against our hypotheses, the results showed no effects of mothering or fathering in infancy, middle childhood, or late adolescence on adolescents' emotion regulation patterns. The results were consistent irrespective of both the reporter (i.e., self or partner) and the parental dimension (i.e., autonomy or intimacy). In addition to our main results, there were relatively low agreement between the parents in each other's parenting and descriptive discontinuity of parenting across time (i.e., configural measurement invariance). Overall, we found no support for the stage-specific effects of parent-reported parenting in infancy, middle childhood, or late adolescence on adolescents' emotion regulation. Instead, our findings might reflect the high developmental plasticity of emotion regulation from infancy to late adolescence.
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Affiliation(s)
- Jaakko Tammilehto
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | | | - Marjo Flykt
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mervi Vänskä
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Lotta M. Heikkilä
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Piia Poikkeus
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jallu Lindblom
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
- Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
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11
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Nyarko F, Punamäki RL. The content and meaning of war experiences: A qualitative study of trauma and resilience among Liberian young refugees in Ghana. Transcult Psychiatry 2021; 58:254-267. [PMID: 32089103 DOI: 10.1177/1363461520901636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 01/30/2023]
Abstract
Abundant research has shown that traumatic war experiences can interfere with the mental health and wellbeing of children and adolescents, but less is known about the subjective experiences and views of war survivors. The present study identified and described the different types of war experiences of young refugees in an African context and analyzed how they perceived the meanings and impact of war on their lives. The participants were 13 Liberian 25-35-year-old male and female refugees living in Ghana who agreed to take part in semi-structured interviews based on the life history approach. The transcripts were analyzed using a phenomenological method to detect themes incorporating multiple subthemes. The results revealed five main themes about war experiences, all negative in nature: pain and humiliation, loss of close relationships, horrific scenes, threats to life, and fleeing for one's life. Concerning the perceived meanings and impact of war, the results identified six main themes. Three of them were positive in nature: increased awareness of life, compassion for life, and identification with those suffering. The negative main themes incorporated vivid horrific memories, deprivation of age-appropriate opportunities, and self-harm and destructive behavior. Our findings suggest that young war survivors may be highly motivated to participate in nation- and peace-building and should be provided opportunities to contribute to broader political and civic life.
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12
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Qouta SR, Vänskä M, Diab SY, Punamäki RL. War trauma and infant motor, cognitive, and socioemotional development: Maternal mental health and dyadic interaction as explanatory processes. Infant Behav Dev 2021; 63:101532. [PMID: 33588286 DOI: 10.1016/j.infbeh.2021.101532] [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: 03/05/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Taking care of infants in conditions of war is highly demanding and a few studies reveal the negative impact of war trauma on maternal and infant well-being. Yet, little is known regarding the influence of trauma on infant development and the potential explanatory mechanisms. First, the present study examines how mothers' prenatal exposure to traumatic war events is associated with infant cognitive, motor, and socioemotional development. Second, it analyses the mediating roles of maternal postpartum mental health problems, quality of dyadic mother-infant interaction, and earlier infant development (at six months) in the association between prenatal traumatic war events and infants' developmental skills at 18 months. METHOD This prospective three-wave study involved 502 Palestinian pregnant females in their first trimester during the 2014 Gaza War and participated at delivery (T1) and when the child was six (T2;N = 392) and eighteen (T3; N = 386) months of age. Mothers reported their exposure to traumatic war events (human and material losses, horrors, and threat to life) at T1 and T2, and researchers photo-documented the extent of destruction at T1. Mothers reported infants' language, fine- and gross-motor, and socioemotional skills at T2 and researchers tested infants' motor, cognitive-language and socioemotional skills using the Bayley Scales of Infant development (BSID-II) at T3. Mothers reported their mental health problems (symptoms of post-traumatic stress disorder [PTSD], depression and somatization) at T2 and T3 as well as dyadic interaction quality (the emotional availability self-report, [EA-SR] brief) at T2. RESULTS First, the structural equation model (SEM) on direct effects indicated, in contrast to our hypotheses, that maternal prenatal exposure to traumatic war events did not associate with infants' developmental skills at T2 and predicted higher level of developmental skills at T3. Second, as hypothesized, we found two negative underlying mechanisms (paths) between high exposure and low levels of motor, cognitive-language, and socioemotional skills at T3: (1) through increased maternal mental health problems at T2, which then were associated with problems at T3, and (2) through increased maternal mental health problems at T2, which then were associated with a low quality of mother-infant-interaction and low level of infant developmental skills at T2. CONCLUSION Improving maternal mental health and encouraging close and positive dyadic interaction can be critical for infant sensorimotor, cognitive, and socioemotional development in war conditions.
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Affiliation(s)
- Samir R Qouta
- Doha Institut for Graduate Studies, School of Social Sciences and Humanities, Qatar
| | - Mervi Vänskä
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland
| | - Safwat Y Diab
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland
| | - Raija-Leena Punamäki
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland.
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13
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Durbeej N, McDiarmid S, Sarkadi A, Feldman I, Punamäki RL, Kankaanpää R, Andersen A, Hilden PK, Verelst A, Derluyn I, Osman F. Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial): study protocol for a cluster randomized controlled trial. Trials 2021; 22:98. [PMID: 33509268 PMCID: PMC7841907 DOI: 10.1186/s13063-020-04995-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools. METHODS This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI). DISCUSSION This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools. TRIAL REGISTRATION ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.
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Affiliation(s)
- Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Serena McDiarmid
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Inna Feldman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Raija-Leena Punamäki
- Faculty of Social Sciences, Psychology, FI- 30014, University of Tampere, Tampere, Finland
| | - Reeta Kankaanpää
- Faculty of Social Sciences, Psychology, FI- 30014, University of Tampere, Tampere, Finland
| | - Arnfinn Andersen
- Norwegian Centre for Violence and Traumatic Stress Studies, NO-0409 Oslo, Norway
| | - Per Kristian Hilden
- Norwegian Centre for Violence and Traumatic Stress Studies, NO-0409 Oslo, Norway
| | - An Verelst
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Ilse Derluyn
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Fatumo Osman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
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14
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Baraquoni NA, Qouta SR, Vänskä M, Diab SY, Punamäki RL, Manduca P. It Takes Time to Unravel the Ecology of War in Gaza, Palestine: Long-Term Changes in Maternal, Newborn and Toddlers' Heavy Metal Loads, and Infant and Toddler Developmental Milestones in the Aftermath of the 2014 Military Attacks. Int J Environ Res Public Health 2020; 17:ijerph17186698. [PMID: 32938007 PMCID: PMC7558099 DOI: 10.3390/ijerph17186698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
Toxicant, teratogen and carcinogen metal war remnants negatively affect human health. The current study analyzes, first, the persistence of heavy metal contamination in newborn hair in four cohorts across time in Gaza Palestine; second, the change in mothers’ and infants’ heavy metal contamination from birth to toddlerhood; and third, the impact of heavy metal contamination on infants’ and toddlers’ growth and development. The hair of newborns was analyzed for twelve heavy metals by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) in cohorts recruited at delivery in 2011, 2015, 2016, and 2018–2019. In the 2015 cohort, mothers’ hair samples were taken at delivery, and toddlers and mothers hair were also analyzed 18 months later. Growth levels of infants at six months and toddlers at 18 months were assessed according to World Health Organization (WHO) standards according to a mother report and pediatric check-up, respectively. 1. The level of metal contamination in utero was persistently high across 8 years, 2011, 2015, 2016, 2019, following three major military attacks (2009, 2012, 2014). 2. The 2015 cohort babies exposed in utero to attacks in 2014 at six months showed association of high load at birth in mother of arsenic and in newborn of barium with underweight, of barium and molybdenum in newborn with stunting. 3. Eighteen months after birth, toddlers had a higher level of metals in hairs than when they were born, while, in their mothers, such levels were similar to those at delivery, confirming persistence in the environment of war remnants. Underweight and stunting, both in infants and toddlers, were higher than reported for previous years, as well as being progressive within the cohort. Severe environmental factors, metal contamination and food insecurity put Gaza’s infant health at risk.
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Affiliation(s)
| | - Samir R. Qouta
- Doha Institute for Graduate Studies, School of Social Sciences and Humanities, Al Tarfa Street, Zone 70, Doha, P.O. Box 200592, Qatar;
| | - Mervi Vänskä
- Department of Psychology, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (M.V.); (S.Y.D.); (R.-L.P.)
| | - Safwat Y. Diab
- Department of Psychology, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (M.V.); (S.Y.D.); (R.-L.P.)
| | - Raija-Leena Punamäki
- Department of Psychology, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (M.V.); (S.Y.D.); (R.-L.P.)
| | - Paola Manduca
- Association for Scientific Research, Nwrg-onlus, 16123 Genova, Italy
- Correspondence:
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15
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Nyarko F, Peltonen K, Kangaslampi S, Punamäki RL. Emotional intelligence and cognitive skills protecting mental health from stress and violence among Ghanaian youth. Heliyon 2020; 6:e03878. [PMID: 32395655 PMCID: PMC7205861 DOI: 10.1016/j.heliyon.2020.e03878] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/25/2020] [Accepted: 04/24/2020] [Indexed: 10/27/2022] Open
Abstract
This study investigates the protective mental health function of high emotional intelligence (EI), and cognitive skills (CS) among Ghanaian adolescents when exposed to stressful life-events and violence. It examines, first, how exposure to stressful life-events and violent experiences is associated with mental health, indicated by depressive and psychological distress symptoms, and, second, whether EI and CS could serve as possible moderators between stress, violence and mental health problems. Participants were 415 Ghanaian secondary education students. They reported about their depressive symptoms (Bireleson), psychological distress (Strength and Difficult Questionnaire, SDQ), and emotional intelligence (Trait Emotional Intelligence Question-naire, TEIQue), cognitive skills (The Amsterdam Executive Function Inventory). They also reported their stressful life-events and violent experiences. Statistical analyses were conducted using structural equation modeling (SEM). As hypothesized, high level of stressful life events were associated with high levels of depressive symptoms and psychological distress. Yet violent experiences did not associate with mental health problems. Against hypothesis, high levels of EI and CS could not protect adolescents mental health from negative effects of stressful life events or violent experiences. A direct effects were found between low level of EI and CS and high level of mental health problems. The results are discussed in relations to psychological and cultural factors present in EI and CS in adolescence.
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Affiliation(s)
- Felix Nyarko
- Faculty of Social Science, Psychology, Tampere University, Tampere, Finland
| | - Kirsi Peltonen
- Faculty of Social Science, Psychology, Tampere University, Tampere, Finland
| | - Samuli Kangaslampi
- Faculty of Social Science, Psychology, Tampere University, Tampere, Finland
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16
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Sezgin AU, Punamäki RL. Impacts of early marriage and adolescent pregnancy on mental and somatic health: the role of partner violence. Arch Womens Ment Health 2020; 23:155-166. [PMID: 30955087 PMCID: PMC7183488 DOI: 10.1007/s00737-019-00960-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
Abstract
Researchers agree that early marriage (EM) and adolescent pregnancy (AP) can form severe risks for women's somatic, mental, and reproductive health, as well as on educational and social status. Yet, less is known about factors that may moderate or mediate these associations. This study examined, first, retrospectively the impacts of EM and AP on self-reported mental and somatic health among multicultural group of women living in Eastern Anatolia, Turkey. Second task was to analyze whether and how the partner violence would mediate and/or moderate between EM and AP and mental health problems. The participants were 1569 women (16-72 years of age), who reported their age of being married, first pregnancy, and demographic characteristics. They described their mental health status through General Health Questionnaire (GHQ-28: depressive, anxiety, social dysfunction, and somatization symptoms) and symptoms of posttraumatic stress disorder (PTSD; DSM-5). Women's reports of somatic illnesses were classified according to WHO-ICD-10. The revised conflict tactics scale, short form was used as a proxy to partner violence. Women who gave birth at 13-19 years of age reported more anxiety and somatization symptoms than later delivered, and those married younger than 25 showed a higher level of depressive symptoms than later married. Both AP and EM formed a heightened risk for somatic illnesses. The partner violence functioned as a moderator; AP was associated with especially high levels of depressive and anxiety symptoms among women exposed to sexual coercion in their marriage. Non-significant mediation analysis indicates that partner violence did not explain the severe impacts of the AP and EM on women's mental health. Yet, the AP and EM were associated with heightened level of partner violence. Adolescent pregnancy forms a comprehensive mental health risk, and both AP and EM were risks for somatic illnesses, such as cardiovascular problems. The mental health risk of AP further intensified if women experienced sexual coercion in their partnership. Our fundamental work is to abolish these patriarchal phenomena.
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Affiliation(s)
- Aysen Ufuk Sezgin
- Istanbul University, Istanbul Medical Faculty, Forensic Medicine Department, Istanbul, Turkey
| | - Raija-Leena Punamäki
- Faculty of Social Sciences/Psychology, Tampere University, Kalevankatu 5, Linna 4krs, FIM-33014, Tampere, Finland.
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17
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Punamäki RL, Qouta SR, Diab SY. The role of maternal attachment in mental health and dyadic relationships in war trauma. Heliyon 2020; 5:e02867. [PMID: 31890934 PMCID: PMC6926227 DOI: 10.1016/j.heliyon.2019.e02867] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/01/2019] [Accepted: 11/12/2019] [Indexed: 01/16/2023] Open
Abstract
Background Infant care is a demanding task in dangerous war conditions, but research on the wellbeing of mother-infant dyads is mainly available in peaceful conditions. Knowledge on protective versus risking processes is especially vital for tailoring effective help, and the present study proposes the maternal attachment style to play an important role in dangerous war conditions. Objective The study analyses, first, how various traumatic war events, such as losses, horrors and life-threat, are associated with maternal mental health and dyadic mother-infant interaction quality, indicated by maternal emotional availability (EA). Second, it tests a hypothesis that maternal insecure attachment risks and secure attachment protects good mental health and optimal EA from negative impacts of traumatic war events. Method The prospective three-wave study involved 502 Palestinian mothers, who were pregnant during the 2014 War on Gaza, and participated at delivery (T1), and when the infant was seven (T2; N = 392) and eighteen (T3; N = 386) months. Mothers reported about war events at T1 and T2 (death and losses, witnessing horrors and life-threat), and posttraumatic stress disorder (PTSD) and depression symptoms at T2 and T3. Dyadic interaction quality was assessed by mother-perceived emotional availability (EA) scale at T2 and T3, and attachment styles by mothers’ self-reports at T3. Results Death and losses, witnessing horrors, and life-threat were all associated with a high level of maternal PTSD, but only at T2, whereas death and losses were associated with her depressive symptoms both at T2 and T3. Witnessing horrors was associated with a low close and positive and a high distant and negative emotional availability at T2 and T3. As hypothesized, maternal avoidant attachment was associated with a low level of close and positive EA in general, and especially when the dyads were exposed to a high level of traumatic war events, thus indicating a risking function. Against the hypothesis, secure attachment did not show any protective function on emotional availability, while, unexpectedly, maternal preoccupied attachment was associated with close and positive emotional availability, when dyads were exposed to a high level of traumatic war events. Conclusion Mothering in conditions of war and military violence is an overwhelmingly demanding task, and mother-infant dyads need legal, social, and psychological assistance. Knowledge and reflection of unique responses and meanings of different attachment styles would be fruitful in tailoring effective help.
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Affiliation(s)
- Raija-Leena Punamäki
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland
- Corresponding author.
| | - Samir R. Qouta
- Doha Institute For Graduate Studies, Qatar
- Islamic University Gaza, Department of Education and Psychology, Gaza, Palestine
| | - Safwat Y. Diab
- Tampere University, Faculty of Social Sciences, Department of Psychology, Finland
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18
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Sezgin AU, Punamäki RL. Correction to: Impacts of early marriage and adolescent pregnancy on mental and somatic health: the role of partner violence. Arch Womens Ment Health 2020; 23:167. [PMID: 31104117 PMCID: PMC7645573 DOI: 10.1007/s00737-019-00971-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The published version of the article contains an error in the author name and in the affiliation.
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Affiliation(s)
- Aysen Ufuk Sezgin
- grid.9601.e0000 0001 2166 6619Istanbul University, Istanbul Medical Faculty, Forensic Medicine Department, Istanbul, Turkey
| | - Raija-Leena Punamäki
- Faculty of Social Sciences/Psychology, Tampere University, Kalevankatu 5, Linna 4krs, FIM-33014, Tampere, Finland.
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19
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de Haan A, Landolt MA, Fried EI, Kleinke K, Alisic E, Bryant R, Salmon K, Chen SH, Liu ST, Dalgleish T, McKinnon A, Alberici A, Claxton J, Diehle J, Lindauer R, de Roos C, Halligan SL, Hiller R, Kristensen CH, Lobo BO, Volkmann NM, Marsac M, Barakat L, Kassam-Adams N, Nixon RD, Hogan S, Punamäki RL, Palosaari E, Schilpzand E, Conroy R, Smith P, Yule W, Meiser-Stedman R. Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis. J Child Psychol Psychiatry 2020; 61:77-87. [PMID: 31701532 PMCID: PMC7116234 DOI: 10.1111/jcpp.13101] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. METHODS We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. RESULTS The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. CONCLUSIONS Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.
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Affiliation(s)
- Anke de Haan
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland,Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Markus A. Landolt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland,Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Eiko I. Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | | | - Eva Alisic
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Karen Salmon
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Sue-Huei Chen
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Shu-Tsen Liu
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK
| | - Anna McKinnon
- Department of Psychology, Centre for Emotional Health Clinic, Macquarie University, Sydney, NSW, Australia
| | - Alice Alberici
- Sussex Partnership NHS Foundation Trust, West Sussex Child and Adolescent Mental Health Service, West Sussex, UK
| | | | - Julia Diehle
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramón Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Carlijn de Roos
- De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Sarah L. Halligan
- Department of Psychology, University of Bath, Bath, UK,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Rachel Hiller
- Department of Psychology, University of Bath, Bath, UK
| | | | - Beatriz O.M. Lobo
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nicole M. Volkmann
- Department of Human Development, Institute of Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Meghan Marsac
- Kentucky Children’s Hospital, University of Kentucky, Lexington, KY, USA,Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Lamia Barakat
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy Kassam-Adams
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Susan Hogan
- School of Psychology, Flinders University, Adelaide, SA, Australia
| | | | - Esa Palosaari
- School of Management, University of Tampere, Tampere, Finland
| | | | - Rowena Conroy
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic, Australia
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK
| | - William Yule
- Department of Psychology, King’s College London Institute of Psychiatry, London, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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Mölsä M, Tiilikainen M, Punamäki RL. Usage of healthcare services and preference for mental healthcare among older Somali immigrants in Finland. Ethn Health 2019; 24:607-622. [PMID: 28669226 DOI: 10.1080/13557858.2017.1346182] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/06/2016] [Accepted: 06/14/2017] [Indexed: 05/25/2023]
Abstract
Objectives: The aims of the study were, first, to describe and analyze healthcare services utilization patterns of older immigrants in Finland, and particularly to compare the availability and accessibility of health services between older Somalis and Finns. The second aim was to examine the preferences for mental healthcare within the group of Somalis. The third aim was to test the existence of a service usage gap expected to be characteristic of the Somali group, in which high levels of mental health problems occur alongside simultaneous low levels of mental health service usage. Design: The participants were 256 men and women between the ages of 50-85; half were Somali migrants and the other half Finnish matched pairs. The participants were surveyed regarding their usage of somatic, mental, and preventive health services, as well as symptoms of depression, general distress, and somatization. The Somali participants were also surveyed regarding their usage of traditional healing methods and preferences for mental healthcare. Results: The Somali group had significantly lower access to personal/family doctors at healthcare centers as well as a lower availability of private doctors and occupational health services than the Finns. Instead, they used more nursing services than Finnish patients. The Somali participants attended fewer age-salient preventive check-ups than the Finns. The majority of the Somalis preferred traditional care, most commonly religious healing, for mental health problems. The hypothesized service gap was not substantiated, as a high level of depressive symptoms was not associated with a low usage of health services among the Somalis, but it was found unexpectedly among the Finns. Conclusion: Our findings call for culturally appropriate general and mental health services for older immigrants, which requires awareness of clients' preferences, needs, and alternative healing practices. Somali participants encountered institutional barriers in accessing healthcare, and they preferred informal mental healthcare, especially religious healing instead of Western practices.
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Affiliation(s)
- Mulki Mölsä
- a Department of Public Health , University of Helsinki , Helsinki , Finland
| | - Marja Tiilikainen
- b Department of Social Research , University of Helsinki , Helsinki , Finland
| | - Raija-Leena Punamäki
- c Faculty of Social Sciences, Psychology , University of Tampere , Tampere , Finland
- d Department of Evolution and Education Psychology , University of Sevilla , Sevilla , Spain
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Vänskä M, Diab SY, Perko K, Quota SR, Albarqouni NM, Myöhänen A, Punamäki RL, Manduca P. Toxic Environment of war: Maternal prenatal heavy metal load predicts infant emotional development. Infant Behav Dev 2019; 55:1-9. [DOI: 10.1016/j.infbeh.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 02/08/2023]
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Dalgaard NT, Diab SY, Montgomery E, Qouta SR, Punamäki RL. Is silence about trauma harmful for children? Transgenerational communication in Palestinian families. Transcult Psychiatry 2019; 56:398-427. [PMID: 30702385 DOI: 10.1177/1363461518824430] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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] [Indexed: 11/17/2022]
Abstract
Style of family communication is considered important in the transgenerational transmission of trauma. This study had three aims: first, to identify the contents of family communication about past national trauma; second, to examine how parents' current war trauma is associated with transgenerational communication; and third, to analyze the associations between transgenerational communication and children's mental health, measured as posttraumatic stress disorder (PTSD), depression and psychological distress. The study sample consisted of 170 Palestinian families in Gaza Strip, in which both mothers (n = 170) and fathers (n = 170) participated, each with their 11-13-year-old child. Mothers and fathers responded separately to three questions: 1) what did their own parents tell them about the War of 1948, Nakba?; 2) what did they tell their own children about the Nakba?; and 3) What did they tell their own children about the 1967 Arab-Israeli War and military occupation? Current war trauma, as reported separately by mothers, fathers and their children, refers to the Gaza War 2008/09. Children reported their symptoms of PTSD, depression, and psychological distress. Results revealed seven communication content categories and one category indicating maintaining silence about the traumas. Fathers' high exposure to current war trauma was associated with a higher level of communicating facts, reasons, and meanings regarding the1948 and 1967 wars, and mothers' high exposure to current war trauma was associated with a lower level of maintaining silence. Family communication about facts, reasons, and meanings was significantly associated with children not showing PTSD and marginally with not showing psychological distress, while maintaining silence was not associated with children's mental health.
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Isosävi S, Wahlström J, Flykt M, Heiskanen L, Finger B, Puura K, Punamäki RL. Dysregulated Motherhood: Exploring the Risk Features in a Mother’s Caregiving Representations. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/15289168.2019.1568032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lahti K, Vänskä M, Qouta SR, Diab SY, Perko K, Punamäki RL. Maternal experience of their infants' crying in the context of war trauma: Determinants and consequences. Infant Ment Health J 2019; 40:186-203. [PMID: 30715730 DOI: 10.1002/imhj.21768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We examined, first, how prenatal maternal mental health and war trauma predicted mothers' experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother-infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother-infant interaction and infant sensorimotor and language development at 12 months of infants' age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers' sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers' active and positive responses predicted high emotional availability in mother-infant interaction. Crying is the first communication tool for infants, and mothers' sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.
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Affiliation(s)
- Katri Lahti
- Department of Psychology, University of Tampere, Tampere, Finland
| | - Mervi Vänskä
- Department of Psychology, University of Tampere, Tampere, Finland
| | - Samir R Qouta
- Department of Education and Psychology, Islamic University Gaza, Gaza City, Palestine
| | - Safwat Y Diab
- Department of Educational Psychology, Al Quds Open University, Gaza Strip, Palestine
| | - Kaisa Perko
- Department of Psychology, University of Tampere, Tampere, Finland
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Diab SY, Palosaari E, Punamäki RL. Society, individual, family, and school factors contributing to child mental health in war: The ecological-theory perspective. Child Abuse Negl 2018; 84:205-216. [PMID: 30118970 DOI: 10.1016/j.chiabu.2018.07.033] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/12/2018] [Accepted: 07/29/2018] [Indexed: 06/08/2023]
Abstract
Mental health problems are common in war-affected areas, but children have different levels of vulnerability. Based on ecological theory (Bronfenbrenner, 2005), this study analyses how factors related to the child (cognitive capacity), their family (parental depression and parenting styles), and their school (teachers' practices and peer relations) mediate the association between traumatic stress (traumatic war experiences and stressful life-events) and child mental health (posttraumatic stress and psychological distress symptoms). The participants were 303 Palestinian children (51.2% girls) of 10-13 years (M = 10.94 ± 0.50) and their parents from the Gaza Strip. The children filled in questionnaires during school classes and the parents did so at their homes. The results of structural equation modeling substantiated the hypothesis that parental depression, poor parenting and low-quality peer relations mediated between traumatic stress and children's mental health problems. Contrary to the hypothesis, child-related factors did not mediate that association. To conclude, parents and peers provide important age-salient social resources for children in war conditions, and psychosocial interventions should therefore enhance their beneficial functions.
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Affiliation(s)
| | - Esa Palosaari
- University of Tampere, Tampere, Aalto University, Helsinki, Finland
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Sälevaara M, Punamäki RL, Unkila-Kallio L, Vänskä M, Tulppala M, Tiitinen A. The mental health of mothers and fathers during pregnancy and early parenthood after successful oocyte donation treatment: A nested case-control study. Acta Obstet Gynecol Scand 2018; 97:1478-1485. [PMID: 29975790 DOI: 10.1111/aogs.13421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to compare the mental health problems between parents after oocyte donation treatment, after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with own gametes and after naturally conceiving (NC). MATERIAL AND METHODS This is a prospective, longitudinal questionnaire study. The study group consisted of 26 oocyte donation mothers and their matched IVF/ICSI (n = 52) and NC (n = 52) controls. Matching was performed according to mother's age, parity, type of pregnancy, and number of returned questionnaires. The parents filled-in the General Health Questionnaire (GHQ-36) at gestational weeks 18-20 (T1), and at 2 months (T2) and 12 months (T3) after the childbirth. RESULTS Full response rate (T1-T3) for oocyte donation mothers was 76.9% and for oocyte donation fathers was 73.1%. At T1, no significant differences were found between groups in depression, anxiety, sleeping difficulties, or social dysfunction, but they differed at T2 and T3 in anxiety (T2, P = .02; T3, P = .01), in sleeping difficulties (T2, P = .02; T3, P = .04) and in social dysfunction (T2, P = .01; T3, P = .04). Oocyte donation mothers showed less anxiety than NC mothers (T2, T3), and fewer sleeping difficulties and less social dysfunction than IVF/ICSI (T2, T3) and NC mothers (T2). Mental health problems of oocyte donation fathers did not differ from those of IVF/ICSI and NC control fathers at T1-T3. CONCLUSIONS Oocyte donation mothers showed fewer mental health symptoms in early parenthood compared with IVF/ICSI and NC mothers. No differences were found among mothers during pregnancy and among fathers at any time point.
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Affiliation(s)
- Mari Sälevaara
- Väestöliitto Fertility Clinic Helsinki, Helsinki, Finland
| | | | - Leila Unkila-Kallio
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Mervi Vänskä
- Faculty of Social Sciences/Psychology, University of Tampere, Tampere, Finland
| | - Maija Tulppala
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
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Punamäki RL, Diab SY, Isosävi S, Kuittinen S, Qouta SR. Maternal pre- and postnatal mental health and infant development in war conditions: The Gaza Infant Study. ACTA ACUST UNITED AC 2018; 10:144-153. [DOI: 10.1037/tra0000275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Diab SY, Isosävi S, Qouta SR, Kuittinen S, Punamäki RL. The protective role of maternal post-traumatic growth and cognitive trauma processing in Palestinian mothers and infants: a longitudinal study. Lancet 2018; 391 Suppl 2:S39. [PMID: 29553438 DOI: 10.1016/s0140-6736(18)30405-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women at pre partum and post partum are especially susceptible to war trauma because they struggle to protect their infants from danger. Trauma research suggests increased problems in maternal mental health and infant development. Yet many cognitive-emotional processes affect the trauma survivors' mental health, such as post-traumatic growth and post-traumatic cognition. The aim of this study was to examine whether a mother's high post-traumatic growth and optimal post-traumatic cognition could protect their own mental health and their infant's stress regulation from the effects of traumatic war experiences. METHODS This three-wave prospective study involved Palestinian women living in the Gaza Strip who were at the second trimester of pregnancy (T1), women with infants aged 4 months (T2), and women with children aged 12 months (T3) months. The participants reported their war experiences in a 30-item checklist of losses, destruction, and atrocities in the 2008-09, 2012, and 2014 military offensives. Post-traumatic growth was assessed by a 21-item scale and post-traumatic cognition by a 36-item scale. Maternal mental health was assessed by post-traumatic stress disorder (PTSD), depressive, anxiety, and dissociation symptoms at T1 and T3, and infants' stress regulation was assessed with the Infant Behaviour Questionnaire at T2 and T3. FINDINGS We included 511 women at T1, 481 women at T2, and 454 women at T3. High maternal post-traumatic growth and post-traumatic cognition had protective roles. Post-traumatic growth had a protective effect on maternal mental health since severe exposure to traumatic war experiences was not associated with maternal PTSD, depression, and dissociation if women showed high post-traumatic growth, as indicated by the significant interaction effect between post-traumatic growth and war trauma on each of the three symptoms. Post-traumatic cognition had a protective effect on infant development since severe exposure was not associated with dysfunctional infant emotion regulation when mothers reported optimal post-traumatic cognition, as indicated by the significant interaction effect between post-traumatic cognition and war trauma on each of negative affectivity and surgency or extraversion. INTERPRETATION The nature of cognitive emotional processing of war trauma could explain the distinct roles of post-traumatic growth and post-traumatic cognition. High post-traumatic growth involves increased social affiliation, spiritual awareness, and psychological strengths resulting from painful and traumatic experiences. In the national struggle for independence, post-traumatic growth is often associated with heroism and even hardiness, which might benefit a mother's mental health but not their infant's wellbeing. Optimal post-traumatic cognition indicates successful and harmonious trauma processing, which enables mothers to be more reflective and sensitive to their infant's needs. Interventions to promote healthy infant development in war settings should encourage and support mothers' effective cognitive-emotional processing of traumatic experiences. FUNDING The Academy of Finland and University of Tampere, Finland.
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Affiliation(s)
- Safwat Y Diab
- Faculty of Education, Al-Quds Open University, Ramallah, Gaza Strip, occupied Palestinian territory.
| | - Sanna Isosävi
- Department of Psychology, School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
| | - Samir R Qouta
- Department of Education and Psychology, Islamic University of Gaza, Gaza City, Gaza Strip, occupied Palestinian territory
| | - Saija Kuittinen
- Department of Psychology, School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
| | - Raija-Leena Punamäki
- Department of Psychology, School of Social Sciences and Humanities, University of Tampere, Tampere, Finland; Department of Developmental and Educational Psychology, Faculty of Psychology, University of Sevilla, Seville, Spain
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Schubert CC, Punamäki RL, Suvisaari J, Koponen P, Castaneda A. Trauma, Psychosocial Factors, and Help-Seeking in Three Immigrant Groups in Finland. J Behav Health Serv Res 2018; 46:80-98. [DOI: 10.1007/s11414-018-9587-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Isosävi S, Diab SY, Kangaslampi S, Qouta S, Kankaanpää S, Puura K, Punamäki RL. MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS. Infant Ment Health J 2017; 38:617-633. [DOI: 10.1002/imhj.21658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | | | | | - Kaija Puura
- University of Tampere
- University Hospital of Tampere
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Abstract
OBJECTIVES The aim of this study was to examine, first, how past traumatic stress and present acculturation indices, and discrimination are associated with mental health; and, second, whether religiousness can buffer the mental health from negative impacts of war trauma. METHOD Participants were 128 older (50-80 years) Somali refugees living in Finland. They reported experiences of war trauma and childhood adversities, and filled-in questionnaires of perceived ethnic discrimination, religiousness (beliefs, attendance, and observance of Islamic faith), and symptoms of posttraumatic stress disorder (PTSD), depressive (BDI-21), psychological distress (GHQ-12), and somatization (SCL-90). RESULTS Symptom-specific regression models showed that newly arrived refugees with non-permanent legal status and severe exposures to war trauma, childhood adversity, and discrimination endorsed greater PTSD symptoms, while only war trauma and discrimination were associated with depressive symptoms. Results confirmed that high religiousness could play a buffering role among older Somalis, as exposure to severe war trauma was not associated with high levels of PTSD or somatization symptoms among highly religious refugees. CONCLUSION Health care should consider both unique past and present vulnerabilities and resources when treating refugees, and everyday discrimination and racism should be regarded as health risks.
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Affiliation(s)
- Mulki Mölsä
- a Department of Public Health , University of Helsinki , Helsinki , Finland.,b Department of Health and Welfare Inequalities Unit , National Institute for Health and Welfare , Helsinki , Finland
| | - Saija Kuittinen
- c School of Social Sciences and Humanities/ Psychology, University of Tampere , Tampere , Finland
| | - Marja Tiilikainen
- d Department of Social Research , University of Helsinki , Helsinki , Finland
| | - Marja-Liisa Honkasalo
- e Center for the Study of Culture and Health , University of Turku , Turku , Finland.,f Department of Social Research , University of Helsinki , Helsinki , Finland
| | - Raija-Leena Punamäki
- c School of Social Sciences and Humanities/ Psychology, University of Tampere , Tampere , Finland
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Diab SY, Isosävi S, Qouta SR, Kuittinen S, Punamäki RL. The protective role of maternal posttraumatic growth and cognitive trauma processing among Palestinian mothers and infants. Infant Behav Dev 2017; 50:284-299. [PMID: 28619421 DOI: 10.1016/j.infbeh.2017.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/29/2016] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
War survivors use multiple cognitive and emotional processes to protect their mental health from the negative impacts of trauma. Because mothers and infants may be especially vulnerable to trauma in conditions of war, it is urgent to determine which cognitive and emotional processes are effective for preventing negative trauma impacts." This study examined whether mothers' high posttraumatic growth (PTG) and positive posttraumatic cognitions (PTC) protected (a) their own mental health and (b) their infants' stress regulation and sensorimotor and language development from the effects of war trauma. The participants were 511 Palestinian mothers and their infants living in the Gaza strip. The mothers were interviewed in their second trimester of pregnancy (T1) as well as when the infant was four months (T2) and twelve months (T3). Mothers reported posttraumatic growth (PTG; Tedeschi & Calhoun, 1996) at T1 and posttraumatic cognitions (PTCI; Foa et al., 1999) at T2. They also reported their exposure to traumatic war events both at T1 and T3 and described their mental health conditions (e.g., PTSD and/or depressive and dissociation symptoms) at T3. The Infant Behaviour Questionnaire (IBQ) was used to measure infants' stress regulation at T2 and sensorimotor and language development at T3. The results, based on regression analyses with interaction terms between trauma and PTG, showed that high levels of traumatic war events were not associated with high levels of PTSD, depressive, or dissociation symptoms among mothers showing high levels of PTG. This suggests that PTG may protect maternal mental health from the effects of trauma. In turn, positive maternal PTCs appeared to protect the infants' stress regulation from the effects of war trauma. The study concludes by discussing ways to develop and implement preventive interventions for mother-infant dyads in war conditions.
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Affiliation(s)
- Safwat Y Diab
- Al Quds Open University, Department of Educational Psychology, Gaza Strip, Palestine
| | - Sanna Isosävi
- University of Tampere, Faculty of Social Sciences, Department of Psychology, Finland
| | - Samir R Qouta
- Islamic University Gaza, Department of Education and Psychology, Gaza, Palestine
| | - Saija Kuittinen
- University of Tampere, Faculty of Social Sciences, Department of Psychology, Finland
| | - Raija-Leena Punamäki
- University of Tampere, Faculty of Social Sciences, Department of Psychology, Finland; Universidad de Sevilla, Facultad de Psicología, Departemento de Psicologia Evolutiva y de la Education, Spain.
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Punamäki RL, Isosävi S, Qouta SR, Kuittinen S, Diab SY. War trauma and maternal-fetal attachment predicting maternal mental health, infant development, and dyadic interaction in Palestinian families. Attach Hum Dev 2017; 19:463-486. [PMID: 28556692 DOI: 10.1080/14616734.2017.1330833] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Optimal maternal-fetal attachment (MFA) is believed to be beneficial for infant well-being and dyadic interaction, but research is scarce in general and among risk populations. Our study involved dyads living in war conditions and examined how traumatic war trauma associates with MFA and which factors mediate that association. It also modeled the role of MFA in predicting newborn health, infant development, mother-infant interaction, and maternal postpartum mental health. Palestinian women from the Gaza Strip (N = 511) participated during their second trimester (T1), and when their infants were 4 (T2) and 12 (T3) months. Mothers reported MFA (interaction with, attributions to, and fantasies about the fetus), social support, and prenatal mental health (post-traumatic stress disorder, depression, and anxiety) at T1, newborn health at T2, and the postpartum mental health, infant's sensorimotor and language development, and mother-infant interaction (emotional availability) at T3. Results revealed, first, that war trauma was not directly associated with MFA but that it was mediated through a low level of social support and high level of maternal prenatal mental health problems. Second, intensive MFA predicted optimal mother-reported infant's sensorimotor and language development and mother-infant emotional availability but not newborn health or maternal postpartum mental health.
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Affiliation(s)
- Raija-Leena Punamäki
- a Department of Psychology , School of Social Science and Humanities, University of Tampere , Tampere , Finland.,b Department of Psychologia Evolutiva and Education , University of Sevilla , Sevilla , Spain
| | - Sanna Isosävi
- a Department of Psychology , School of Social Science and Humanities, University of Tampere , Tampere , Finland
| | - Samir R Qouta
- c Department of Education and Psychology , Islamic University Gaza , Gaza City , Palestine
| | - Saija Kuittinen
- a Department of Psychology , School of Social Science and Humanities, University of Tampere , Tampere , Finland
| | - Safwat Y Diab
- d Department of Educational Psychology , Al Quds Open University , Gaza Strip , Palestine
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Nyarko F, Punamäki RL. Meanings and preconditions of forgiveness among young adult war survivors in African context: A qualitative study. Peace and Conflict: Journal of Peace Psychology 2017. [DOI: 10.1037/pac0000245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Diab M, Peltonen K, Qouta SR, Palosaari E, Punamäki RL. Can functional emotion regulation protect children's mental health from war trauma? A Palestinian study. Int J Psychol 2017; 54:42-52. [PMID: 28421608 DOI: 10.1002/ijop.12427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 04/08/2016] [Accepted: 03/27/2017] [Indexed: 11/05/2022]
Abstract
Effective emotion regulation (ER) is expected to protect mental health in traumatic stress. We first analysed the protective (moderator) function of different ER strategies and the associations between ER and mental health. Second, we tested gender differences in the protective function of ER and the associations between ER strategies and mental health. Participants were 482 Palestinian children (girls 49.4%; 10-13 years, M = 11.29, SD = .68) whose ER was assessed by the Emotion Regulation Questionnaire and mental health by post-traumatic stress (Children's Impact Event Scale), depressive, and psychological distress (Strengths and Difficulties Questionnaire) symptoms, and by psychosocial well-being (Mental Health Continuum-Short Form). War trauma involved 42 events. Results showed, first, that none of the ER strategies could protect a child's mental health from negative impact of war trauma, but self-focused ER was associated with low depressive symptoms, and other-facilitated ER with high psychological well-being. However, controlling of emotions formed a comprehensive risk for children's mental health. Second, gender differences were found in the protective role of ER, as self-focused and distractive ER formed a vulnerability among boys. The results are discussed in the context of emotional and regulative demands of war and life-threat.
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Affiliation(s)
- Marwan Diab
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland.,Training and Research Department, Gaza Community Mental Health Programme, Gaza City, Palestine
| | - Kirsi Peltonen
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
| | - Samir R Qouta
- Faculty of Education, Islamic University of Gaza, Gaza City, Palestine
| | - Esa Palosaari
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland.,Department of Finance, Aalto University, Helsinki, Finland
| | - Raija-Leena Punamäki
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
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Lindblom J, Vänskä M, Flykt M, Tolvanen A, Tiitinen A, Tulppala M, Punamäki RL. From early family systems to internalizing symptoms: The role of emotion regulation and peer relations. J Fam Psychol 2017; 31:316-326. [PMID: 27854439 DOI: 10.1037/fam0000260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research has demonstrated the importance of early family characteristics, such as the quality of caregiving, on children's later mental health. Information is, however, needed about the role of more holistic family systems and specific child-related socioemotional mechanisms. In this study, we conceptualize families as dynamic family system types, consisting of both marital and parenting trajectories over the transition to parenthood. First, we examine how early family system types predict children's anxiety, depression, peer exclusion, and emotion regulation. Second, we test whether couples' infertility history and other family related contextual factors moderate the effects of family system types on child outcomes. Third, we test whether children's emotion regulation and peer exclusion mediate the effects of family system types on anxiety and depression. The participants were 452 families representing cohesive, distant, authoritative, enmeshed, and discrepant family types, identified on the basis of relationship autonomy and intimacy from pregnancy to the child's age of 2 and 12 months. Children's anxiety, depression, emotion regulation, and peer exclusion were assessed at the age of 7-8 years. Structural equation modeling showed that distant, enmeshed, and discrepant families similarly predicted children's heightened anxiety and depression. Infertility history, parental education, and parity moderated the associations between certain family system types and child outcomes. Finally, emotion regulation, but not peer exclusion, was a common mediating mechanism between distant and enmeshed families and children's depression. The results emphasize the importance of early family environments on children's emotion regulation development and internalizing psychopathology. (PsycINFO Database Record
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Affiliation(s)
| | - Mervi Vänskä
- School of Social Sciences and Humanities/Psychology
| | - Marjo Flykt
- School of Social Sciences and Humanities/Psychology
| | | | - Aila Tiitinen
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital
| | - Maija Tulppala
- Department of Obstetrics and Gynaecology, University of Helsinki
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Kuittinen S, Mölsä M, Punamäki RL, Tiilikainen M, Honkasalo ML. Causal attributions of mental health problems and depressive symptoms among older Somali refugees in Finland. Transcult Psychiatry 2017; 54:211-238. [PMID: 28398194 DOI: 10.1177/1363461516689003] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [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] [Indexed: 11/15/2022]
Abstract
Causal attributions of mental health problems play a crucial role in shaping and differentiating illness experience in different sociocultural and ethnic groups. The aims of this study were (a) to analyze older Somali refugees' causal attributions of mental health problems; (b) to examine the associations between demographic and diagnostic characteristics, proxy indicators of acculturation, and causal attributions; and (c) to analyze the connections between causal attributions and the manifestation of somatic-affective and cognitive depressive symptoms. A sample of 128 Somali refugees aged 50-80 years living in Finland were asked to list the top three causes of mental health problems. Depressive symptoms were analyzed using the Beck Depression Inventory (BDI). The results showed that the most commonly endorsed causal attributions of mental health problems were jinn, jealousy related to polygamous relationships, and various life problems. We identified five attribution categories: (a) somatic, (b) interpersonal, (c) psychological, (d) life experiences, and (e) religious causes. The most common causal attribution categories were life experiences and interpersonal causes of mental health problems. Men tended to attribute mental health problems to somatic and psychological causes, and women to interpersonal and religious causes. Age and proxy indicators of acculturation were not associated with causal attributions. Participants with a psychiatric diagnosis and/or treatment history reported more somatic and psychological attributions than other participants. Finally, those who attributed mental health problems to life experiences (e.g., war) reported marginally fewer cognitive depressive symptoms (e.g., guilt) than those who did not. The results are discussed in relation to biomedical models of mental health, service use, immigration experiences, and culturally relevant patterns of symptom manifestation.
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Peltonen K, Kangaslampi S, Qouta S, Punamäki RL. Trauma and autobiographical memory: contents and determinants of earliest memories among war-affected Palestinian children. Memory 2017; 25:1347-1357. [DOI: 10.1080/09658211.2017.1303073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kirsi Peltonen
- School of Social Sciences/Psychology, University of Tampere, Tampere, Finland
| | - Samuli Kangaslampi
- School of Social Sciences/Psychology, University of Tampere, Tampere, Finland
| | - Samir Qouta
- Department of Psychology, Islamic University Gaza, IUG, Gaza, Palestine
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Punamäki RL, Qouta SR, Peltonen K. Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents. Eur J Psychotraumatol 2017; 8:1439649. [PMID: 29844884 PMCID: PMC5965042 DOI: 10.1080/20008198.2018.1439649] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/22/2017] [Accepted: 01/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective: This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children's mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers (N = 325) and their children (one per family; 49.4% girls; 10-13 years old; mean ± SD age = 11.35 ± 0.57 years) after the Gaza War of 2008-2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child's internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children's Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children's Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n = 44). Further, families with discrepant experiences (23.0%; n = 65) and moderate security and neutral relationships (25.2%; n = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic interventions for children should, thus, also involve parents and siblings. Knowledge of unique family attachment patterns is fruitful for tailoring therapeutic treatments and preventive interventions for war-affected children and families.
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Affiliation(s)
| | - Samir R Qouta
- Department of Education and Psychology, Islamic University Gaza, Gaza City, Palestine
| | - Kirsi Peltonen
- Faculty of Social Sciences Psychology, University of Tampere, Tampere, Finland
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Peltonen K, Kangaslampi S, Saranpää J, Qouta S, Punamäki RL. Peritraumatic dissociation predicts posttraumatic stress disorder symptoms via dysfunctional trauma-related memory among war-affected children. Eur J Psychotraumatol 2017; 8:1375828. [PMID: 29209466 PMCID: PMC5706949 DOI: 10.1080/20008198.2017.1375828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/22/2016] [Accepted: 08/18/2017] [Indexed: 10/31/2022] Open
Abstract
Background: Among adults there is strong evidence about peritraumatic dissociation (PD) predicting posttraumatic stress disorder (PTSD), yet evidence among children is very limited. It has been suggested that disturbances in memory functioning might explain the association between PD and PTSD, but this has not yet been empirically tested. Objective: We aimed to test the hypotheses that greater PD would be associated with more posttraumatic stress disorder (PTSD) symptoms, and that some of this association would be mediated by disorganized and non-verbal memories about the traumatic event. Method: The sample included 197 Palestinian children (10-12-years) living in the Gaza Strip, participating in the aftermath of the 2008/9 war. Self-report questionnaires were used to measure PD (Peritraumatic Dissociative Experiences Questionnaire) three months post-war, as well as trauma-related memory (Trauma Memory Quality Questionnaire) and PTSD symptoms (Children's Revised Impact of Event Scale) six months later. Exposure to war trauma was assessed by a checklist. Structural equation modelling was used to examine direct and indirect paths from PD to posttraumatic PTSS, controlling for number of traumatic war events. Results: Structural equation modelling results showed that greater self-reported PD predicted higher levels of PTSS nine months post-war, and that a significant part, but not all, of this relationship was mediated via the quality of trauma-related memories. Conclusions: This study provided empirical evidence that, among war-affected children, greater PD during traumatic events is linked with higher levels of PTSD symptoms several months later, even when accounting for their personal exposure to war trauma. Further, the study supported the idea that the detrimental effects of dissociation during a traumatic event may be due to dysfunctional memories characterized by disorganization and lack of access to verbal and coherence. Further tests of these hypotheses with larger samples and more points of measurement are called for.
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Affiliation(s)
- Kirsi Peltonen
- University of Tampere, Finland/Faculty of Social Sciences/Psychology, Tampere, Finland
| | - Samuli Kangaslampi
- University of Tampere, Finland/Faculty of Social Sciences/Psychology, Tampere, Finland
| | - Jenni Saranpää
- Lapua Developmental and Family Counselling, Lapua, Finland
| | - Samir Qouta
- Islamic University of Gaza, Department of Education and Psychology, Gaza
| | - Raija-Leena Punamäki
- University of Tampere, Finland/Faculty of Social Sciences/Psychology, Tampere, Finland
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Kangaslampi S, Punamäki RL, Qouta S, Diab M, Peltonen K. Psychosocial Group Intervention Among War-Affected Children: An Analysis of Changes in Posttraumatic Cognitions. J Trauma Stress 2016; 29:546-555. [PMID: 27859680 DOI: 10.1002/jts.22149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/08/2022]
Abstract
Cognitive theories point to reduction in dysfunctional posttraumatic cognitions (PTCs) as one mechanism involved in recovery from posttraumatic stress symptoms (PTSS), yet research findings have shown individual differences in the recovery process. We tested the cognitive mediation hypothesis above in a previously published psychosocial group intervention among war-affected children. We also examined heterogeneity in children's PTCs during the intervention. We used a cluster randomized trial of Smith et al.'s (2002) teaching recovery techniques (TRT) intervention among 482 Palestinians 10-13 years of age (n = 242 for intervention group, n = 240 for control group). Children reported PTSS, PTCs, and depressive symptoms at baseline, midpoint, postintervention, and at 6-month follow-up. Path analysis results showed that TRT was not effective in reducing dysfunctional PTCs, and the reductions did not mediate intervention effects on PTSS. Using latent class growth analysis, we chose the model with 3 differing trajectories in the intervention group: high, decreasing, moderate, downward trending, and severe, stable levels of PTCs. Higher PTSS and depressive symptoms at baseline were associated with membership in the severe, stable trajectory. The intervention did not produce the kind of beneficial cognitive change needed in the cognitive mediation conceptualization. Nevertheless, cognitive changes differed substantially across children during the intervention, and were associated with their preintervention mental health status. These findings call for more detailed examination of the process of cognitive mediation.
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Affiliation(s)
- Samuli Kangaslampi
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
| | - Raija-Leena Punamäki
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
| | - Samir Qouta
- Faculty of Education, Islamic University of Gaza, Gaza City, Palestine
| | - Marwan Diab
- Gaza Community Mental Health Programme, Gaza City, Palestine
| | - Kirsi Peltonen
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
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Kuittinen S, García Velázquez R, Castaneda AE, Punamäki RL, Rask S, Suvisaari J. Construct validity of the HSCL-25 and SCL-90-Somatization scales among Russian, Somali and Kurdish origin migrants in Finland. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/17542863.2016.1244213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Saija Kuittinen
- School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
| | | | - Anu E. Castaneda
- Team of Multicultural Wellbeing, National Institute for Health and Welfare, Helsinki, Finland
| | - Raija-Leena Punamäki
- School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
| | - Shadia Rask
- Team of Multicultural Wellbeing, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Team of Multicultural Wellbeing, National Institute for Health and Welfare, Helsinki, Finland
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Sezgin AU, Punamäki RL. Perceived Changes in Social Relations after Earthquake Trauma among Eastern Anatolian Women: Associated Factors and Mental Health Consequences. Stress Health 2016; 32:355-366. [PMID: 25516368 DOI: 10.1002/smi.2629] [Citation(s) in RCA: 8] [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: 05/23/2014] [Revised: 11/13/2014] [Accepted: 11/20/2014] [Indexed: 11/09/2022]
Abstract
In this study, we examined social relations in women exposed to earthquake trauma in Eastern Anatolia, Turkey. We examined women's perceptions regarding the changes in their social relations within their neighbourhood, within their marriage and with their children; analysed the factors that were associated with these relations; and tested the hypothesis that an improvement in social relations will protect women's mental health from the negative impact of earthquake trauma. Participants consisted of a random selection of 1253 women, who were interviewed regarding their psychosocial needs and mental health status 1 year after earthquake. They reported trauma-related changes in their social relations; their mental health was evaluated using the Post Traumatic Stress Diagnostic Scale and Brief Symptom Inventory. Our study demonstrated severe earthquake trauma was associated with deteriorated social relations, especially neighbourhood and marital relations. Deteriorated marital and child relations were associated with increased levels of psychiatric distress; deteriorated neighbourhood relations were associated with intrusive posttraumatic stress symptoms. Improved neighbourhood relations, but not family relations, were able to protect women's mental health from the negative impact of trauma. The results are discussed regarding their relevance to gender effects and the provision of relation-specific and symptom-specific disaster relief. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- A Ufuk Sezgin
- Istanbul Faculty of Medicine, Department of Forensic Medicine, Istanbul University, Istanbul, Turkey.
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Lindblom J, Peltola MJ, Vänskä M, Hietanen JK, Laakso A, Tiitinen A, Tulppala M, Punamäki RL. Early family system types predict children’s emotional attention biases at school age. International Journal of Behavioral Development 2016. [DOI: 10.1177/0165025415620856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The family environment shapes children’s social information processing and emotion regulation. Yet, the long-term effects of early family systems have rarely been studied. This study investigated how family system types predict children’s attentional biases toward facial expressions at the age of 10 years. The participants were 79 children from Cohesive, Disengaged, Enmeshed, and Authoritarian family types based on marital and parental relationship trajectories from pregnancy to the age of 12 months. A dot-probe task was used to assess children’s emotional attention biases toward threatening (angry) and affiliative (happy) faces at the early (500 ms) and late (1250 ms) stages of processing. Situational priming was applied to activate children’s sense of danger or safety. Results showed that children from Cohesive families had an early-stage attentional bias toward threat, whereas children from Enmeshed families had a late-stage bias toward threat. Children from Disengaged families had an early-stage attentional bias toward threat, but showed in addition a late-stage bias away from emotional faces (i.e., both angry and happy). Children from Authoritarian families, in turn, showed a late-stage attentional bias toward emotional faces. Situational priming did not moderate the effects of family system types on children’s attentional biases. The findings confirm the influence of early family systems on the attentional biases, suggesting differences in the emotion regulation strategies children have developed to adapt to their family environments.
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Affiliation(s)
| | | | | | | | | | - Aila Tiitinen
- Helsinki University Central Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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Abstract
The mental health function of dreaming was studied among Palestinian children and adolescents in a trauma group ( N= 268) and a comparison ( N= 144) group. The subjects were 6- to 15-year-old boys and girls, the mean age being 11.2± 2.64. They used a seven-day dream diary to record the dreams they could recall every morning. The results suggest that compensatory dreams could moderate between trauma and psychological symptoms. Traumatic events were not associated with psychological symptoms among children whose dreams were bizarre, vivid and active, and involved joyful feelings and happy endings. A mediating model suggested that exposure to traumatic events was associated with mundane persecution and unpleasant repetitious dreams. These dysfunctional dreams were, in turn, associated with poor psychological adjustment. The dynamics of mastery and compensation dreams in traumatic conditions are discussed.
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Punamäki RL, Muhammed AH, Abdulrahman HA. Impact of traumatic events on coping strategies and their effectiveness among Kurdish children. International Journal of Behavioral Development 2016. [DOI: 10.1080/01650250344000271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aims were, first, to identify behavioural, cognitive, emotional, and social coping responses to traumatic and stressful situations, and second, to examine how the nature and severity of traumatic events are associated with coping dimensions. Third, the effectiveness of coping dimensions was evaluated for their ability to buffer the children’s mental health from negative trauma effects. The participants were 153 Kurdish girls and boys (Mean age 12.26 0.14) from Northern Iraq living in both orphanages and family homes. Coping strategies were measured by a cartoon test depicting traumatic and stressful situations to which children responded in their own words. Factor analyses identified Reconstructing, Active Affiliation, Passivity, and Denial as the coping dimensions. The nature of traumatic events determined their impact on coping strategies. Family-related hardships were associated with low Reconstructing, and economic hardships with low Active Affiliation, while military violence was not associated with coping dimensions. The effectiveness of coping dimensions was symptom specific. Active Affiliation moderated between exposure to traumatic events and post-traumatic symptoms and sleeping difficulties, and Denial between exposure to traumatic events and aggressive symptoms. Reconstructing was marginally directly associated with low levels of post-traumatic and aggressive symptoms, but showed no buffering effect. The results failed to substantiate the hypothesis of a wide coping repertoire buffering between exposure to traumatic events and psychological symptoms.
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Punamäki RL. Book Review: Minefields in their hearts. The mental health of children in war and communal violence. International Journal of Behavioral Development 2016. [DOI: 10.1177/016502549702100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Punamäki RL, Qouta S, El-Sarraj E. Resiliency factors predicting psychological adjustment after political violence among Palestinian children. International Journal of Behavioral Development 2016. [DOI: 10.1080/01650250042000294] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The effects of cognitive capacity, perceived parenting, traumatic events, and activity, which were ” rst measured in the midst of the political violence of the Intifada in 1993, were examined on post-traumatic stress disorder (PTSD), emotional disorders, school performance, and neuroticism three years later in more peaceful conditions among 86 Palestinian children of 14.04 ± 0.79 years of age. The results showed, ” rst, that PTSD was high among the children who had been exposed to a high level of traumatic events and had responded passively (not actively) to Intifada violence. Discrepant perceived parenting was also decisive for adjustment: Children who perceived their mothers as highly loving and caring but their fathers as not so showed a high level of PTSD. High intellectual but low creative performance was also characteristic of the children suffering from emotional disorders. Second, the hypothesis that cognitive capacity and activity serve a resiliency function if children feel loved and nonrejected at home was confirmed. Third, neuroticism decreased significantly over the three years, especially among the children who had been exposed to a high number of traumatic events.
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Affiliation(s)
| | - Samir Qouta
- Gaza Community Mental Health Program, Palestine
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49
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Punamäki RL, Qouta S, Sarraj EE, Montgomery E. Psychological distress and resources among siblings and parents exposed to traumatic events. International Journal of Behavioral Development 2016. [DOI: 10.1177/0165025406066743] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined symmetries and asymmetries within family members' psychological distress and resources in general and when exposed to traumatic events in particular. PTSD and depressive symptoms indicated distress and resilient attitudes, and satisfaction with quality of life indicated resources. We also analysed potential complementary dynamics between family members and identified family types according to their distress and resources. Concerning trauma impact, we hypothesized that exposure to family military violence (FMV) and recent personal trauma (RPT) predict family members' psychological distress and resources differently, indicating asymmetry in family responses. The participants were 65 Palestinian families each consisting of a mother, a father and their 15-, 17and 19-year-old children. The within-family MANOVA results showed asymmetric in psychological distress and resources in sibling and spousal subsystems, for example older siblings reported a higher level of depressive symptoms than both parents, and mothers reported PTSD more often than fathers. The cluster analysis identified four family types, two with symmetric responses: In the “resilient families” all members showed low distress and high resources, and in the “ordeal families” all showed distress and low resources. In the asymmetric families either the children or the parents showed low distress and high resources, named the “children's strength families” and the “parental strength families”, respectively. Partial correlation analysis revealed complementary dynamics between children and their parents: If mothers reported high levels of psychological distress, the 15and 17-year-olds reported low or vice versa. Spousal complementary dynamics were found in psychosocial resources: If the mother showed highly resilient attitudes, the father showed low or vice versa. As hypothesized, exposure to traumatic events was differently associated with family members’ psychological distress and resources. Family military trauma (FMT) predicted depressive symptoms only among the youngest siblings, and recent personal trauma (RPT) was associated with dissatisfaction with quality of life only among the oldest sibling and fathers.
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Affiliation(s)
| | | | | | - Edith Montgomery
- Rehabilitation and Research Center for Torture Victims, Copenhagen, Denmark
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Leinonen JA, Solantaus TS, Punamäki RL. The specific mediating paths between economic hardship and the quality of parenting. International Journal of Behavioral Development 2016. [DOI: 10.1080/01650250143000364] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Finland, one of the welfare states of northern Europe, faced an exceptionally deep economic recession at the beginning of the 1990s. Based on the Family Stress Model (Conger & Elder, 1994) we studied specific mediating paths between economic hardship and the different domains of parenting in 527 mother-father-child triads. The results show that economic hardship created economic pressures for both parents. For fathers, both the general and specific pressures were further associated with symptoms of anxiety and social dysfunction, whereas for mothers, only the specific economic pressures were negatively reflected in mental health by increasing depressing mood and anxiety symptoms. Paternal anxiety was then associated with hostile marital interaction, perceived by the wife, and maternal anxiety with low marital support, perceived by the husband. The negative marital interaction finally was associated with poor parenting, especially among the fathers. Fathers’ anxiety was also directly related to their punitive and noninvolved fathering, and social dysfunction to noninvolved fathering. Depressive symptoms in mothers were negatively reflected in authoritative mothering. Finally, the results revealed that supportive and nonhostile marital interaction was able to moderate the negative impact of economic hardship on parenting. The findings suggest that mothers and fathers fulfil gendered roles in dealing with the family economy and relationships.
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