Mothers with depression, anxiety or eating disorders: outcomes on their children and the role of paternal psychological profiles

A Systematic Review and Meta-Analysis: Paternal Anxiety and the Emotional and Behavioral Outcomes in Their Offspring

OBJECTIVE

Anxiety disorders are highly prevalent worldwide; however, the literature lacks a meta-analytic quantification of the risk posed by fathers' anxiety for offspring development. This systematic review and meta-analysis aimed to provide a comprehensive estimate of the magnitude of the association between paternal anxiety and emotional and behavioral problems of offspring.

METHOD

In February 2022, Web of Science, Ovid (Embase, MEDLINE, PsycINFO), Trip Database, and ProQuest were searched to identify all quantitative studies that measured anxiety in fathers and emotional and/or behavioral outcomes in offspring. No limits were set for offspring age, publication language, or publication year. Summary estimates were extracted from the primary studies. Meta-analytic random-effects 3-level models were used to calculate correlation coefficients. Quality was assessed using the Newcastle-Ottawa Scale. The study protocol was preregistered with PROSPERO (CRD42022311501) and adhered to PRISMA reporting guidelines.

RESULTS

Of 11,746 records identified, 98 were included in the meta-analysis. Small but significant associations were found between paternal anxiety and offspring emotional and behavioral problems overall (r = 0.16, 95% CI [0.13, 0.19]) and behavioral (r = 0.19, 95% CI [0.13, 0.24]), emotional (r = 0.15, 95% CI [0.12, 0.18]), anxiety (r = 0.13, 95% CI [0.11, 0.16]), and depression (r = 0.13, 95% CI [0.03, 0.23]) problems. Some significant moderators were identified.

CONCLUSION

Paternal mental health is associated with offspring development, and the offspring of fathers with anxiety symptoms or disorders are at increased risk of negative emotional and behavioral outcomes, in line with the principles of multifinality and pleiotropy. The substantial heterogeneity among studies and the overrepresentation of White European American groups in this literature highlight the need for further research.

PLAIN LANGUAGE SUMMARY

In this meta-analysis of 98 studies and ∼55,000 unique participants, the authors examined the associations between fathers' anxiety and offspring mental health difficulties. The study found small but significant associations between paternal anxiety and offspring emotional and behavioral problems (Pearson r ranging between .13 and .19). Findings from the study highlight the importance of paternal mental health in offspring development, with paternal anxiety associated with a generalized offspring vulnerability to psychopathology. The results of the study are limited by the heterogeneity among studies and overrepresentation of White European American groups highlighting the need for further research.

CLINICAL GUIDANCE

DIVERSITY & INCLUSION STATEMENT: While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

History of pre-pregnancy maternal symptoms of binge eating and childhood behavioral problems in girls and boys

OBJECTIVE

To explore whether children of mothers with pre-pregnancy binge eating (BE) symptoms have more behavioral difficulties compared with those without and whether associations are moderated by ED symptoms and other maternal health and social factors measured during childhood.

METHOD

Pre-pregnancy BE symptoms were collected by the Australian Longitudinal Study on Women's Health at Survey 1 (in 1996) and/or at Survey 2 (in 2000) using questions mapped to DSM BE criterion 1. In 2016/7, 2180 women from the 1973-78 cohort provided data on externalizing and internalizing behavior, measured by Strengths and Difficulties Questionnaire, on 4054 of their children (2-12 years) in the Mothers and their Children's Health study. Covariates were markers of other ED symptoms, sociodemographic, social support, and mental health factors collected proximally to the child outcomes. Hierarchical multivariable regression models, using generalized estimating equations accounting for clustering of children within mothers, were used.

RESULTS

Pre-pregnancy BE symptoms were associated with child behavior, with associations only moderated after adjustment for proximal markers of ED (girls internalizing behavior, b (95%CI) .30 (-.02, .61); boys externalizing behavior .34 (-.04, .73)) or social support (girls externalizing behavior 0.26 (-.08, .61)). Pre-pregnancy BE symptoms were not associated with boys internalizing behavior (-.27 (-.02, 0.57)).

DISCUSSION

Studies with repeated ED measures should test hypotheses that these associations vary by timing of ED measurement. Identification of young women at risk of BE symptoms pre-pregnancy, as well as when children are older, may enable health services, treatment programs, and supports to minimize longer term effects on children.

PUBLIC SIGNIFICANCE STATEMENT

A history of binge eating symptoms up to 10 years pre-pregnancy in mothers is associated with behavior problems in their girls and boys at average age of 7. However, the association is moderated by behaviors of eating disorders and social support in the mothers during childhood. Identification of ED symptoms prior to pregnancy, and then after childbirth, might enable health services to intervene to maximize child and mother outcomes.

The impact of COVID-19 pandemic on psychopathological symptoms in mothers and their school-age children before, during and after the COVID-19 pandemic peak

The COVID-19 pandemic had an impact on children's and caregivers' mental health. We investigated psychopathological symptoms in a group of non-at-risk and a group of at-risk mothers and their school-age children from the pre-pandemic period to the lockdown period and to the post-lockdown period. We used the SCL-90/R to assess mothers' psychological symptoms, the CBCL 1½-5, and the CBCL 6-18 for the perceived children's emotional-behavioral functioning. Analysis of variance was conducted to assess significant differences in the groups over the three assessment points. Linear regressions were run to investigate the effect of maternal psychological symptoms on their children's functioning. In the non-at-risk group, maternal psychopathological symptoms significantly varied during the pandemic. Children's Aggression scores decreased after the lockdown, while Depression scores significantly increased during lockdown and after. The mothers in the at- risk group presented overall decreasing scores over the three assessment points. Children's Aggression scores did not increase during lockdown. Depression scores did not show significant changes over the three assessment points. Overall, our results showed that mothers' psychopathological risk did not influence specific areas of children's emotional/behavioral functioning, but it had an effect on the general offspring psychological well-being.

Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy

OBJECTIVES

Relationships between weight and fertility are well known. The aim of this study is to assess the prevalence of lifetime eating disorder (ED) in a sample of infertile women seeking a specific infertility treatment, pulsatile gonadotropin-releasing hormone (pGnRH) treatment, and to compare it to the prevalence of lifetime ED in a sample of infertile women seeking other types of assisted reproductive technology (ART) treatments.

DESIGN

Non-randomized, observational study including infertile female patients. Two-group design including consecutive women treated with GnRH pump (pGnRH) or with other types of ART.

SETTING

Multi-centric infertility centers, France METHODS: Twenty one consecutive women treated with pGnRH treatment were compared to 21 consecutive women receiving other types of infertility treatment. Diagnosis of ED was based on DSM-IV and the Composite International Diagnostic Interview (CIDI).

RESULTS

Twenty patients (95.2%) from the sample of women treated with pulsatile GnRH treatment and 5 patients (23.8%) from the patients receiving other types of infertility treatment met the criteria of lifetime ED diagnosis (p < 0.000).

CONCLUSION

This study highlights the fact that the prevalence of ED is considerably higher in women receiving GnRH pulsatile treatment, when compared to women receiving other kinds of infertility treatment. In our study population ED were under-diagnosed, particularly in women receiving pulsatile GnRH treatment. Fertility clinicians should use reliable diagnostic tools to identify promptly ED in women presenting with hypothalamic amenorrhea and difficulties in conceiving. Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Interventions to Empower Adults with Eating Disorders and Their Partners around the Transition to Parenthood

The transition to parenthood is perceived as a stressful life event, when parents experience an immense change of their psychological focus and a reorientation of roles and responsibilities in the family system. This process may be even more challenging in the presence of a parental eating disorder history. This paper reviews the impact of parental eating disorders on the parents, the couple relationship, and their child during the perinatal period. A parental eating disorder is associated with more negative expectations of parental efficacy as well as specific difficulties in couple communication over the child's feeding, shape, and weight. Providers who better understand the effects of an eating disorder on parental functioning can more effectively intervene early on. We also present couple- or parent-based, empirically supported interventions for adults with eating disorders and their partners in the prenatal and postnatal periods: Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and Uniting couples In the Treatment of Eating disorders (UNITE) both enhance recovery from the eating disorder through a couple-based intervention; the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) incorporates the support of partners, when appropriate; Parent-Based Prevention (PBP) focuses on improving parental functioning and reducing risk of negative parental and child outcomes. Finally, we discuss the clinical implications of addressing parental eating disorders and encourage more research on these families.

Relationship between parents' mental disorders and socioeconomic status and offspring's psychopathology: A cross-sectional study

Mental disorders (MD) are one of the main causes of the disease burden worldwide. Associations between socioeconomic status (SES) and presence of MD in parents have been related with increased odds of MD in offspring. However, there is a lack of population-based research in this field. The aim of the present study was to examine together the relationship between the presence of MD in children, and the SES and presence of MD in their parents, in a whole of population data. A gender approach was undertaken aiming to discern how these variables influence children's mental health when related with the father and the mother. Using administrative individual data from the National Health System, a retrospective cross-sectional study was conducted. The entire children population aged 6 to 15 resident in Catalonia in 2017 was examined. A logistic regression model was performed. Low SES was associated with increased odds of children's MD. Offspring of a parent with MD were at more risk of presenting MD than offspring of parents without these problems. Although these associations were consistent for both boys and girls when looking at the father's or mother's SES and MDs, the mother's SES and MDs showed a higher association with the offspring's MDs than the father's. Lowest associations, found for boys when looking at the father's SES and MDs, were: OR of 1.21, 95%CI 1.16 to 1.27 for lowest SES, and OR of 1.66, 95%CI 1.61 to 1.70 for parental MDs. Children's familiar environment, which includes SES and mental health of parents, plays an important role in their mental health. Socially constructed gender roles interfere with SES and parent's MD. These findings support the relevance of examining MD and its risk factors within a gender approach.

Eating disorders mothers and their children: a systematic review of the literature

To provide an overview of the impact of maternal eating disorders (ED) on child development in a number of domains including feeding and eating behaviour, neuropsychological profile and cognitive development, psychopathology and temperament. PubMed, Embase and PsychInfo were searched for studies exploring the impact of maternal ED on children between January 1980 and September 2018. Initial search yielded 569 studies. After exclusion, 32 studies were reviewed. Overall, available evidence shows that children of mothers with ED are at increased risk of disturbances in several domains. They exhibit more difficulties in feeding and eating behaviours, display more psychopathological and socio-emotional difficulties, and they are more likely to be described as having a difficult temperament. Maternal ED have an impact on child psychological, cognitive and eating behaviours, and might affect the development of ED in the offspring. Future research should focus on resilience and on which protective factors might lead to positive outcomes. These factors can be then used as therapeutic and preventative targets.

Prospective Pathways to Depressive Symptoms and Disordered Eating in Adolescence: A 7-Year Longitudinal Cohort Study

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls.

Emotional-Behavioral Functioning, Maternal Psychopathologic Risk and Quality of Mother-Child Feeding Interactions in Children with Avoidant/Restrictive Food Intake Disorder

The literature on food intake disorder (ARFID) in early childhood has evidenced psychopathologic difficulties in both children and their mothers and a poor quality of feeding interactions. Only a few studies have focused on three different ARFID subtypes: irritable/impulsive (I/I), sensory food aversions (SFA) and post traumatic feeding disorder (PTFD). The aim of this study was to explore possible differences between the three groups in children’s emotional-behavioral functioning, maternal psychopathologic risk and the quality of mother–child feeding interactions, comparing these clinical groups with a control group. The sample consisted of 100 child–mother dyads, of which 23 children with I/I, 25 children with SFA, 27 children with PTFD and 27 children with no diagnosis. The mothers primarily filled out questionnaires assessing their psychopathologic symptoms and children’s emotional-behavioral functioning. Then, all dyads were videotaped during a main meal. Results revealed significant differences between the study groups in relation to children’s emotional–adaptive functioning, mothers’ psychological profile and mother–child interactions during feeding. These findings are relevant for the development of target intervention programs to treat specific ARFID disorders.

[The impact of adolecent motherhood on child development in preschool children- identification of maternal risk factors]

The impact of adolecent motherhood on child development in preschool children- identification of maternal risk factors Abstract. Objective: This longitudinal study aims to identify relevant risk factors in adolescent mothers which might impact their child's cognitive and speech development as well as behavior problems at preschool age. Based on earlier findings, maternal sensitivity (EA), socioeconomic status (SES) and psychological stress were identified as potentially influencing factors. Method: N = 31 adolescent and N = 47 adult mothers with their children aged 3;0 to 5;9 (M = 3;55) participated in this study. Child variables included cognitive development (WPPSI-III), language development (SSV), and behavioral problems (SDQ). Maternal factors were EA, SES, and mental health problems (BSI-18). Results: Children of adolescent mothers performed worse on cognitive and speech development and are described by their mothers as exhibiting more behavioral problems compared to children of adult mothers. Mediation analyses revealed that the effect of maternal age on children's cognitive development is occurs through reduced maternal sensitivity of adolescent mothers. Further, higher psychological stress of adolescent mothers mediated the effect of maternal age on children's behavior problems. Conclusion: Preschool children of adolescent mothers showed poorer developmental outcomes compared to children of adult mothers. This is partly explained by lower maternal sensitivity and higher rates of psychological stress among adolescent mothers.

The Role of Family Relationships in Eating Disorders in Adolescents: A Narrative Review

Background: Adolescents' eating disorders have been explored through various conceptual and empirical models. Only recently, scientific literature in this area has more specifically investigated the role of relationships, with particular attention to family functioning. Objective: This paper reviews family relationships aspects of eating disorders in adolescence. Methods: A narrative literature review of relational issues in adolescents' eating disorders was performed. Results: Empirical evidence of family relationships in adolescents' eating disorders confirms the relevance of relational aspects in the development and maintenance of the pathology. In particular, the contribution of the relational-systemic approach is wide, suggesting the need to refer to the family context for a better understanding of adolescents' sufferance. Additionally, the empirical contributions from the conceptual model of Developmental Psychopathology, highlighting the importance of risk and protection factors in family relationships, provides knowledge about the phenomenon of adolescents' eating disorders in terms of complexity. Conclusions: An integrated relational model aimed to explore adolescents' eating disorders is worthy of investigation to accomplish specific program of intervention.

Longitudinal association between low self-esteem and depression in early adolescents: The role of rejection sensitivity and loneliness

OBJECTIVES

Although the relation between low self-esteem and depression has been well established, little is known about the possible psychological mechanisms that account for the relation between them. Based on Beck's cognitive theory of depression, the main aim of this study was to explore the notion that rejection sensitivity and loneliness serve as mediators of the relation between low self-esteem and depression among early adolescents.

DESIGN

Using a longitudinal design, we evaluated the hypothesized model with a sample of 866 Chinese early adolescents (51% females) between 11 and 15 years old who completed questionnaires on three occasions at 1-year intervals.

RESULTS

Structural equation modelling showed that: (1) low self-esteem at Time 1 positively predicted depression at Time 3; (2) rejection sensitivity at Time 2 partially mediated the relation between low self-esteem at Time 1 and depression at Time 3; (3) low self-esteem at Time 1 demonstrated partial indirect effects on depression at Time 3 successively via rejection sensitivity and loneliness at Time 2; and (4) rejection sensitivity predicted an increase in loneliness but not vice versa, and depression accounted for later loneliness, but not for rejection sensitivity.

CONCLUSIONS

The associations between low self-esteem and depression among early adolescents may be explained by rejection sensitivity and loneliness. These results suggest implications for effective interventions for depression in early adolescents.

PRACTITIONER POINTS

Low self-esteem is a risk factor for depression in early adolescents, and rejection sensitivity and loneliness help explain the vulnerability model. Implementing empirically based intervention plans to overcome low self-esteem may be helpful in efforts to reduce depression in early adolescents. Effective interventions should likely include efforts to decrease rejection sensitivity and loneliness and their effects, such as training to interpret verbal and behavioural cues in social interactions more accurately and to develop more effective social skills to enhance social confidence.

Effects of interventions for women and their partners to reduce or prevent stress and anxiety: A systematic review

BACKGROUND

The period from conception to two years postpartum (the first 1000 days) represents a normative transitional period, which can be potentially stressful for some parents. Parental stress and anxiety adversely impacts psychological and physical health for parents and children.

AIM

The aim of this review is to systematically examine effects of interventions for women and their partners to reduce or prevent stress and/or anxiety during the first 1000 days.

METHODS

MEDLINE, Embase, CINAHL, PsychINFO, and Maternity and Infant Care were searched from inception to March 2019. Randomised controlled trials examining intervention effects on parental stress and/or anxiety during first 1000 days were eligible for inclusion. Data were independently extracted by two reviewers and narratively synthesised.

FINDINGS

Fifteen interventions, reported in 16 studies, met inclusion criteria (n=1911 participants). Overall, findings were inconsistent and the majority of trials demonstrated high risk of bias. Interventions were predominantly delivered to women during pregnancy and only two studies included fathers. There was some evidence that adapting interventions to the pre and postnatal periods provided benefits for stress and anxiety reduction, however there was limited evidence for individual intervention types or approaches.

CONCLUSIONS

There is currently inconsistent evidence of what interventions are most effective for women during the first 1000 days and there is insufficient evidence for any interventions for male partners during this period. There is a clear need for rigorous development and examination of interventions developed specifically to reduce or prevent stress and/or anxiety across the first 1000 days.

Children's DAT1 Polymorphism Moderates the Relationship Between Parents' Psychological Profiles, Children's DAT Methylation, and Their Emotional/Behavioral Functioning in a Normative Sample

Parental psychopathological risk is considered as one of the most crucial features associated with epigenetic modifications in offspring, which in turn are thought to be related to their emotional/behavioral profiles. The dopamine active transporter (DAT) gene is suggested to play a significant role in affective/behavioral regulation. On the basis of the previous literature, we aimed at verifying whether children’s DAT1 polymorphisms moderated the relationship between parents’ psychological profiles, children’s emotional/behavioral functioning, and DAT1 methylation in a normative sample of 79 families with school-age children (Ntot = 237). Children’s biological samples were collected through buccal swabs, while Symptom Check-List-90 item Revised, Adult Self Report, and Child Behavior Check-List/6–18 was administered to assess parental and children’s psychological functioning. We found that higher maternal externalizing problems predicted the following: higher levels of children’s DAT1 methylation at M1, but only among children with 10/10 genotype; higher levels of methylation at M2 among children with 10/10 genotype; while lower levels for children with a 9-repeat allele. There was also a positive relationship between fathers’ externalizing problems and children’s externalizing problems, only for children with a 9-repeat allele. Our findings support emerging evidence of the complex interplay between genetic and environmental factors in shaping children’ emotional/behavioral functioning, contributing to the knowledge of risk variables for a child’s development and psychological well-being.

Parental Socialization Styles: The Contribution of Paternal and Maternal Affect/Communication and Strictness to Family Socialization Style

The aim of this study is two-fold: (a) to determine the general degree of family affect/communication and strictness by examining the combination of the two classical dimensions of mother parenting style: affect/communication and strictness, and (b) to analyze the impact of both parents' affect and strictness on the family style, thereby exploring the specific contribution made by each parent's style and dimension. Participants were 1190 Spanish students, 47.1% boys and 52.3% girls (M = 14.68; SD = 1.76). The Affect Scale (EA-H) and the Rules and Demandingness Scale (ENE-H) (both by Fuentes, Motrico, and Bersabé, 1999) were used. Structural equation models (SEMs) were extracted using the EQS program. The results reveal that it is not the father's and the mother's parenting style combined, but rather the combination of maternal and paternal affect/communication, and maternal and paternal strictness which generates one perception of family affect and another of family strictness. The results also indicated that the weight of both dimensions varies in accordance with the parent's gender, with maternal dimensions playing a more important role in family socialization style.

Children of Parents with Eating Disorders

PURPOSE OF REVIEW

Our primary goal in this article is to review recent findings (from 2015 and on) concerning children of parents with eating disorders. This review addresses the question of whether the offspring of parents with past or present eating disorders have adverse outcomes. This update is timely and informative because recent research includes controlled studies and large cohort designs and earlier reviews relied on case report evidence.

RECENT FINDINGS

Despite substantial diversity in study design, sample size, and parental eating disorder definition, overall, existing research suggests that the children of parents with eating disorders exhibit compromised development: a greater risk of perinatal complications; a tendency toward extremes of growth at birth; greater problems in feeding and eating behaviors and greater incidence of eating disorder symptoms; more psychological and socioemotional difficulties; and more negative qualities to parent-child interactions. Data on children's cognitive outcomes is thus far inconsistent. Given the relatively high incidence of eating disorder history in individuals of childbearing age, research into its potential effects on children is necessary. However, the methodological shortcomings and a limited evidence base caution in drawing conclusions. Nevertheless, mental health services should address the possible problems that these children face and offer tailored programs.

Parent pain catastrophizing predicts child depressive symptoms in youth with sickle cell disease

BACKGROUND

Youth with sickle cell disease (SCD) are at risk for recurrent pain and depressive symptoms, both of which contribute to poorer health outcomes. Furthermore, youth and family coping with child pain, including pain catastrophizing, is known to be associated with poorer psychosocial adjustment and greater functional disability among youth with SCD. In particular, child catastrophizing about pain and parent catastrophizing about their child's pain have been linked to increased pain and depressive symptoms in youth with chronic pain conditions. Despite this, the impact of child and parent pain catastrophizing on depressive symptoms remains unexplored in pediatric SCD.

PROCEDURE

The current study evaluated the predictive value of child and parent pain catastrophizing on child depressive symptoms in a sample of 100 youth with SCD. Differences in child and parent pain catastrophizing across youth with and without clinically elevated depressive symptoms were also examined.

RESULTS

Pain frequency and parent and child pain catastrophizing accounted for 35.9% of variance in child depressive symptoms, with only pain frequency and parent pain catastrophizing emerging as unique predictors of clinically elevated depressive symptoms. Additionally, parents of youth with clinically elevated depressive symptoms showed increased helplessness relative to parents of youth with minimal to mild depressive symptoms.

CONCLUSIONS

Findings support the value of depression screening and interventions to promote parent self-efficacy in managing childhood SCD pain.

Time-specific and cumulative effects of exposure to parental externalizing behavior on risk for young adult alcohol use disorder

BACKGROUND

Previous studies indicate that parental externalizing behavior (EB) is a robust risk factor for alcohol use disorder (AUD) in their children, and that this is due to both inherited genetic liability and environmental exposure. However, it remains unclear whether the effects of exposure to parental EB vary as a function of timing and/or chronicity.

METHODS

We identified biological parents with an alcohol use disorder, drug abuse, or criminal behavior, during different periods of their child's upbringing, using Swedish national registries. Logistic regression was used to determine whether the effect of parental EB exposure during different developmental periods differentially impacted children's risk for young adult AUD (ages 19-24). In addition, we tested how multiply affected parents and/or sustained exposure to affected parents impacted risk.

RESULTS

While parental EB increased risk for young adult AUD, timing of exposure did not differentially impact risk. Having a second affected parent increased the risk of AUD additionally, and sustained exposure to parental EB across multiple periods resulted in a higher risk of young adult AUD than exposure in only one period.

CONCLUSIONS

In this well-powered population study, there was no evidence of "sensitive periods" of exposure to national registry-ascertained parental EB with respect to impact on young adult AUD, but sustained exposure was more pathogenic than limited exposure. These findings suggest developmental timing does not meaningfully vary the impact, but rather there is a pervasive risk for development of young adult AUD for children and adolescents exposed to parental EB.

Paternal psychopathological risk and psychological functioning in children with eating disorders and Disruptive Behavior Disorder

Several studies demonstrated that maternal psychopathological risk is related to child's maladjustment, but until recently research has relatively neglected fathers. Disruptive Behavior Disorder (DBD) and Eating disorders (ED) have a large prevalence during childhood but a few studies have focused on their association with paternal psychopathological risk. One-hundred and thirty-nine children and their fathers were recruited from pediatric hospitals and outpatient clinics and paired with a healthy control group (CG). Fathers were administered the SCL-90/R and the CBCL 6-18 to assess: 1) psychopathological risk of fathers of children with DBD, ED and CG; 2) significant differences between ED and DBD fathers' psychopathological profiles; and 3) associations between specific fathers' psychopathological symptoms and children's emotional-behavioral problems. Fathers of children with ED showed a higher psychopathological risk than fathers of DBD offspring. Children with DBD showed higher externalizing symptoms. Paternal hostility was associated with internalizing problems in children with DBD. Paternal hostility showed a non-significant but clinically interesting association with internalizing problems in DBD children; interpersonal sensitivity was associated with internalizing problems in ED children. This study can constitute a contribution to a better understanding of the clinical characteristics of fathers of children with DBD and ED.

Paternal Mental Health: Why Is It Relevant?

Father's mental health is an emerging area of interest that is beginning to be recognized in research, and to a lesser extent in clinical practice and society. Fathers are part of a parenting dyad with 2 partners who are responsible for their children's emotional development. Similar to mothers, the risk for mental health problems increases once a male becomes a father, but there is limited research examining this issue. The purpose of this review is to present the available literature on father's mental health and its effect on child emotional health through various mechanisms. In general, father's mental health was found to be related to increased child internalizing and externalizing behaviors, but each disorder had different risk factors, and a unique effect on parenting behaviors and the child's emotional health. The most developed paternal mental health literature is focused on depression. However, key conceptual and methodological problems exist that may limit our understanding of paternal depression. Additionally, the focus on paternal depression may not accurately represent the largest risk for paternal psychopathology and the resultant child mental health outcomes because men have an increased likelihood of displaying externalizing behaviors. Implications for research, clinical practice, and policy are discussed.

A Longitudinal Study of Fathers' and Young Children's Depressive Symptoms

Considerable research has examined the effects of maternal depression on children, but few studies have focused on the relation between paternal and child depressive symptoms, particularly during early childhood. Even fewer studies have been longitudinal, leaving open questions about how paternal and child depression covary over time. The present study sought to address this gap by examining the relation between fathers' and children's depressive symptoms over a 3-year period. Participants were 153 preschool children with behavior problems and their parents. Three longitudinal analytic approaches were used to examine how father and child depression change together and predict one another over time. Additional analyses examined whether externalizing problems or maternal depression might account for the associations between fathers' and children's depressive symptoms. Changes in paternal depression significantly predicted changes in father-reported and mother-reported child depressive symptoms. These effects were evident both in year-to-year fluctuations and in linear trajectories across the 3-year period. Cross-lagged analyses suggested that these relations may have been driven by father-effects; paternal depression at one time point predicted child depression at the next time point, but child depression did not significantly predict later paternal depression. We found little evidence that externalizing problems or maternal depression accounted for the relations between fathers' and children's depressive symptoms. Results provide convergent evidence that fathers' depression may play an important role in the development of depressive symptoms in young children and underscore the importance of including fathers in studies of depression in families.

Depressive Symptoms, Self-Esteem and Perceived Parent-Child Relationship in Early Adolescence

AIMS

Early adolescence represents a critical developmental period both from a psychological and a psychopathological point of view. During this period, one of the most common disorders that frequently arise is represented by depression, that tends to become chronic and may produce many subsequent psychosocial impairments. The present study aimed to analyze characteristics of depressive symptoms in an Italian sample of early adolescents, and to explore their connections with self-esteem levels and perceived maternal and paternal emotional availability.

METHODS

594 adolescents (50% females) with a mean age of 12.11 years (SD = 0.98) were administered the Children's Depression Inventory, the Rosenberg Self-Esteem Scale, and the maternal and the paternal forms of the Lum Emotional Availability of Parents.

RESULTS

Findings highlighted a slightly higher, though not statistically significant, level of depressive symptoms in girls than in boys. Regression analysis showed that, as far as predictors of depression, self-esteem was the most relevant one, followed by maternal and paternal emotional availability.

CONCLUSION

Our results strongly suggested to plan intervention programs aimed at monitoring early adolescents' self-esteem and supporting relationship with both parents, in order to prevent the emergence of depressive symptoms.

Mothers and Fathers with Binge Eating Disorder and Their 18-36 Months Old Children: A Longitudinal Study on Parent-Infant Interactions and Offspring's Emotional-Behavioral Profiles

Maternal Binge Eating Disorder (BED) has been suggested to be associated with poor parent-infant interactions during feeding and with children's emotional and behavioral problems during infancy (Blissett and Haycraft, 2011). The role of fathers has received increasing consideration in recent years, yet the research has not focused on interactional patterns between fathers with BED and their children. The present study aimed to longitudinally investigate the influence of BED diagnosis, in one or both parents, on parent-infant feeding interactions and on children's emotional-behavioral functioning. 612 subjects (408 parents; 204 children), recruited in mental health services and pre-schools in Central Italy, were divided into four groups: Group 1 included families with both parents diagnosed with BED, Group 2 and 3 included families with one parent diagnosed with BED, Group 0 was a healthy control. The assessment took place at T1 (18 months of age of children) and T2 (36 months of age of children): feeding interactions were assessed through the Scale for the Assessment of Feeding Interactions (SVIA) while child emotional-behavioral functioning was evaluated with the Child Behavior Check-List (CBCL). When compared to healthy controls, the groups with one or both parents diagnosed with BED showed higher scores on the SVIA and on the CBCL internalizing and externalizing scales, indicating poorer adult-child feeding interactions and higher emotional-behavioral difficulties. A direct influence of parental psychiatric diagnosis on the quality of mother-infant and father-infant interactions was also found, both at T1 and T2. Moreover, dyadic feeding interactions mediated the influence of parental diagnosis on children's psychological functioning. The presence of BED diagnosis in one or both parents seems to influence the severity of maladaptive parent-infant exchanges during feeding and offspring's emotional-behavioral problems over time, consequently affecting different areas of children's psychological functioning. This is the first study to demonstrate the specific effects of maternal and paternal BED on infant development. These results could inform prevention and intervention programs in families with one or both parents diagnosed with BED.

Developmental trajectories of body mass index and emotional-behavioral functioning of underweight children: A longitudinal study

Although several studies have addressed developmental trajectories from childhood to adolescence of internalizing/externalizing problems, limited attention has been given to underweight children. Two groups were recruited for this study from a community sample: underweight (Ug, N = 80, 50% female) and normal weight (NWg, N = 80, 50% female) to examine the developmental trajectories of body mass index and emotional-behavioral functioning of underweight children from the age two years, and their risk of eating disorder at early adolescence. The study was organized over four waves, each of three years. Pediatricians measured BMI, parents completed the Child Behavior Checklist (CBCL) and the Eating Disorders Inventory-Referral Form (EDI-3-RF). Our results showed that children in the two groups recorded different BMI trajectories over time. In NWg, male and female subjects started from a higher BMI at T1 than their peers. In Ug, internalizing and externalizing problems in males and females remained higher than their peers at all points of assessment. Males and females in Ug scored higher than those in NWg on EDI-3-RF total score. Our results indicate a need for effective physical and psychological assessment of underweight children in community samples to prevent psychological difficulties and eating disorders in adolescence.

Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review

BACKGROUND

Men's experiences of anxiety within the perinatal period can adversely impact themselves, their partner and infant. However, we know little about the prevalence and course of men's anxiety across the perinatal period. The current review is one of the first to systematically review the published literature.

METHODS

Five databases (PubMed, PsycINFO, Cochrane, SCOPUS, and Web of Science) were searched to identify relevant papers published prior to April 2015. The literature search identified articles with data for expectant fathers (prenatal period) and/or fathers of an infant aged between 0 and 1 (postnatal period). The following data were extracted: (a) anxiety disorder prevalence (diagnostic clinical interviews), (b) 'high' anxiety symptom prevalence (above thresholds/cut-points on anxiety symptom scales) and (c) mean anxiety levels (anxiety symptom scales). Initially, 537 unique papers were identified. Subsequently, 43 papers met criteria for inclusion in the review.

RESULTS

Prevalence rates for 'any' anxiety disorder (as defined by either diagnostic clinical interviews or above cut-points on symptom scales) ranged between 4.1% and 16.0% during the prenatal period and 2.4-18.0% during the postnatal period. The data reviewed suggest the course of anxiety across the perinatal period is fairly stable with potential decreases postpartum.

LIMITATIONS

Wide variation in study measurement and methodology makes synthesis of individual findings difficult. Anxiety is highly comorbid with depression, and thus measures of mixed anxiety/depression might better capture the overall burden of mental illness.

CONCLUSIONS

Anxiety disorders are common for men during the perinatal period. Both partners should be included in discussions and interventions focused on obstetric care and parent mental health during the perinatal period.

Early maternal relational traumatic experiences and psychopathological symptoms: a longitudinal study on mother-infant and father-infant interactions

Early maternal relational traumas and psychopathological risk can have an impact on mother-infant interactions. Research has suggested the study of fathers and of their psychological profiles as protection or risk factors. The aim of the paper is to assess the quality of parental interactions during feeding in families with mothers with early traumatic experiences. One hundred thirty-six (N = 136) families were recruited in gynecological clinics: Group A included families with mothers who experienced early sexual/physical abuse; Group B was composed of families with mothers who experienced early emotional abuse or neglect; and Group C comprised healthy controls. The subjects participated in a 10-month longitudinal protocol [at the fourth month of pregnancy (T₀), 3 months after child birth (T₁), and 6 months after child birth (T₂)] that included an observation of mother-infant and father-infant interactions during feeding (Scala di Valutazione dell’Interazione Alimentare [SVIA]) and a self-reporting 90-item Symptom Checklist-Revised (SCL-90-R). Maternal higher rates of depression and early traumatic experiences of neglect and emotional abuse predicted more maladaptive scores on the affective state of the dyad SVIA subscale. Paternal anxiety predicted more severe levels of food refusal in the child during feeding.

Parent-infant interactions in families with women diagnosed with postnatal depression: a longitudinal study on the effects of a psychodynamic treatment

BACKGROUND

Several studies have shown a connection between mothers with postnatal depression (PND) and emotional-behavioral problems in their children. Mothers' psychopathology may impair interactional patterns with children and these outcomes can be influenced by father's psychopathological symptoms. The primary aim of the study was to assess over time parent-infant interaction in families where mothers have experienced PND and have received psychological treatment during the child's first year of life considering the severity of parents' psychopathological symptoms and children's temperament.

METHODS

Three groups of families were involved: families with mothers with PND wherein both parents followed a psychological treatment (TxMF); families with mothers affected by PND wherein only the mother followed the treatment (TxM) and control families wherein the mothers did not have a psychopathological diagnosis and did not receive any treatment (Con). The families were assessed at two time points through Symptom Check-List-90-Revised (SCL-90-R), Questionari Italiani Temperamento (QUIT) and the video-recorded procedure observing mealtime Scala di Valutazione Interazioni Alimentari (SVIA).

RESULTS

Parents in the TxMF group had significantly lower SVIA scores (i.e., less maladaptive) at T2. TxMF group scored lower at T2 at SCL-90-R, whereas TxM showed no significant differences between T1 and T2. Involvement of fathers in the treatment was important to improve the psychopathological symptoms of both parents and the quality of interactions with their children.