Maternal mental health and children's internalizing and externalizing behaviors: Beyond maternal substance use disorders

Treatment for substance use disorder in mothers of young children: A systematic review of maternal substance use and child mental health outcomes

Substance use disorders (SUD) in mothers of young children can negatively impact the family unit and promote the intergenerational cycle of mental health disorders. This systematic review aims to: 1) provide an overview of substance use treatments for mothers of young children (from birth to 5 years old); 2) synthesize findings on maternal substance use and child/maternal mental health outcomes; and 3) identify key treatment components. Database searches in Medline, PsycINFO, PubMED, and PsycARTICLES were conducted on May 7th, 2024. A total of 14, 916 articles were identified following duplicate removal. Articles were screened following PRISMA guidelines. Eight articles (n = 900) met inclusion criteria. Outcomes of interest included maternal substance use, child/maternal mental health, and treatment components. All studies indicated maternal substance use treatments were at least as, or more, effective in improving maternal substance use and child/maternal mental health outcomes compared to controls. Treatment components included: mother/family mental health, basic needs, parenting skills, occupation/education, operant conditioning, crisis management, and medical education. Operant conditioning was the only treatment component which appeared to positively impact maternal substance use outcomes; no other treatment components were associated with outcomes of interest. This review provides preliminary evidence highlighting the benefits of substance use treatments for mothers of young children on substance use and mental health outcomes. Future randomized controlled trials with harmonized outcome measures and qualitative data that identifies treatment needs of mothers with lived experience are crucial to evaluate maternal substance use treatments and improve treatment development.

The relative effects of parental alcohol use disorder and maltreatment on offspring alcohol use: Unique pathways of risk

Childhood adversity represents a robust risk factor for the development of harmful substance use. Although a range of empirical studies have examined the consequences of multiple forms of adversity (i.e., childhood maltreatment, parental alcohol use disorder [AUD]), there is a dearth of information on the relative effects of each form of adversity when considered simultaneously. The current study utilizes structural equation modeling to investigate three unique and amplifying pathways from parental AUD and maltreatment exposure to offspring alcohol use as emerging adults: (1) childhood externalizing symptomatology, (2) internalizing symptomatology, and (3) affiliation with substance-using peers and siblings. Participants (N = 422) were drawn from a longitudinal follow-up study of emerging adults who participated in a research summer camp program as children. Wave 1 of the study included 674 school-aged children with and without maltreatment histories. Results indicated that chronic maltreatment, over and above the effect of parent AUD, was uniquely associated with greater childhood conduct problems and depressive symptomatology. Mother alcohol dependence was uniquely associated with greater affiliation with substance-using peers and siblings, which in turn predicted greater alcohol use as emerging adults. Results support peer and sibling affiliation as a key mechanism in the intergenerational transmission of substance use between mothers and offspring.

Reducing risk factors for child maltreatment: The Parenting-STAIR open pilot study

BACKGROUND

Despite a large body of evidence linking the impact of trauma, parenting, and child maltreatment recidivism, current child welfare services often do not target maternal trauma and post-traumatic stress disorder (PTSD). Moreover, there is little evidence that traditional family preservation services (FPS) lower the rates of repeat incidences of child abuse and neglect. The novel intervention, Parenting-STAIR (P-STAIR), seeks to address maternal mental health and parenting skills in order to reduce punitive parenting behaviors.

OBJECTIVE

This study analyzes the effects of P-STAIR on child maltreatment risk.

PARTICIPANTS AND SETTING

P-STAIR was administered to 112 child welfare-involved mothers in New York City (NYC). The mothers were between 18 and 52 years old (M = 31.1, SD = 6.6) and were referred from 4 child welfare preventive service agencies in NYC.

METHODS

To evaluate change over time in indicators of maltreatment risk, two-tailed paired sample t-tests compared 1) pre- and post-treatment scores and 2) pre-treatment and 3-month follow-up scores.

RESULTS

Among the 71 mothers who completed treatment, significant improvements from baseline to post-assessment and pre- to 3-month follow-up were observed across total scores on the CTSPC and the AAPI-2. Improvements were evident in nonviolent disciple, psychological aggression, expectations, empathy, and parent-child family roles at both the post-assessment and 3-month follow-up which are proximal outcomes of P-STAIR (CTSPC: pre-post nonviolent disciple d = 0.70; pre-post psychological aggression d = 0.34; pre-follow-up nonviolent disciple d = 0.42; pre-follow-up psychological aggression d = 0.36; AAPI-2; pre-post expectations d = 0.31; pre-post empathy d = 0.39; pre-post parent-child roles d = 0.47; pre-follow-up expectations d = 0.33; pre-follow-up empathy d = 0.42; pre-follow-up parent-child roles d = 0.66).

CONCLUSIONS

The improvement in indicators of maltreatment risk demonstrates promising support for the utility of P-STAIR within the child welfare system.

Parenting Among Women in Methadone Treatment: Contributions of Mental Health Problems and Violence Exposure

The aim of the current study is to explore factors associated with quality of parenting among women in treatment for opioid use disorders. 150 Black American women with 3-5 year old children were recruited through methadone treatment programs. Parenting representations were assessed through the Working Model of the Child Interview and parenting behavior through video recordings of mother-child interaction. Interviews were used to assess mothers' history of violence exposure and to make DSM diagnoses. Mothers' mood disorder was related to distorted representations and to expressions of concerned affect (anxiety, fear, guilt). Mothers' personality disorder was related to expressions of negative affect (anger and frustration) and inversely related to sensitive parenting behavior. Mothers' experience of family violence during childhood and partner violence during adulthood were related to concerned affect in their representations. Women in treatment for substance use disorder have complex and interconnected needs, including parenting supports and trauma-informed mental health services.

Contextual factors of child behavioral health across developmental stages

This study examines the relative influence of environmental contexts (family, school, neighborhood) on child behavioral health at ages 3, 5, 9, and 15 years. Path analysis was conducted on a sample of 4,898 urban children from a longitudinal dataset called the Fragile Families and Child Wellbeing Study. Child physical abuse, emotional abuse, maternal depression, substance use, neighborhood social cohesion, neighborhood poverty, school connectedness, and peer bullying had concurrent relationships with child behavior problems at one or more developmental stages. Early childhood abuse (age 3) and school age environmental contexts (age 9) had lasting effects on later behavior problems. Findings underscore the importance of both multilevel contextual factors and developmental timing in determining behavioral health outcomes in children.

Self-Regulation and Rumination as a Transdiagnostic Factors for Internalizing and Externalizing Disorders Among Adolescents

OBJECTIVE

Internalizing and externalizing disorders are developmentally complex entities with multifactorial pathogenesis. The findings from recent research on the transdiagnostic responsibility of self-regulation and rumination suggest that their deficits underlie all psychiatric disorders in adults, and yet only a small number of studies have been conducted on the population of adolescents.

METHOD

The clinical study included 162 adolescents, divided into two clinical groups, treated in the Department of Child and Adolescent Psychiatry in Hospital. The first clinical group consisted of 91 adolescents with internalizing mental disorders, with the second clinical group consisting of 71 adolescents with externalizing mental disorders. They had been referred for psychodiagnostic assessment after their first psychiatric examination, and were diagnosed according to the International Classification of Diseases (ICD-)10 criteria, the diagnoses confirmed through structured clinical interviews. They additionally met the inclusion and exclusion criteria for participating in this study.

RESULTS

The results suggest that self-regulation significantly and negatively predicted symptoms of mental disorder in both clinical groups, and rumination significantly predicted symptoms of anxiety and depression in the group of adolescents suffering from internalizing disorders.

CONCLUSIONS

The findings emphasize the importance of maladaptive self-regulation as a transdiagnostic factor underlying various forms of psychopathology in adolescents, and the importance of rumination as a unique transdiagnostic process related to different disorders in the internalizing dimension.

Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.

The Occurrence and Co-Occurrence of Harsh Parenting and Family Conflict in Hong Kong

The violation of children's right to a safe home environment is a major public health problem in need of serious attention. Evidence has been limited about the family characteristics that go with the co-occurrence of harsh parenting and family conflict. By using a representative community sample of Hong Kong families, this study aims to examine the prevalence and risk factors of harsh parenting and family conflict. This study was conducted using a secondary analysis obtained from the 2017 Hong Kong Family Survey with a sample size of 1926 respondents who have children. Results showed that participants' ages are negatively related to the occurrence and co-occurrence of harsh parenting and/or family conflict. Married mothers reported less family conflict. Fathers with lower education levels reported more experiences of family violence. Mothers reporting a higher level of family satisfaction were less associated with harsh parenting. This study provides insights into the unique and shared familial elements that prevent harsh parenting and family conflict and help facilitate the development of effective intervention strategies for family violence co-occurrence. Family-based prevention for family violence may screen for the presence of harsh parenting and family conflict and take into consideration these signals to better support families in need.

Parenting experiences of Chinese mothers living with a mental illness

BACKGROUND

Although the experiences of mothers with mental illness are well researched in Western countries, little is known about the experiences of Chinese mothers. This study aims to explore the experiences of family life and parenting of Chinese mothers, in the context of their mental illness.

METHODS

Fourteen Chinese mothers with mental illness undertook in-depth, semi-structured interviews. Interpretative Phenomenological Analysis was employed to guide the data analysis.

RESULTS

Seven themes were identified: motherhood as a central identity, the stigma associated with being a mother with mental illness, participants' perceptions about the impact of mental illness on parenting and their children, experiences of talking to children about mental illness, how having children impacts mothers' illness and recovery, and support obtained and needed. Similar to Western mothers, Chinese mothers experienced stigma and fluctuating mental illness symptoms which impacted on parenting. Unlike mothers based in Western countries, the mothers interviewed in this study highlighted complicated co-caring relationships with parents-in-law and did not raise child custody concerns.

CONCLUSIONS

Mental health professionals need to have the skills to identify and recognize the mothering role of their clients. Culturally sensitive interventions are required to assist Chinese families where mothers have a mental illness. Future research is required to investigate family experiences of parental mental illness from the perspectives of children, partners, and mental health professionals.

Psychiatric comorbidity and treatment outcomes in patients with opioid use disorder: Results from a multisite trial of buprenorphine-naloxone and methadone

BACKGROUND

Individuals treated for opioid use disorder (OUD) have high rates of psychiatric disorders potentially diminishing treatment outcomes. We examined long-term treatment experiences and outcomes by type of psychiatric disorder among participants who participated in the Starting Treatment with Agonist Replacement Therapies (START) study and its follow-up study.

METHODS

We categorized the 593 participants who completed the Mini-International Neuropsychiatric Interview (MINI) during the START follow-up study into four mutually exclusive groups to indicate current psychiatric diagnosis: 1) bipolar disorder (BPD; n = 51), 2) major depressive disorder (MDD; n = 85), 3) anxiety disorder (AXD; n = 121), and 4) no comorbid mental disorder (NMD; n = 336). We compared participants' baseline characteristics and treatment outcomes.

RESULTS

Groups with mental disorders had worse substance use outcomes and poorer psychosocial functioning than the NMD group. Participants with BPD had significantly more self-reported days using opioids (Mean: 8.6 for BPD vs. 3.4 days for NMD, p < 0.01) and heroin (Mean: 6.4 for BPD vs. 2.0 for MDD, 3.1 days for NMD, p < 0.05) in the 30 days prior to the final interview. Compared to patients without mental disorders, patients with MDD spent more time engaged with OUD pharmacotherapy during the ∼16-month period between MINI and final interview (mean: 71.6 % vs. 50.6 %; p < 0.001).

CONCLUSIONS

Our results show that treatment outcomes in individuals with OUD vary by psychiatric comorbidity groups, which supports the need for mental health assessment and treatment for psychiatric conditions in the context of pharmacotherapy for patients with OUD.

Mothering in the Context of Mental Disorder: Effect of Caregiving Load on Maternal Health in a Predominantly Hispanic Sample

BACKGROUND

Mothering in the context of mental disorders presents with multiple challenges. However, this phenomenon is poorly understood: It is not known how child caregiving affects the health of their mothers.

AIMS

The purpose of this study was to examine associations between child caregiving load and health indicators in mothers receiving outpatient behavioral health services for mental or substance use disorders.

METHOD

A total of 172 mothers (80% Hispanic/Latina) completed surveys on their mental and physical health, and children's behaviors and medical problems. Child caregiving load consisted of number of children living with the mother, and presence of children's internalizing, externalizing, or medical problems.

RESULTS

Child caregiving load had significantly positive associations with mother's psychological distress, fatigue, pain, and body mass index. Child internalizing and medical problems were associated with mothers' poor health status.

CONCLUSIONS

Hispanics/Latinos experience health disparities, and Hispanic/Latina mothers who are already at risk due to their mental disorders experience an additional health burden associated with caring for children with emotional or health problems. Psychiatric and mental health nurse practitioners should assess child caregiving impact on mothers with mental disorders and seek to mitigate their caregiving burden and maintain their health. Further research is needed to clarify child characteristics and the mechanisms associated with maternal caregiver burden, suboptimal self-care, and adverse health outcomes. Structural Ecosystems Therapy for women in Recovery (SET-R) study/Healthy Home; Clinical Trial ID NCT02702193.

Effects of Morphine and Maternal Care on Behaviors and Protein Expression of Male Offspring

Genes and environment interact during development to alter gene expression and behavior. Parental morphine exposure before conception has devastating effects on the offspring. In the present study, we evaluated the role of maternal care in the intergenerational effect of maternal morphine exposure. Female rats received morphine or saline for ten days and were drugfree for another ten days. Thereafter, they were allowed to mate with drug-naïve male rats. When pups were born, they were cross-fostered to assess the contribution of maternal care versus morphine effects on the offspring. Adult male offspring were examined for anxiety-like behavior, spatial memory, and obsessive-compulsive-like behavior. To determine the mechanisms underlying the observed behavioral changes, protein levels of acetylated histone H3, BDNF, Trk-B, NMDA subunits, p-CREB, and 5-HT₃R were measured in the brain. Our results indicate that maternal caregiving is impaired in morphine-abstinent mothers. Interestingly, maternal care behaviors were also affected in drug-naïve mothers that raised offspring of morphine-exposed mothers. In addition, the offspring of morphine abstinent and non-drug dependent mothers, when raised by morphine abstinent mothers, exhibited more anxiety, obsessive-compulsive behaviors and impaired spatial memory. These altered behaviors were associated with alterations in the levels of the above-mentioned proteins. These data illustrate the intergenerational effects of maternal morphine exposure on offspring behaviors. Moreover, exposure to morphine before gestation not only affects maternal care and offspring behavior, but also has negative consequences on behaviors and protein expression in adoptive mothers of affected offspring.

Prenatal programming of depression: cumulative risk or mismatch in the Ontario Child Health Study?

Consistent with cumulative risk hypotheses of psychopathology, studies examining prenatal adversity and later mental health largely suggest that pre and postnatal stress exposures have summative effects. Fewer data support that a mismatch in stress levels between pre- and postnatal life increases risk (the mismatch hypothesis). In this retrospective cohort study using data from the 1983 Ontario Child Health Study (OCHS), we examined interactions between birth weight status and childhood/adolescent stress to predict major depression in adulthood. Ninety-five participants born at low birth weight (LBW; <2500 g) and 972 normal birth weight (NBW) control participants completed the Composite International Diagnostic Interview Short-Form Major Depression module at 21-34 years of age. A youth risk scale consisting of five stressful exposures (family dysfunction, socioeconomic disadvantage, parental criminality, maternal mental illness, exposure to other life stresses) indexed child/adolescent adversity. Birth weight groups did not differ by childhood risk score nor depression levels. A significant interaction was observed between birth weight and the youth risk scale whereby exposure to increasing levels of exposure to childhood/adolescent adversity predicted increased levels of depression in the NBW group, but lower rates in those born at LBW. Consistent with the mismatch hypothesis, data from a large, longitudinally followed cohort suggest that the mental health of adults born LBW may be more resilient to the adverse effects of childhood/adolescent stress. Taken in the context of previous studies of low birth weight infants, these findings suggest that the nature of associations between gestational stress and later mental health may depend on the magnitude of prenatal stress exposure, as well as the degree of resilience and/or plasticity conferred by their early-life environment.

Genetic and environmental contributions to psychopathological symptoms in adulthood: Clarifying the role of individual and parental risk factors

Psychopathology-related suicide attempts and deaths are increasing, and the research focus remains on mental disorder in childhood and adolescence. We examined the genetic and environmental contributions to internalizing, externalizing, and general psychopathological distress to clarify the role of individual/parental risk factors for suicide in young adults. Data from 1206 young adults were obtained from a publicly available dataset from the Human Connectome Project. Heritability estimates were analyzed by twin modelling using OpenMx and data from a subsample of 402 monozygotic and dizygotic twins. The estimated prevalence of psychopathological symptoms ranged from 9 to 16%. The heritability of internalizing, externalizing, and general psychopathological distress reached significance, with estimates ranging from 22 to 46%. Shared (common) environments contributed to aggressive behavior (30 %). Determining factors for psychopathological distress (internalizing, externalizing, general) were evaluated using logistic regression analysis. Household income (<$50,000), childhood conduct problems, and maternal drug or alcohol problems were common risk factors of internalizing, externalizing, and general psychopathological distress. Marijuana dependence and maternal anxiety were additional risk factors of externalizing distress. The presence of alcohol and maternal drug or alcohol problems was linked to general psychopathological distress. The results highlight risk factors associated with psychopathological symptoms that should be considered in the early detection of high-risk groups and implementation of family-based interventions. Providing continuous care and/or follow-up in at-risk children and young adults may improve mental health and well-being.

PROTOCOL: Psychosocial, pharmacological and legal interventions for improving the psychosocial outcomes of children with substance misusing parents

This review aims to first enhance and update existing reviews by comprehensively synthesising the full array of psychosocial, pharmacological and legal interventions that aim to improve the psychosocial outcomes of children with substance misusing parents. Second, the review aims to use network meta-analysis to integrate and examine the comparative impact of these interventions. Specifically, the review will address the following research questions: (1) What is the comparative impact of psychosocial, pharmacological, and legal interventions for improving the psychosocial outcomes of children with substance misusing parents? (2) Does the impact of interventions vary according to the child developmental period (e.g., infancy, early childhood, adolescence) or the type of (a) outcome measure; (b) substance misuse; (c) practitioner implementing the intervention; or (d) intervention setting? (3) Does the impact of interventions vary by the country of implementation?

Effect of the Attachment and Child Health Parent Training Program on Parent-Child Interaction Quality and Child Development

BACKGROUND

Exposure to chronic stressors (poverty, addiction, family violence) in early life can derail children's development. Interventions focused on parental reflective function may promote parents' abilities to regulate their feelings and behaviors toward their children and buffer the impact of chronic stressors on children's development by nurturing high-quality parent-child interaction.

PURPOSE

To test the effectiveness of parental reflective function-focused intervention entitled Attachment and Child Health on parent-child interaction and child development.

METHODS

We conducted two pilots with vulnerable mothers and children <36 months. Randomized controlled trial (n = 20) and quasi-experimental (n = 10) methods tested the effect of Attachment and Child Health on parent-child interaction via Parent-Child Interaction Teaching Scale (PCITS) and on child development via Ages and Stages Questionnaire (ASQ-3) and Ages and Stages Questionnaire-Social Emotional (ASQSE). We employed analysis of covariance and t-tests to examine the outcomes.

RESULTS

For randomized controlled trial, we found significant improvements in PCITS parent total, combined total, and cognitive growth fostering scores, and ASQ-3 personal-social scores post-intervention. For quasi-experimental study, we found significant improvements in PCITS combined total, sensitivity to cues, response to child's distress, and responsiveness to caregiver scores.

CONCLUSION

Incorporating Attachment and Child Health contributed to effective programming for vulnerable families with young children.

lankarani K. The relationship between maternal mental health and communication skills in children in Shiraz, Iran

OBJECTIVES

Child development is a significant issue in global public health, and maternal mental health (MMH) can have a remarkable effect on children's development of communication skills. We aimed to investigate the association between MMH and communication skills in a sample of Iranian children.

METHODS

This study was conducted in Shiraz, Iran during 2016. In total, 640 mothers who lived in Shiraz and were registered in the Fars Birth Cohort (FBC) study were invited to attend the FBC clinic with their children. A trained physician evaluated MMH using the General Health Questionnaire (GHQ). Additionally, a trained nurse assessed the children's communication development status using the Ages and Stages Questionnaire for 60-month old children.

RESULTS

The majority of the mothers were homemakers (82.8%) and had high school diplomas (38.9%). The mothers' mean age was 33.7±4.6 years. Seventy-nine (12.3%) children had delayed communication skills, but no significant association was found between children's communication skills and the mothers' total GHQ score (p=0.43). In total, 493 mothers (77.0%) had abnormal somatic symptoms, 497 (77.7%) had abnormal anxiety/insomnia, 337 (52.7%) had social dysfunction, and 232 (36.3%) suffered from depression. Logistic regression indicated that after adjusting for confounders, the odds of delayed communication skills were 3-fold higher among the children of mothers with abnormal somatic symptoms than among other children (p=0.01).

CONCLUSIONS

The study results confirmed that MMH had a significant impact on children's communication skills. Moreover, maternal abnormal somatic symptoms exerted the strongest impact on the development of communication skills in 5-yearold children.

Anxiety, depression, self-esteem among children of alcoholic and nonalcoholic parents

Context:

Children of alcoholics (COAs) face risks of behavioral problems during childhood and mental health problems in adult life. Identifying these problems at the earliest can significantly reduce the problems in future.

Aims:

To compare the anxiety, depression, and self-esteem between COA and non-COA parents.

Settings and Design:

A cross-sectional comparative survey research design was adopted for the present study. The study was conducted at selected government high school located in Bangalore urban.

Subjects and Methods:

The simple random sampling technique was used. A total of 200 children comprising 100 children of each alcoholic parents and nonalcoholic were recruited for the study. A screening test (modified) was used for identifying COA. Spence Children's Anxiety Scale, Center for Epidemiological Studies Depression Scale for Children (CES-DC), and Rosenberg Self-Esteem Scale were used to assess anxiety, depression, and self-esteem, respectively.

Statistical Analysis Used:

Data were analyzed using Statistical Package for the Social Sciences software package (version 23).

Results:

The results show that there is statistically significant difference between COA and non-COA group with regard to anxiety, depression, self-esteem, separation anxiety, social phobia, obsessive compulsive problems, and physical injury.

Conclusion:

The study concludes that COAs are having higher rate of anxiety, depression, and low self-esteem compared with children of nonalcoholics.

Parenting With a Substance Abuse History: The Moderating Role of Parenting Behaviors on Obesity and Internalizing Symptoms in Adolescence

Although numerous studies have shown that child obesity is associated with internalizing symptoms, relatively few studies have examined the role of parenting behaviors on this relationship. Youth meeting obesity status may be at higher risk of psychosocial maladjustment when exposed to more vulnerable parenting contexts. The current study interviewed mothers with a history of substance abuse to assess whether parenting behaviors moderated the relationship between obesity and internalizing symptoms among adolescents (N = 160; 51% girls; M = 12.76 years). Hierarchical regression analyses identified physical discipline as a moderator; girls meeting obesity status displayed higher levels of internalizing symptoms when exposed to higher versus lower levels of physical discipline. Prevention/intervention efforts targeting mothers with substance abuse histories should aim to not only improve physical and emotional health but also highlight the connections between physical and emotional health and the influence of parenting behaviors on associations.

The Effects of a Family Systems Intervention on Co-Occurring Internalizing and Externalizing Behaviors of Children with Substance Abusing Mothers: A Latent Transition Analysis

Children of substance abusing parents are at heightened risk to develop problem behaviors, yet little is known about the co-occurring patterns of internalizing and externalizing behaviors among this population. With 183 children (M age = 11.54 years, SD = 2.55, range 8-16) whose mothers were diagnosed with a substance use disorder, the current study identified subgroups/classes of children that were clinically distinct in their co-occurring patterns of internalizing and externalizing behaviors, and examined how children in different clinical subgroups responded to a family systems intervention. Latent class analyses identified four classes of internalizing and externalizing behaviors: internalizing only, externalizing only, comorbid, and normative. Latent transition analyses showed that participation in family systems therapy resulted in an increased likelihood of transitioning from the externalizing class at baseline to the normative class at 18 months post-baseline, and from the comorbid class at baseline to the internalizing class at 18 months post-baseline as well. The findings support the effectiveness of family systems therapy in interrupting the stability of children's problem behaviors and improving children's behavioral outcomes.

Family Experiences and Sexual Victimization Histories: A Comparative Analysis Between Youth Sexual and Nonsexual Offenders

Youth who commit sexual offenses often have sexual victimization histories that occur in the family context. These victimization experiences can be exacerbated by other risks present in the family environment. This research study uses MANOVAs to explore how family environments including substance use, mental health, physical and emotional victimization experiences, attachment, and parenting styles differentiate subgroups of youth offenders including youth sexual offenders with ( n = 179) and without ( n = 176) sexual victimization histories, and nonsexual offenders without sexual victimization histories ( n = 150). Results reveal that youth sexual offenders with sexual victimization histories had greater risks in family environments relative to youth sexual and nonsexual offenders without sexual victimization histories. Treatment and research implications are discussed.

Emotional Availability, Neuropsychological Functioning, and Psychopathology: The Context of Parental Substance Use Disorder

Parental Substance Use Disorder (SUD) constitutes a high-risk condition for parent-child interactions and child development. Empirical evidence indicates high rates of psychopathology and neuropsychological impairments in individuals with SUD. Despite research indicating that parenting skills are related to psychological well-being and cognitive/neuropsychological functioning, prior studies have not examined the associations between these areas of parental functioning and the quality of parent-child interactions in the context of SUD. Aim(s). The present study adopts an integrated perspective to investigate the way in which maternal neuropsychological functioning and psychopathology are associated with mother-child emotional availability (EA), in the context of parental Substance Use Disorder. Methods. Twenty-nine mothers with SUD were assessed in interaction with their children, as well as with respect to their neuropsychological functioning and psychopathology. Results. In this group, high rates of maternal neuropsychological impairments and psychopathology, as well as generally low levels of EA, were uncovered. Regression analyses showed that maternal neuropsychological functioning was significantly associated with mother-child EA, specifically sensitivity; the role of maternal psychopathology, however, was only marginally significant. Conclusion. In the context of SUD, maternal neuropsychological impairments are significantly associated with mother-child EA. Clinical implications of the findings are discussed.

Parent-dependent stressors and the onset of anxiety disorders in children: links with parental psychopathology

Exposure to stressors is associated with an increased risk for child anxiety. Investigating the family origins of stressors may provide promising avenues for identifying and intervening with children at risk for the onset of anxiety disorders and their families. The aim of this study was to compare the frequency of parent-dependent negative life events and chronic adversities experienced by children with an anxiety disorder (n = 34) in the 12 months prior to the onset of the child's most recent episode, compared to healthy controls (n = 34). Life events and chronic adversities were assessed using maternal report during an investigator-based interview, which provided independent panel ratings of the extent that reported experiences were related to parent behaviour. There were no group differences in the number of parent-dependent negative life events for anxious children compared to controls. However, significantly more parent-dependent chronic adversities were present for anxious children compared to controls. Findings suggest that parents contribute to an increased frequency of chronic adversities but not negative life events prior to their child's most recent onset of anxiety. Furthermore, increased child exposure to parent-dependent chronic adversities was related to parental history of mental disorder.

Gender-specific linkages of parents' childhood physical abuse and neglect with children's problem behaviour: evidence from Japan

Background

Childhood abuse has far-reaching effects, not only for survivors of maltreatment but also for subsequent generations. However, the mechanism of such intergenerational linkages has not been fully explored. This study investigated this linkage with special reference to its gender-specific features.

Methods

A dataset of parents and their children, obtained from a cross-sectional survey in the Tokyo metropolitan area of Japan, was used. The study sample consisted of 1750 children aged between 2 and 18 years (865 daughters and 885 sons) and their parents (1003 mothers and fathers). Regression models were estimated to assess the associations among 1) both parents’ childhood physical abuse and neglect (childhood abuse), 2) parents’ psychological distress, as measured by the Kessler Psychological Distress Scale (K6), and 3) children’s problem behaviour, as measured by the clinical scales of the Child Behavior Checklist.

Results

Daughters’ problem behaviour was more closely associated with mothers’ than fathers’ childhood abuse, whereas sons’ problem behaviour was more closely associated with their fathers’ experience. The impact of mothers’ childhood abuse on daughters’ problem behaviour was mediated at a rate of around 40 % by both parents’ psychological distress. The proportion of the effect mediated by parents’ psychological distress was less than 20 % for the impact of fathers’ childhood abuse on sons’ problem behaviour.

Conclusion

The intergenerational impact of parental childhood abuse on children’s problem behaviour is gender specific, i.e. largely characterized by the same gender linkages. Further studies that explore the mechanisms involved in the intergenerational impact of childhood abuse are needed.

Immediate Needs and Concerns among Pregnant Women During and after Typhoon Haiyan (Yolanda)

Introduction: Pregnant and postpartum women are especially vulnerable to natural disasters. These women suffer from increased risk of physical and mental issues including pregnant related problems. Typhoon Haiyan (Yolanda), which hit the Philippines affected a large number of people and caused devastating damages. During and after the typhoon, pregnant women were forced to live in particularly difficult circumstances. The purpose of this study was to determine concerns and problems regarding public health needs and coping mechanisms among pregnant women during and shortly after the typhoon.

Methods: This study employed a cross-sectional design utilizing focus group discussions (FGDs). Participants were 53 women (mean age: 26.6 years old; 42 had children) from four affected communities who were pregnant at the time of the typhoon. FGDs were conducted 4 months after the typhoon, from March 19 to 28, 2014, using semi-structured interviews. Data were analyzed using the qualitative content analysis.

Result: Three themes were identified regarding problems and concerns during and after the typhoon: 1) having no ideas what is going to happen during the evacuation, 2) lacking essentials to survive, and 3) being unsure of how to deal with health concerns. Two themes were identified as means of solving issues: 1) finding food for survival and 2) avoiding diseases to save my family. As the pregnant women already had several typhoon experiences without any major problems, they underestimated the catastrophic nature of this typhoon. During the typhoon, the women could not ensure their safety and did not have a strong sense of crisis management. They suffered from hunger, food shortage, and poor sanitation. Moreover, though the women had fear and anxiety regarding their pregnancy, they had no way to resolve these concerns. Pregnant women and their families also suffered from common health problems for which they would usually seek medical services. Under such conditions, the pregnant woman cooperated with others for survival and used their knowledge of disease prevention.

Discussion: Pregnant women experienced difficulties with evacuation, a lack of minimum survival needs, and attending to their own health issues. Pregnant women were also concerned about needs and health issues of their families, particular, when they had small children. Collecting accurate information regarding the disaster and conducting self-sustainable preparation prior to the disaster among pregnant women will help them to protect their pregnancy status, thereby improving their families’ chance of survival during and after disasters.

Substance Use and Associated Health Conditions throughout the Lifespan

A life stage perspective is necessary for development of age-appropriate strategies to address substance use disorders (SUDs) and related health conditions in order to produce better overall health and well-being. The current review evaluated the literature across three major life stages: adolescence, adulthood, and older adulthood.

FINDINGS

1) Substance use is often initiated in adolescence, but it is during adulthood that prevalence rates for SUDs peak; and while substance involvement is less common among older adults, the risk for health complications associated with use increases. 2) Alcohol, tobacco, marijuana, and, increasingly, prescription medications, are the most commonly misused substances across age groups; however, the use pattern of these and other drugs and the salient impact vary depending on life stage. 3) In terms of health outcomes, all ages are at risk for overdose, accidental injury, and attempted suicide. Adolescents are more likely to be in vehicular accidents while older adults are at greater risk for damaging falls. Adulthood has the highest rates of associated medical conditions (e.g., cancer, sexually transmitted disease, heart disease) and mental health conditions (e.g., bipolar disorder, anxiety disorders, antisocial personality disorder).

CONCLUSION

Prolonged heavy use of drugs and/or alcohol results in an array of serious health conditions. Addressing SUDs from a life stage perspective with assessment and treatment approaches incorporating co-occurring disorders are necessary to successfully impact overall health.