Syndromes of Self-Reported Psychopathology for Ages 18-59 in 29 Societies

Sex-specific associations between co-exposure to multiple metals and externalizing symptoms in adolescence and young adulthood

Externalizing disorders, such as attention-deficit/hyperactivity disorder (ADHD), account for the majority of the child/adolescent referrals to mental health services and increase risk for later-life psychopathology. Although the expression of externalizing disorders is more common among males, few studies have addressed how sex modifies associations between metal exposure and adolescent externalizing symptoms. This study aimed to examine sex-specific associations between co-exposure to multiple metals and externalizing symptoms in adolescence and young adulthood. Among 150 adolescents and young adults (55% female, ages: 15-25 years) enrolled in the Public Health Impact of Metals Exposure (PHIME) study in Brescia, Italy, we measured five metals (manganese (Mn), lead (Pb), copper (Cu), chromium (Cr), nickel (Ni)) in four biological matrices (blood, urine, hair, and saliva). Externalizing symptoms were assessed using the Achenbach System of Empirically Based Assessment (ASEBA) Youth Self-Report (YSR) or Adult Self Report (ASR). Using generalized weighted quantile sum (WQS) regression, we investigated the moderating effect of sex (i.e., assigned at birth) on associations between the joint effect of exposure to the metal mixture and externalizing symptoms, adjusting for age and socioeconomic status. We observed that metal mixture exposure was differentially associated with aggressive behavior in males compared to females (β = -0.058, 95% CI [-0.126, -0.009]). In males, exposure was significantly associated with more externalizing problems, and aggressive and intrusive behaviors, driven by Pb, Cu and Cr. In females, exposure was not significantly associated with any externalizing symptoms. These findings suggest that the effect of metal exposure on externalizing symptoms differs in magnitude between the sexes, with males being more vulnerable to increased externalizing symptoms following metal exposure. Furthermore, our findings support the hypothesis that sex-specific vulnerabilities to mixed metal exposure during adolescence/young adulthood may play a role in sex disparities observed in mental health disorders, particularly those characterized by externalizing symptoms.

A Pilot Randomized Controlled Trial of the Family Assessment and Feedback Intervention (FAFI): Effects on Mental Health Literacy and Attitudinal Engagement with Health Supports and Services

This randomized controlled trial tested the Family Assessment and Feedback Intervention (FAFI), a new intervention to enhance family engagement with emotional and behavioral health services. The FAFI is a guided conversation with families about results of their multidimensional assessment that is set in the context of motivational enhancement. It differs from other assessment-with-feedback interventions by extending the focus of assessment beyond the target child to parents and the family environment, addressing parental emotional and behavioral problems and competencies, spanning a broad range of children's and parents' strengths and difficulties, and being generalizable to many settings and practitioners. Participants were 81 families in primary care pediatrics. The FAFI was associated with a significant increase in parental mental health literacy and with an increase in parental attitudinal engagement with health supports and services that closely approached statistical significance (p = .052), while controlling for children's age and gender and family socioeconomic status.

Psychosocial resources and psychopathology among persons with neuromuscular disorders during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic substantially affected the lives of persons with inherited neuromuscular disorders (INMD), causing disruption in clinical and support services. While several studies have investigated mental health, distress and psychosocial resources in the general population during the pandemic, little is known about the experience of persons with INMD.

METHODS

This study was aimed to fill this gap by jointly investigating both psychopathological symptoms and psychosocial resources - specifically, resilience and perceived social support - among persons with INMD during the pandemic, taking into account demographic and clinical factors. Between April and December 2020, 59 participants with INMD (aged 15-59, 71.2% M) completed a questionnaire collecting demographic and clinical data, the Multidimensional Scale of Perceived Social Support, the Resilience Scale for Adults, and the Achenbach System of Empirically Based Assessment.

RESULTS

Overall, participants showed good levels of resilience and perceived social support. A minority of participants reported clinically relevant psychopathological symptoms, 28.81% for anxiety and depression. Most psychopathological symptoms were negatively correlated with resilience (-0.347 < r < - .420), but not significantly associated with social support. Consistent with previous studies, regression analyses highlighted that participants with Duchenne muscular dystrophy were more prone to report anxious and depressive symptoms (B = 1.748, p = .028, OR = 5.744), and participants with myotonic dystrophy, attention problems (B = 2.339, p = .006, OR = 10.376). Resilience emerged as a potential predictor of lower anxious-depressive symptoms (B=-1.264, p = .012, OR = 0.283).

CONCLUSIONS

The findings suggest the importance to investigate psychosocial resources in addition to psychopathology among persons with INMD, and to design interventions supporting resilience as a protective factor for mental health promotion.

Effectiveness of psychodynamic treatment: Comparing trajectories of internalizing and externalizing psychopathology of adolescents in treatment, healthy and physically ill adolescents

Effectiveness of psychodynamic therapy for adolescents in reducing internalizing and externalizing psychopathology was determined by comparing treated adolescents (86 sessions) with the normative developmental progression in two groups without treatment: healthy and diabetic adolescents. In a three-wave longitudinal study, n = 531 adolescents (n = 303 patients, n = 119 healthy, n = 109 diabetics) and their mothers filled out psychopathology questionnaires (Youth Self-Report and Child Behavior Checklist). Latent growth curve modeling and multilevel modeling were used to analyze and compare within-person symptoms changes across groups. Analyses showed a significant reduction over the course of treatment for internalizing (Cohen's d = .90-.92) and externalizing (d = .58-.72) symptoms, also when the developmental progression of both control groups was accounted for (d = .48-.76). Mothers reported lower levels than their children in internalizing symptoms (p ≤ .01) while this discrepancy increased over time for treated adolescents (p = .02). Results established the effectiveness of psychodynamic treatment for adolescents both with externalizing and internalizing symptoms in comparison with growth and change in nonclinical samples. Cross-informant differences and age-specific trajectories require attention in psychotherapy treatment and research.

Psychometric Properties of the MMPI-3 in a Sample of Black and White American Undergraduate Students: Examining Group Differences and Convergent/Discriminant Validity with the ASEBA Adult Self-Report

The current study examined MMPI-3 internal and external psychometric properties with a focus on the impact of racialized group membership (Black and White Americans). The second aim was to examine convergent/discriminant MMPI-3 scale associations with a different broadband, hierarchical self-report assessment tool [Adult Self-Report (ASR)]. Consistent with findings on prior MMPI iterations, we expected to observe no clinically meaningful mean differences on MMPI-3 scale T-scores. We hypothesized that validity coefficients between MMPI-3 and ASR scales measuring similar constructs would be stronger (convergent validity) and the inverse for scales measuring disparate constructs (discriminant validity). We also expected coefficient magnitude consistency across racial groups. The final sample was composed of 254 undergraduates (74.4% female; 63.8% White, 36.2% Black). Results suggest 1) MMPI-3 substantive scale mean T-scores are comparable between White and Black American undergraduates; 2) MMPI-3 scales correlate with ASR scale scores in expected ways with regard to internalizing problems, rule breaking and impulsivity, thought problems, and substance use (but not overall externalizing, aggression, attention problems, and intrusiveness); and 3) convergent and discriminant associations between MMPI-3 and ASR scales are consistent across White and Black Americans. This work provides support for MMPI-3 use with racially diverse individuals, considers next steps for understanding MMPI-3 scale score functioning in diverse populations, and provides novel information on MMPI-3 correspondence with the ASR.

Cultural contributions to adults' self-rated mental health problems and strengths: 7 culture clusters, 28 societies, 16 906 adults

BACKGROUND

It is unknown how much variation in adult mental health problems is associated with differences between societal/cultural groups, over and above differences between individuals.

METHODS

To test these relative contributions, a consortium of indigenous researchers collected Adult Self-Report (ASR) ratings from 16 906 18- to 59-year-olds in 28 societies that represented seven culture clusters identified in the Global Leadership and Organizational Behavioral Effectiveness study (e.g. Confucian, Anglo). The ASR is scored on 17 problem scales, plus a personal strengths scale. Hierarchical linear modeling estimated variance accounted for by individual differences (including measurement error), society, and culture cluster. Multi-level analyses of covariance tested age and gender effects.

RESULTS

Across the 17 problem scales, the variance accounted for by individual differences ranged from 80.3% for DSM-oriented anxiety problems to 95.2% for DSM-oriented avoidant personality (mean = 90.7%); by society: 3.2% for DSM-oriented somatic problems to 8.0% for DSM-oriented anxiety problems (mean = 6.3%); and by culture cluster: 0.0% for DSM-oriented avoidant personality to 11.6% for DSM-oriented anxiety problems (mean = 3.0%). For strengths, individual differences accounted for 80.8% of variance, societal differences 10.5%, and cultural differences 8.7%. Age and gender had very small effects.

CONCLUSIONS

Overall, adults' self-ratings of mental health problems and strengths were associated much more with individual differences than societal/cultural differences, although this varied across scales. These findings support cross-cultural use of standardized measures to assess mental health problems, but urge caution in assessment of personal strengths.

Symptoms of depression and internalizing problems in early adulthood - associated factors from birth to adolescence

PURPOSE

Even though the mechanisms behind the development of depression and internalizing problems remains unknown, many different factors have been shown to increase the risk. Longitudinal studies enable the investigation of exposure during different developmental periods during childhood. This study aims to examine factors associated with depressive and internalizing problems at age 20 in terms of sociodemographic factors, previous mental health problems and stressful life events during childhood, adolescence, and early adulthood.

METHODS

A birth cohort of 1723 children were followed to age 20. At the 20-year follow-up, n = 731 (44%) participated. Standardized instruments were filled out at baseline and the 3-,12- and 20-year follow-ups.

RESULTS

Depressive problems at age 20 were associated with female gender, experience of interpersonal life events reported at age 20, bullying victimization and reports on paternal mental health problems. Participants with depressive problems were also less likely to have experienced adolescence as happy and to report that their father had been a good father. Internalizing problems at age 20 were, in addition, associated with internalizing problems at age 12 and reports on maternal mental health problems. Internalizing problems were associated with a lower likelihood of experiencing adolescence as happy in the final model.

CONCLUSION

Recent events (i.e. interpersonal life events and bullying) seemed to be the most influential factors on the development of internalizing and depressive problems. Internalizing problems during childhood increased the risk for internalizing problems in early adulthood, emphasizing the importance of early intervention. Fewer factors were found to increase the risk for depressive problems compared to internalizing problems.

The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children's and Parents' Emotional and Behavioral Problems and Parents' Health-Related Quality of Life

This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3-15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.

Long-term follow-up of self-reported mental health and health-related quality of life in adults born extremely preterm

BACKGROUND

Survival of extremely preterm (EP) birth is increasing, but long-term consequences are still largely unknown as their high survival rates are recent achievements.

AIMS

To examine self-reported mental health, and health related quality of life (HRQoL) in a cohort of adults born EP in the early 1990s and individually matched term-born controls, and to describe development through the transition from teenager to adults.

METHODS

Thirty-five eligible subjects were born at gestational age ≤ 28 weeks or with birth weight ≤ 1000 g during 1991-1992 in this population-based cohort from Western Norway. We assessed mental health using Youth Self-Report (YSR) at 18 years of age, and Adult Self-Report (ASR) at 27 years, and HRQoL by RAND-36 at 27 years. Data were analysed by unadjusted and adjusted mixed effects models with time by group as interaction term.

RESULTS

At 27 years, 24 (69 %) EP-born and 26 (74 %) term-born controls participated. Scores for internalising problems, and syndrome scale anxious/depressed and withdrawn were higher among EP-born compared to term-born controls. For HRQoL, scores were similar in EP-born and term-born groups, except the domain physical functioning where EP-born scored lower. Development over time from 18 to 27 years showed increasing (i.e. deteriorating) scores for internalising, anxious/depressed, somatic complaints, and attention problems in the EP born group. For the term-born, scores for anxious/depression increased over time.

CONCLUSIONS

At 27 years of age, EP-born adults reported more internalising problems than term-born controls, while HRQoL was relatively similar except physical functioning. Mental health problems in the EP-born increased from adolescence to adulthood.

Emotional Dysregulation in Adults from 10 World Societies: An Epidemiological Latent Class Analysis of the Adult-Self-Report

Background/Objective

Method

Results

Conclusions

Adolescents' somatic complaints in eight countries: what influence do parental rearing styles have?

Medically unexplained physical symptoms are frequently named by adolescents in both clinical and normative samples. This study analyzed the associations between parental rearing styles and adolescents' body complaints in diverse cultural contexts. In a cross-cultural study of 2415 adolescents from eight countries (Argentina, France, Germany, Greece, Pakistan, Peru, Poland, and Turkey), the associations of maternal and paternal support, psychological control, and an anxious parental monitoring style with youth body complaints were tested. Girls reported more somatic complaints than boys, the level of complaints differed between countries, and gender differences varied significantly between countries. Hierarchic multilevel models revealed that the expression of distress via body complaints, after controlling for country, gender, and sociodemographic status, was significantly associated with parental rearing styles. The negative impact of mothers' psychological control on body complaints generalize across countries. In addition, mothers' anxious monitoring had a negative impact on the offspring's health, whereas higher levels of paternal support and lower levels of paternal psychological control contributed to lower levels of somatic complaints. Sociodemographic variables such as family structure, standard of living, and employment status of the parents, did not turn out as significant in the final model. The findings point to the different roles of fathers and mothers play in adolescents' health and their complex interplay.

Continuity of Genetic Risk for Aggressive Behavior Across the Life-Course

We test whether genetic influences that explain individual differences in aggression in early life also explain individual differences across the life-course. In two cohorts from The Netherlands (N = 13,471) and Australia (N = 5628), polygenic scores (PGSs) were computed based on a genome-wide meta-analysis of childhood/adolescence aggression. In a novel analytic approach, we ran a mixed effects model for each age (Netherlands: 12-70 years, Australia: 16-73 years), with observations at the focus age weighted as 1, and decaying weights for ages further away. We call this approach a 'rolling weights' model. In The Netherlands, the estimated effect of the PGS was relatively similar from age 12 to age 41, and decreased from age 41-70. In Australia, there was a peak in the effect of the PGS around age 40 years. These results are a first indication from a molecular genetics perspective that genetic influences on aggressive behavior that are expressed in childhood continue to play a role later in life.

Bottom-Up and Top-Down Paradigms for Psychopathology: A Half-Century Odyssey

Bottom-up paradigms prioritize empirical data from which to derive conceptualizations of psychopathology. These paradigms use multivariate statistics to identify syndromes of problems that tend to co-occur plus higher-order groupings such as those designated as internalizing and externalizing. Bottom-up assessment instruments obtain self-ratings and collateral ratings of behavioral, emotional, social, and thought problems and strengths for ages 1½-90+. Ratings of population samples provide norms for syndrome and higher-order scales for each gender, at different ages, rated by different informants, in relation to multicultural norms. The normed assessment instruments operationalize the empirically derived syndromes and higher-order groupings for applications to clinical services, research, and training. Because cross-informant agreement is modest and no single informant provides comprehensive assessment data, software compares ratings by different informants. Top-down paradigms prioritize conceptual representations of the nature and structure of psychopathology, as exemplified by psychodynamic, DSM/ICD, and HiTOP paradigms. Although these paradigms originated with observations, they tend to prioritize conceptual representations over empirical data.

Symptoms of anxiety/depression during the COVID-19 pandemic and associated lockdown in the community: longitudinal data from the TEMPO cohort in France

BACKGROUND

To cope with the COVID-19 pandemic, social distancing restrictions where implemented in France, which could have led to social isolation. This is expected to have affected the mental health situation, including increasing risk of symptoms of anxiety and depression in the general population. Persons with prior mental health difficulties could be an especially vulnerable group, however, few studies have tested this empirically considering preexisting mental health difficulties. We examine the association between preexisting symptoms of anxiety/depression and anxiety/depression during lockdown due to the COVID-19 pandemic in a longitudinal community sample.

METHODS

A longitudinal follow-up during lockdown (data collection March-June 2020) was implemented among participants of the TEMPO cohort. Prior knowledge of anxiety/depression was included from prior waves of data collection. Generalized estimation equations models were used to estimate the association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown among 662 mid-aged individuals.

RESULTS

Individuals with symptoms of anxiety/depression measured prior to lockdown had 6.73 higher odds [95% CI = 4.45-10.17] of symptoms of anxiety/depression during lockdown. Additionally, the likelihood of symptoms of anxiety/depression during lockdown was elevated among women (OR = 2.07 [95% CI = 1.32-3.25]), subjects with low household income (OR = 2.28 [1.29-4.01]) and persons who reported being lonely (OR = 3.94 [95% CI = 2.47-6.28]).

CONCLUSIONS

Our study underlines the role of preexisting symptoms of anxiety/depression as a vulnerability factor of anxiety/depression during lockdown. Interventions focusing on individuals with mental health difficulties as well as people feeling lonely should be considered, to reduce the psychological impact of the COVID-19 pandemic.

Impact of COVID-19-like symptoms on occurrence of anxiety/depression during lockdown among the French general population

Background

The outbreak of the COVID-19 epidemic lead to high levels of morbidity and mortality around the globe. Consequences of this outbreak and possible associated infection are an increase in mental health disorders and an increased likelihood of internalizing problems, particularly depression. However, to date few studies have tested this hypothesis while taking into account individuals’ preexisting mental health difficulties.

Methods

We used longitudinal data collected among 729 persons in the context of the French TEMPO cohort between March and June 2020 (7 waves of data collection). COVID-19-like symptoms as well as anxiety/depression (assessed by the Adult Self Report), were reported at each wave of data collection. To study the relationship between COVID-19-like symptoms and anxiety/depression, we used generalized estimation equation (GEE) models controlled for socio-demographic and health-related characteristics, including anxiety/depression prior to 2020.

Results

Overall, 27.2% of study participants reported anxiety/depression during lockdown. 17.1% of participants reported COVID-19-like symptoms during the course of follow-up, 7.3% after the beginning of lockdown, with an average number of 2.7 symptoms, and 3.6% reported respiratory distress. In multivariate analyses, nearly all the considered indicators of COVID-19-like symptoms were associated with higher odds of symptoms of anxiety/depression (symptoms Yes/No: OR = 1.66, 95% CI = 1.08–2.55; symptoms after the beginning of lockdown: OR = 1.91, 95% CI = 1.03–3.52; number of symptoms: OR for each additional symptom = 1.19, 95% CI = 1.02–1.39. This relationship exists after taking into account prior symptoms of anxiety/depression, which are associated with a 5-fold increased likelihood of psychological distress. And this impact is stronger among men than women.

Conclusions

Our study shows higher risk of anxiety/depression among persons who experienced COVID-19-like symptoms, even after accounting for prior mental health difficulties. COVID-19 infection could have both a direct and indirect impact on the occurrence of psychological difficulties, and this association should be studied in greater detail.

The Application of the Adult Self-Report and the Adult Behavior Checklist Form to Chinese Adults: Syndrome Structure, Inter-Informant Agreement, and Cultural Comparison

Given the global public health burden of mental illness, there is a critical need for culturally validated psychopathology assessment tools that perform well in diverse societies. This study examines the psychometric properties of the Adult Self-Report (ASR) and Adult Behavioral Checklist (ABCL) from the Achenbach System of Empirically Based Assessments in adults in China. Chinese adults (N = 1276) and their spouses completed the ASR and ABCL, respectively. We conducted confirmatory factor analysis on 99 ASR items and 93 ABCL items. Estimators of model fit confirmed that both measures demonstrated excellent fit (e.g., root mean square error of approximation = 0.016 and 0.018, respectively). Syndrome loadings on both measures were satisfactory but generally higher on the ASR. Neither gender nor education had significant effects, but there were informant x gender effects on most problem scales. Cross-informant agreement correlations between the ASR and ABCL were medium to large. Findings from this novel sample of Chinese adults are consistent with previous validation studies supporting the dimensionality, syndrome structure, gender differences, and inter-informant agreement of the ASR and ABCL. Our findings contribute to the cross-cultural understanding of mental health assessment and offer a psychometrically sound approach to measuring adult psychopathology in Chinese populations.

[Quality measurement in psychodynamic psychotherapy: Diagnosis-specific courses, the influence of different informants, and their view of moderators of change]

Quality measurement in psychodynamic psychotherapy: Diagnosis-specific courses, the influence of different informants, and their view of moderators of change Abstract. This study uses a naturalistic design to assess the course and effectiveness of long-term psychodynamic therapies from the perspective of adolescent patients and their mothers. It looks at the context of different moderators of change, including the characteristics of the patient, the therapist, and the therapy. Assessments of the internalizing, externalizing, and overall symptom burden using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL) were collected on 161 patients and their mothers at three timepoints - the beginning, middle, and end of therapy. The assessments of both informants showed a decrease in symptoms over the course of therapy with similar effect sizes (η² = .25 for the patients, η² = .31 for their mothers). The adolescents differentiated more between the diagnosis groups, reported higher symptom intensities at the beginning, and saw fewer changes in the second half of the therapy than their mothers. Psychodynamic long-term therapy was particularly effective for internalizing disorders according to both parents and patients. Both informants differed, however, in their evaluation of short-term therapy. An examination of the moderators of change in the mothers' evaluation (difference value of the total symptom burden between the beginning and end) showed that the therapist and therapy characteristics predicted change, whereas for adolescents, the patient characteristics have the greatest influence.

Psychometric Properties of the Adult Self-Report: Data from over 11,000 American Adults

The first purpose of this study was to examine the factor structure of the Adult Self-Report (ASR) via traditional confirmatory factor analysis (CFA) and contemporary exploratory structural equation modeling (ESEM). The second purpose was to examine the measurement invariance of the ASR subscales across age groups. We used baseline data from the Adolescent Brain Cognitive Development study. ASR data from 11,773 participants were used to conduct the CFA and ESEM analyses and data from 11,678 participants were used to conduct measurement invariance testing. Fit indices supported both the CFA and ESEM solutions, with the ESEM solution yielding better fit indices. However, several items in the ESEM solution did not sufficiently load on their intended factors and/or cross-loaded on unintended factors. Results from the measurement invariance analysis suggested that the ASR subscales are robust and fully invariant across subgroups of adults formed on the basis of age (18–35 years vs. 36–59 years). Future research should seek to both CFA and ESEM to provide a more comprehensive assessment of the ASR.

Stress in Caregivers and Children with a Developmental Disorder Who Receive Rehabilitation

This study aimed to evaluate the stress levels of caregivers and children with developmental disorders who were receiving rehabilitation treatment. The relationships between stress levels and factors such as early rehabilitation and home rehabilitation were quantified. Methods: This study was conducted in children with development disorders, aged from 1.5 years to 18 years, who were undergoing rehabilitation. The Korean version of the Child Behavior Checklist (K-CBCL) and the Adult Self-Report (K-ASR) were used to evaluate stress levels in children and caregivers, respectively. Results: Questionnaires were provided to 150 caregivers who agreed to participate. However, only 76 copies of the K-CBCL and 75 copies of the K-ASR were collected. The mean K-CBCL and K-ASR t scores were in the normal range. The K-CBCL score correlated positively with the K-ASR score (p value < 0.5). K-CBCL externalizing problems score correlated positively with the age at the start of rehabilitation, and the K-CBCL and K-ASR externalizing problems scores correlated negatively with home treatment delivered by caregivers. Conclusions: Stress levels of children and caregivers were closely related. Home rehabilitation provided by caregivers reduced stress in both caregivers and children. Early rehabilitation did not impart additional psychological burden on caregivers or children.

Relationship between parenting measures and parents and child psychopathological symptoms: a cross-sectional study

BACKGROUND

Increasing evidence suggests a complex role of family influences, such as the exposure to parent psychopathology through parenting behavior, in parent-to-child psychopathology transmission. Parenting behaviour could represent a relevant target of psychoeducative intervention. Given these premises, we aimed to evaluate homotypic and heterotypic relationships between parent and child psychopathology, mediated by parenting behaviours, taking into account the constructs of parent and offspring internalizing and externalizing psychopathology.

METHODS

Internalizing and externalizing symptoms in 272 clinically-referred subjects (mean age = 14.5 ± 2.3; F = 23.5%) and their parents (mothers n = 272, fathers n = 242) were assessed through the Child Behavior Checklist and the Adult Self Report; four areas of parenting behaviours were investigated through the Family Life Questionnaire. Multiple mediation models were built, considering mother and father psychopathology scales as independent variables, parenting measures and family functioning as mediators (Affirmation, Rules, Discipline and Special Allowances), child psychopathology scales as dependent variables and demographic variables as covariates.

RESULTS

Regression models showed a significant effect of maternal internalizing symptomatology on child externalizing behavioral problems; high levels of maternal pathology predicted high levels of children's psychopathology. A total mediating effect of parenting measures was found: high levels of internalizing symptoms in mothers predicted low levels of affirmation, which in turn predicted high levels of externalizing psychopathology in children.

CONCLUSIONS

Our study results confirmed the existence of interdependent links between mothers' psychiatric symptomatology, parenting behaviour and offspring outcomes, specifically in an Italian context. On a clinical and rehabilitation basis, this work offers suggestions about parenting practices, specifically maternal, involved in the maintenance of child psychopathology.

The generalizability of Older Adult Self-Report (OASR) syndromes of psychopathology across 20 societies

OBJECTIVES

As the world population ages, psychiatrists will increasingly need instruments for measuring constructs of psychopathology that are generalizable to diverse elders. The study tested whether syndromes of co-occurring problems derived from self-ratings of psychopathology by US elders would fit self-ratings by elders in 19 other societies.

METHODS/DESIGN

The Older Adult Self-Report (OASR) was completed by 12 826 adults who were 60 to 102 years old in 19 societies from North and South America, Asia, and Eastern, Northern, Southern, and Western Europe, plus the United States. Individual and multigroup confirmatory factor analyses (CFAs) tested the fit of the seven-syndrome OASR model, consisting of the Anxious/Depressed, Worries, Somatic Complaints, Functional Impairment, Memory/Cognition Problems, Thought Problems, and Irritable/Disinhibited syndromes.

RESULTS

In individual CFAs, the primary model fit index showed good fit for all societies, while the secondary model fit indices showed acceptable to good fit. The items loaded strongly on their respective factors, with a median item loading of .63 across 20 societies, and 98.7% of the loadings were statistically significant. In multigroup CFAs, 98% of items demonstrated approximate or full metric invariance. Fifteen percent of items demonstrated approximate or full scalar invariance, and another 59% demonstrated scalar invariance across more than half of societies.

CONCLUSIONS

The findings supported the generalizability of OASR syndromes across societies. The seven syndromes offer empirically based clinical constructs that are relevant for elders of different backgrounds. They can be used to assess diverse elders and as a taxonomic framework to facilitate communication, services, research, and training in geriatric psychiatry.

Redefining phenotypes to advance psychiatric genetics: Implications from hierarchical taxonomy of psychopathology

Genetic discovery in psychiatry and clinical psychology is hindered by suboptimal phenotypic definitions. We argue that the hierarchical, dimensional, and data-driven classification system proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium provides a more effective approach to identifying genes that underlie mental disorders, and to studying psychiatric etiology, than current diagnostic categories. Specifically, genes are expected to operate at different levels of the HiTOP hierarchy, with some highly pleiotropic genes influencing higher order psychopathology (e.g., the general factor), whereas other genes conferring more specific risk for individual spectra (e.g., internalizing), subfactors (e.g., fear disorders), or narrow symptoms (e.g., mood instability). We propose that the HiTOP model aligns well with the current understanding of the higher order genetic structure of psychopathology that has emerged from a large body of family and twin studies. We also discuss the convergence between the HiTOP model and findings from recent molecular studies of psychopathology indicating broad genetic pleiotropy, such as cross-disorder SNP-based shared genetic covariance and polygenic risk scores, and we highlight molecular genetic studies that have successfully redefined phenotypes to enhance precision and statistical power. Finally, we suggest how to integrate a HiTOP approach into future molecular genetic research, including quantitative and hierarchical assessment tools for future data-collection and recommendations concerning phenotypic analyses. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

World Health Organization life-skills training is efficacious in reducing youth self-report scores in primary school going children in Kenya

AIM

Documented evidence shows that training in life skills for school going children improves their physical and mental health status. Although Kenya has a curriculum and a policy for life-skills training in schools, these have not been implemented because lack of local evidence for efficacy. Therefore, the objective of this study was to determine the efficacy and effectiveness of the life-skill training curriculum for primary schools developed by the Ministry of Education, Kenya.

METHODS

We randomly selected 23 schools from two randomly selected sub-counties representing urban/peri-urban and rural contexts in Kenya. We collected baseline socio-demographic characteristics and administered the locally validated youth self-report (YSR) for 11 to 18 years old at baseline and 9 months post-intervention. We used the Ministry of Education validated curriculum for life-skills training for upper primary school as the intervention immediately after the baseline.

RESULTS

The World Health Organization life-skills training is efficacious in reducing YSR scores in primary school going children in Kenya. We found that socio-demographic characteristics were predictors for mental health and that there were significant positive improvements in internalizing and externalizing YSR symptoms and syndromes in both sites. The improvement was over 40% and therefore unlikely to be attributable to placebo effect or natural recovery without intervention. However, attention problems worsened more so in rural sites and particularly in girls.

CONCLUSIONS

Life-skills training is efficacious in improving mental health in school going children in the Kenyan context. However, it is not effective in attention problems which seem to be cognitive in nature.

International findings with the Achenbach System of Empirically Based Assessment (ASEBA): applications to clinical services, research, and training

The purpose of this invited article is to present multicultural norms and related international findings obtained with the Achenbach System of Empirically Based Assessment (ASEBA) by indigenous researchers in over 50 societies. The article describes ASEBA instruments for which multicultural norms are available, plus procedures for constructing the multicultural norms. It presents applications to clinical services, including use of multi-informant data for assessing children and their parents. The Multicultural Family Assessment Module (MFAM) enables mental health providers to view side-by-side bar graphs of child and parent scores on syndromes, DSM-oriented scales, Internalizing, Externalizing, and Total Problems. Evidence-based assessment of progress and outcomes is facilitated by the Progress & Outcomes App (P&O App). Research applications are outlined, including longitudinal and outcomes research. Applications to training mental health providers include having trainees study standardized multi-informant assessment data prior to interviewing children and their parents. Trainees can also sharpen their clinical skills by completing assessment forms to describe children and their parents, and then using ASEBA software to compare their ratings with ratings by children, parents, and other informants. Practical evidence-based assessment instruments with multicultural norms enable mental health providers, researchers, and trainees to perform intake, progress, and outcome assessments of children and their parents in terms of a standardized international clinical data language.

Living on the Edge: Emotional and Behavioral Problems in a Sample of Kosovar Veterans and Wives of Veterans 16 Years Postwar

Aim: This study aimed to explore the effects of war traumatic exposure on emotional and behavioral problems in a sample of Kosovar war veterans and the wives of veterans 16 years after the 1998-1999 war, as well as whether the level of education, income, well-being, and substance use are predictors for emotional and behavioral problems. Methods: Self-report data were obtained from 373 adults, 247 male war veterans (66.2% of the sample) and 126 wives of other male war veterans (33.8% of the sample). The sample was recruited from a list of war veterans provided by the Kosovar National Association of War Veterans. The mean age of participants was 45.42 [standard deviation (SD), 7.64] years. Measurements comprised a sociodemographic brief structured interview, the Well-Being Index (WHO-5), the Harvard Trauma Questionnaire, and the Adult Self Report (ASR). Logistic regression analysis was conducted to explore if the demographic variables were predictors for ASR general scales and subscales. Multivariate analysis of covariance was performed by adding as covariates the continuous variables pointed out in the logistic regression analysis as discriminating factors between the groups. Post hoc analyses were corrected, and we estimated partial η² to measure the effect size. Results: The higher traumatic exposure during the war, the greater the tendency to have emotional problems and behavioral problems for both kinds of participants. The result showed that there were no differences on the prevalence of emotional and behavioral problems between the two groups, and both veterans and wives of veterans had no differences on seeking professional help for their emotional and behavioral problems. Wives of veterans living in rural areas showed higher scores on almost all ASR scales compared with those living in urban areas or even with those of veterans from urban and rural areas. Veterans with elementary education level had the highest scores compared with other groups. Veterans with poor well-being had the highest scores compared with other groups. Using Internalizing, Externalizing, and Total Problems as outcome variables and trauma exposure, smoking, drinking alcohol, and well-being as predictors, we found that the model was a significant predictor for both male and female participants on these three scales. Conclusion: The relationship found between the level of exposure to traumatic events and emotional and behavior problems, as well as the factors that moderated such relations, in war veterans and their wives, should help global mental health researchers address the contextual dimensions of this relationship and identify better ways to prevent and treat those problems.

[Psychopathology in adolescents from seven countries: What role does controlling identity development and family relationships play?]

Psychopathology in adolescents from seven countries: What role does controlling identity development and family relationships play? Abstract. This study analyzed the unique effects of gender and culture on psychopathology in adolescents from seven countries, after controlling for factors that might have contributed to variations in psychopathology. In a sample of 2259 adolescents (M = 15 years; 54 % female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland, we assessed identity development, maternal parenting (support, psychological control, anxious rearing), and psychopathology (internalizing, externalizing). Using an analysis of covariance (ANCOVA), we analyzed country, sex, age, and the interaction country x sex as independent variables, while controlling for maternal rearing dimensions and identity development as covariates. This resulted in similar findings for internalizing and externalizing symptoms: Identity rumination and maternal rearing (support, psychological control, anxious rearing) proved to be significant covariates. Further, country, sex, age, and the interaction country x sex were significant. These analyses result in a clearer picture of culture- and gender-specific effects on psychopathology, which is helpful in designing interventions.

Empirically derived dimensional syndromes of self-reported psychopathology: Cross-cultural comparisons of Portuguese and US elders

OBJECTIVE

As the world population ages, mental health professionals increasingly need empirically supported assessment instruments for older adult psychopathology. This study tested the degree to which syndromes derived from self-ratings of psychopathology by elders in the US would fit self-ratings by elders in Portugal.

METHODS

The Older Adult Self-Report (OASR) was completed by 352 60- to 102-year-olds in Portuguese community and residential settings.

RESULTS

Confirmatory factor analyses tested the fit of the 7-syndrome OASR model to self-ratings by Portuguese elders. The primary fit index (Root Mean Square Error of Approximation) showed good fit, while secondary fit indices (the Comparative Fit Index and the Tucker-Lewis Index) showed acceptable fit. Loadings of 95 of the 97 items on their expected syndromes were statistically significant (mean = .63), indicating that the items measured the syndromes well. Correlations between latent factors, ie, between the hypothesized syndrome constructs measured by the items, averaged .66. The correlations between syndromes reflect varying degrees of comorbidity between problems comprising particular pairs of syndromes.

CONCLUSIONS

The results support the syndrome structure of the OASR for Portuguese elders, offering Portuguese clinicians and researchers a useful instrument for assessing a broad spectrum of psychopathology. The results also offer a core of empirically supported taxonomic constructs of later life psychopathology as a basis for advancing clinical practice, training, and cross-cultural research.

Multi-Informant and Multicultural Advances in Evidence-Based Assessment of Students’ Behavioral/Emotional/Social Difficulties

Abstract. This article presents practical tools for evidence-based assessment of students’ behavioral/emotional/social difficulties and strengths in culturally sensitive ways. The assessment instruments obtain teacher, parent, and student ratings, plus observations in classrooms and other group settings, in interviews, and in testing sessions. To document differences in students’ functioning in school and other contexts, plus differences between teacher, parent, and student perspectives, users can display cross-informant comparisons of ratings of specific difficulties items. Users can also display cross-informant comparisons between bar graphs of scores on empirically derived syndromes, DSM-oriented scales, Internalizing, Externalizing, and Total Problems. Scale scores are standardized according to norms for students’ gender and age, type of informant (teacher, parent, student), and multicultural norms. Multicultural norms are based on teacher, parent, and student ratings of population samples of students in many societies. The ratings were used to construct gender-, age-, and informant-specific norms for societies having relatively low difficulties scores, medium scores, or high scores. The assessment instruments can be used to identify students who need help and to tailor interventions to students’ needs. The same instruments can be used to measure changes by comparing pre- versus post-intervention scores. Brief instruments assess progress over short periods.

Psychological outcome after severe traumatic brain injury in adolescents and young adults: The chronic phase

OBJECTIVES

Young individuals surviving severe traumatic brain injury (TBI) frequently experience a wide range of cognitive, emotional and behavioural consequences. This cross-sectional follow-up study investigated psychological outcome of young survivors in the chronic phase, and whether psychological outcome was associated with improvement of functional abilities during sub-acute admission.

METHODS

Patients, who acquired a severe TBI during adolescence or early adulthood (n = 36) and received early intensive rehabilitation, were contacted for follow-up assessment concerning psychological outcome and completed the Adult Self Report 18-59 (ASR18-59). Demographic data, functional outcomes and severity measures were obtained from the local database.

RESULTS

The participants had a mean age of 24.1 years (SD = 4.1) at follow-up, and the mean time since injury was 72.1 months (SD = 44.2). Results showed significantly higher scores compared with the normative reference population in relation to the subscales withdrawal/isolation (p = 0.013), attention problems (p = 0.008) and intrusive behaviour (p = 0.046). Pearson correlation analyses showed that young survivors experiencing more functional improvement during inpatient rehabilitation had fewer psychological problems during the chronic phase in the subscales: withdrawal/isolation, rule breaking, intrusive behaviour and total problems.

CONCLUSION

Young patients reported psychological problems in several areas during the chronic phase of injury, which may hinder complete reintegration and participation in society. Larger functional improvement during sub-acute rehabilitation seemed to be associated with less psychological problems in the chronic phase.

Empirically based assessment and taxonomy of psychopathology for ages 1½-90+ years: Developmental, multi-informant, and multicultural findings

BACKGROUND

Originating in the 1960s, the Achenbach System of Empirically Based Assessment (ASEBA) comprises a family of instruments for assessing problems and strengths for ages 1½-90+ years.

PURPOSE

To provide an overview of the ASEBA, related research, and future directions for empirically based assessment and taxonomy.

CONTENT

Standardized, multi-informant ratings of transdiagnostic dimensions of behavioral, emotional, social, and thought problems are hierarchically scored on narrow-spectrum syndrome scales, broad-spectrum internalizing and externalizing scales, and a total problems (general psychopathology) scale. DSM-oriented and strengths scales are also scored. The instruments and scales have been iteratively developed from assessments of clinical and population samples of hundreds of thousands of individuals. Items, instruments, scales, and norms are tailored to different kinds of informants for ages 1½-5, 6-18, 18-59, and 60-90+ years. To take account of differences between informants' ratings, parallel instruments are completed by parents, teachers, youths, adult probands, and adult collaterals. Syndromes and Internalizing/Externalizing scales derived from factor analyses of each instrument capture variations in patterns of problems that reflect different informants' perspectives. Confirmatory factor analyses have supported the syndrome structures in dozens of societies. Software displays scale scores in relation to user-selected multicultural norms for the age and gender of the person being assessed, according to ratings by each type of informant. Multicultural norms are derived from population samples in 57 societies on every inhabited continent. Ongoing and future research includes multicultural assessment of elders; advancing transdiagnostic progress and outcomes assessment; and testing higher order structures of psychopathology.

A multimodal day treatment program for multi-problem young adults: study protocol for a randomized controlled trial

BACKGROUND

Effective interventions for young adults with severe, multiple problems - such as psychosocial and psychiatric problems, delinquency, unemployment and substance use - are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day treatment program called "New Opportunities" (in Dutch: "De Nieuwe Kans"; DNK) was specifically developed to target multi-problem young adults in The Netherlands. The aim of this study protocol is to describe the design of a randomized controlled trial (RCT) in clinical practice to examine the effectiveness of DNK in comparison with care as usual (CAU).

METHODS/DESIGN

Multi-problem young adults in Rotterdam, The Netherlands, will be assigned randomly to DNK (expected N = 150) and CAU (expected N = 150). Primary outcome measures are recidivism and self-sufficiency. Secondary outcome measures include quality of life, attending school/work, psychological functioning, cognitive distortions and substance use. Participant and program characteristics will be examined as potential moderators of effectiveness. Additionally, cost-effectiveness will be measured. During 14 months, data from multiple resources will be collected at four time points.

DISCUSSION

This study is one of the first RCTs on the effectiveness of interventions developed for multi-problem young adults. The results will contribute to the currently scant knowledge about what works for various multi-problem young adults in their transition to adulthood. In addition, the study protocol will provide insight into implementing an RCT in a dynamic setting of clinical practice.

TRIAL REGISTRATION

Dutch Trial Register, identifier: NTR5163 . Registered on 17 April 2015; retrospectively registered during the recruitment phase.

(Mal)Adaptive Psychological Functioning of Students Utilizing University Counseling Services

Background: University students confront psychological difficulties that can negatively influence their academic performance. The present study aimed to assess several areas of adaptive and maladaptive psychological functioning among university students who request counseling services.

Method: One hundred eighty-four young female students seeking professional psychological help (Counseling seekers) and 185 young female students who have never asked for psychological help (Non-counseling seekers) were asked to complete the Adult Self-Report (ASR) to evaluate both their internalizing and externalizing problems through DSM-oriented scales as well as their adaptive functioning.

Results: ANOVA results indicated worse psychological functioning for the students who sought counseling. They reported lower score in ASR Adaptive Functioning Scales (i.e., friends, jobs, family, education), and higher scores in DSM-oriented scales (i.e., Depressive, Anxiety, Somatic, Avoidant Personality, Attention Deficit/Hyperactivity symptoms) than the students who never asked psychological help. Furthermore, discriminant analysis successfully discriminated between the two groups of students on the basis of the ASR’s adaptive and DSM-oriented scales.

Conclusion: The study findings could be useful to guide university counseling services in their screening activities as well as useful for clinical practice.

Problems and Adaptive Functioning Reported by Adults in 17 Societies

This study tested for similarities and differences across societies in self-ratings of problems, personal strengths, and aspects of adaptive functioning on the Adult Self-Report (ASR) for nonclinical samples of adults ages 18 to 59 in 17 societies ( N = 10,197). Results indicated considerable consistency across societies regarding mean ratings on the ASR problem items. Most effect sizes (ESs) for societal differences in problem scales were small (2–5%). Hierarchical linear modeling (HLM) analyses indicated that culture clusters and society accounted for small percentages of variance in Internalizing, Externalizing, and Total Problems scores, with most of the variation accounted for by individual differences within societies. In contrast to the small effects of society on problem scores, for the ASR Personal Strengths scale the societal ES was 34% and culture cluster accounted for 12% of the variance. Worse reported relations with spouse/partner were associated with higher problem scores. Overall, findings indicated considerable similarity but also some important differences in self-reported problems and adaptive functioning across 17 societies.

Syndromes of collateral-reported psychopathology for ages 18-59 in 18 Societies

The purpose was to advance research and clinical methodology for assessing psychopathology by testing the international generalizability of an 8-syndrome model derived from collateral ratings of adult behavioral, emotional, social, and thought problems. Collateral informants rated 8,582 18-59-year-old residents of 18 societies on the Adult Behavior Checklist (ABCL). Confirmatory factor analyses tested the fit of the 8-syndrome model to ratings from each society. The primary model fit index (Root Mean Square Error of Approximation) showed good model fit for all societies, while secondary indices (Tucker Lewis Index, Comparative Fit Index) showed acceptable to good fit for 17 societies. Factor loadings were robust across societies and items. Of the 5,007 estimated parameters, 4 (0.08%) were outside the admissible parameter space, but 95% confidence intervals included the admissible space, indicating that the 4 deviant parameters could be due to sampling fluctuations. The findings are consistent with previous evidence for the generalizability of the 8-syndrome model in self-ratings from 29 societies, and support the 8-syndrome model for operationalizing phenotypes of adult psychopathology from multi-informant ratings in diverse societies.