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Ostadi-Sefidan H, Faroughi F, Fathnezhad-Kazemi A. Resilience and its related factors among women with breast cancer. Eur J Cancer Prev 2024; 33:129-135. [PMID: 37702615 DOI: 10.1097/cej.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Breast cancer is the most challenging disease, and the level of resilience in patients determines their ability to cope with the arising stress. There is relatively limited information on the resilience of patients in clinical settings. Our study aims were to evaluate the extent of resilience and identify factors that predict resilience in women with breast cancer. PATIENTS AND METHODS A cross-sectional study was conducted with the participation of 218 women with breast cancer who were referred to the Oncology clinic in 2022. The participants completed three scales, namely the Conner-Davidson Resilience, Schneider's Life Expectancy, and the Multidimensional Scale of Perceived Social Support, along with sociodemographic information. Descriptive statistics, bivariate, and multiple linear regression were used to explore the predictors of resilience. RESULT The mean (SD) scores for resilience, social support, and hope were 59.22 (17.25), 38.53 (6.19), and 59.37 (16.68), respectively. Based on analysis 50.8% of the variations in resilience could be explained by 6 variables including social support, hope, women's age, employment, and income status as well as the stage of illness (R 2adj = 0.508, P < 0.001). Employment status and disease stage did not show a significant relationship with resilience and social support was the factor with the highest impact on resilience (β = 0.516, P < 0.001). CONCLUSION Our study showed social support, hope, age, and income level predict significant resilience in women with breast cancer. The findings emphasize the importance of fostering strong support networks, cultivating a hopeful mindset, embracing life's transitions, and addressing financial considerations in the pursuit of enhanced resilience.
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Affiliation(s)
- Hossein Ostadi-Sefidan
- Department of Surgery, Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz
| | - Farnaz Faroughi
- Department of Midwifery, Faculty of Nursing and Midwifery, Maragheh Branch, Islamic Azad University, Maragheh
| | - Azita Fathnezhad-Kazemi
- Department of Midwifery, Women's Reproductive and Mental Health Research Center, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran
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Fares-Otero NE, O J, Spies G, Womersley JS, Gonzalez C, Ayas G, Mossie TB, Carranza-Neira J, Estrada-Lorenzo JM, Vieta E, Schalinski I, Schnyder U, Seedat S. Child maltreatment and resilience in adulthood: a protocol for a systematic review and meta-analysis. Eur J Psychotraumatol 2023; 14:2282826. [PMID: 38010898 PMCID: PMC10993816 DOI: 10.1080/20008066.2023.2282826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Although child maltreatment (CM) has been linked to health problems and poor psychosocial functioning, not all individuals exposed to CM develop or experience negative consequences later in life. This suggests that some individuals show resilience after being exposed to CM. However, conclusions have been limited by inconsistent findings across different CM subtypes and resilience domains.Objective: To develop a protocol for conducting a systematic review and meta-analysis to quantify associations between CM (overall and its subtypes) and resilience (global and its multiple domains) in adulthood, and to examine moderators and mediators of these associations.Method: PubMed, PsycINFO, Embase, Scopus, and Web of Science will be searched to identify relevant studies on the association between CM (exposure) and resilience (outcome) in adults (≥ 18 years). Data will be screened and extracted by at least two independent reviewers. The methodological quality of the included studies will be independently assessed with a modified version of the Newcastle-Ottawa Scale (NOS). If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I2 statistic, and publication bias will be assessed. The effects of potential moderators (e.g. timing and severity of CM, age, sex, family cohesion, socio-economic status, country/region) will be analysed using meta-regression and subgroup analyses, and meta-analytical structural equation modelling will be employed to synthesise indirect mediation effects. Candidate moderators and mediators (e.g. genetic factors, brain functioning, attachment style, personality traits, physical activity, and social support) will be also examined qualitatively.Conclusions: This protocol will facilitate a systematic review and meta-analysis that has the potential to enhance our knowledge about the association between CM exposure in early life and resilience in adulthood. Understanding associations and underlying mechanisms between CM and resilience is potentially important in informing prevention and interventions to sustain health and improve outcomes among adults with a history of CM.PROSPERO registration: CRD42023394120.
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Affiliation(s)
- Natalia E. Fares-Otero
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic, Institute of Neurosciences (UBNeuro), Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Barcelona, Spain
| | - Jiaqing O
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Georgina Spies
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Jacqueline S. Womersley
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Carolina Gonzalez
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Görkem Ayas
- Graduate School of Health Sciences, Koç Üniversitesi, Istanbul, Turkey
| | - Tilahun Belete Mossie
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Julia Carranza-Neira
- Faculty of Health Sciences, School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
| | | | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic, Institute of Neurosciences (UBNeuro), Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Barcelona, Spain
| | - Inga Schalinski
- Universität der Bundeswehr München, Department of Human Sciences, Munich, Germany
| | | | - Soraya Seedat
- South African PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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O'Carroll J, Ando K, Yun R, Panelli D, Nicklin A, Kennedy N, Carvalho B, Blake L, Coker J, Kaysen D, Sultan P. A systematic review of patient-reported outcome measures used in maternal postpartum anxiety. Am J Obstet Gynecol MFM 2023; 5:101076. [PMID: 37402438 DOI: 10.1016/j.ajogmf.2023.101076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and to evaluate the psychometric measurement properties of instruments for postpartum anxiety using the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines to identify the best available patient-reported outcome measure. DATA SOURCES We searched 4 databases (CINAHL, Embase, PubMed, and Web of Science in July 2022) and included studies that evaluated at least 1 psychometric measurement property of a patient-reported outcome measurement instrument. The protocol was registered with the International Prospective Register for Systematic Reviews under identifier CRD42021260004 and followed the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines for systematic reviews. STUDY ELIGIBILITY Studies eligible for inclusion were those that assessed the performance of a patient-reported outcome measure for screening for postpartum anxiety. We included studies in which the instruments were subjected to some form of psychometric property assessment in the postpartum maternal population, consisted of at least 2 questions, and were not subscales. METHODS This systematic review used the Consensus-Based Standards for the Selection of Health Measurement Instruments and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify the best patient-reported outcome measurement instrument for examining postpartum anxiety. A risk of bias assessment was performed, and a modified GRADE approach was used to assess the level of evidence with recommendations being made for the overall quality of each instrument. RESULTS A total of 28 studies evaluating 13 instruments in 10,570 patients were included. Content validity was sufficient in 9 with 5 instruments receiving a class A recommendation (recommended for use). The Postpartum Specific Anxiety Scale, Postpartum Specific Anxiety Scale Research Short Form, Postpartum Specific Anxiety Scale Research Short Form Covid, Postpartum Specific Anxiety Scale-Persian, and the State-Trait Anxiety Inventory demonstrated adequate content validity and sufficient internal consistency. Nine instruments received a recommendation of class B (further research required). No instrument received a class C recommendation (not recommended for use). CONCLUSION Five instruments received a class A recommendation, all with limitations, such as not being specific to the postpartum population, not assessing all domains, lacking generalizability, or evaluation of cross-cultural validity. There is currently no freely available instrument that assess all domains of postpartum anxiety. Future studies are needed to determine the optimum current instrument or to develop and validate a more specific measure for maternal postpartum anxiety.
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Affiliation(s)
- James O'Carroll
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan).
| | - Kazuo Ando
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan)
| | - Romy Yun
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan)
| | - Danielle Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Dr Panelli)
| | - Angela Nicklin
- Department of Anaesthesia, Royal London Hospital, Whitechapel, London, United Kingdom (Dr Nicklin)
| | - Natasha Kennedy
- Department of Anaesthesia, Whipps Cross Hospital, Leytonstone, London, United Kingdom (Dr Kennedy)
| | - Brendan Carvalho
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan)
| | - Lindsay Blake
- University of Arkansas for Medical Sciences, Little Rock, AR (Ms Blake)
| | - Jessica Coker
- Departments of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR (Dr Coker)
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences Stanford University, Stanford, CA (Dr Kaysen)
| | - Pervez Sultan
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan)
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Schulze A, Cloos L, Zdravkovic M, Lis S, Krause-Utz A. On the interplay of borderline personality features, childhood trauma severity, attachment types, and social support. Borderline Personal Disord Emot Dysregul 2022; 9:35. [PMID: 36529765 PMCID: PMC9762015 DOI: 10.1186/s40479-022-00206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACE) have consistently been associated with borderline personality disorder (BPD). Still, it is not yet entirely understood if and how different types of ACE (emotional, physical, sexual abuse, neglect) relate to different BPD subdomains (affective instability, identity disturbance, negative relationships, self-harm). Insecure attachment and lower perceived social support are associated with both ACE and BPD and may therefore contribute to their relationship. No study so far integrated all these variables in one model, while accounting for their mutual influence on each other. We investigated the interplay of BPD subdomains, ACE, attachment, and perceived social support using a graph-theoretical approach. METHODS An international sample of 1692 participants completed the Childhood Trauma Questionnaire (CTQ), the Borderline Feature Scale from the Personality Assessment Inventory (PAI-BOR), the Adult Attachment Scale (AAS), and Multidimensional Scale of Perceived Social Support (MSPSS) via an online survey. We estimated a partial correlation network including subscales of the CTQ and the PAI-BOR as nodes. We extended the network by including subscales of the AAS and MSPSS as additional nodes. RESULTS Emotional abuse was the most central node in both networks and a bridge between other types of ACE and BPD features. All domains of BPD except affective instability were associated with emotional abuse. Identity disturbances was the most central node in the BPD network. The association between ACE and BPD features was partly but not fully explained by attachment and social support. CONCLUSION Our findings suggest that emotional abuse is an important link in the association between ACE and BPD features, also when taking attachment and social support into account. Findings further suggest an outstanding role of identity disturbance, linking emotional abuse to affective instability and being strongly associated with attachment anxiety.
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Affiliation(s)
- Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
| | - Leonie Cloos
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands.,Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Monika Zdravkovic
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Stefanie Lis
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Annegret Krause-Utz
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
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Hitzler M, Behnke A, Gündel H, Ziegenhain U, Kindler H, Kolassa IT, Zimmermann J. Sources of social support for postpartum women with a history of childhood maltreatment: Consequences for perceived stress and general mental health in the first year after birth. CHILD ABUSE & NEGLECT 2022; 134:105911. [PMID: 36191542 DOI: 10.1016/j.chiabu.2022.105911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Women with a history of childhood maltreatment (CM) experience the postpartum period as particularly stressful and may benefit less from social support, implicating a higher risk for mental health problems and higher stress levels in mothers with CM. OBJECTIVE Thus, we investigated the complex relationship of CM and social support provided by different sources (intimate partner, parents, parents-in-law, friends) in predicting stress perception and mental health over the course of the first year postpartum. PARTICIPANTS In N = 295 postpartum women we assessed CM experiences, stress perception, perceived social support and general mental health 3 and 12 months postpartum. METHOD Linear mixed effect models were used to examine the course of social support over the first year postpartum and path analyses were used to investigate mediation and moderation effects. RESULTS We found that CM was linked to lower levels of perceived social support, accounted for more mental health problems, and amplified the negative association between perceived stress and maternal mental health. Most importantly, we showed that only partner support was beneficial for maternal mental health, and this association was mediated by reductions in perceived stress. CONCLUSION CM as a major risk factor for mental health impairs the stress resilience of affected postpartum women. Extending previous research, our results reveal that the source of postpartum social support determines its benefits for maternal health. Our findings emphasize the need of at-risk mothers to be provided with additional sources of support to cope with daily practical, organizational and emotional challenges.
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Affiliation(s)
- Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.
| | - Alexander Behnke
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry, Ulm University Hospital, Ulm, Germany
| | | | - Iris-Tatjana Kolassa
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Janin Zimmermann
- Department of Education and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
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Khalil D, Giurgescu C, Misra DP, Templin T, Jenuwine E. Association of maternal and paternal psychosocial stress and infant hair cortisol among Arab American immigrants: A pilot study. Dev Psychobiol 2022; 64:e22310. [PMID: 36282764 DOI: 10.1002/dev.22310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 05/14/2022] [Accepted: 06/22/2022] [Indexed: 01/27/2023]
Abstract
Acculturative stress is unique among immigrants and refers to the stress associated with maintaining cultural values and traditions in the host country. Immigrant parents confront psychosocial variables such as acculturative stress, anxiety, and depression that might result in intergenerational negative consequences on their infants. Measurement of hair cortisol concentration (HCC), an outcome of neuroendocrine dysregulation, is one relatively noninvasive approach to gauge stress in infants. No published studies have evaluated associations among parents' psychosocial variables and infants' HCC among immigrant families. Therefore, the purpose of this study was to: (1) examine the relationship between maternal and paternal psychosocial stress variables; and (2) examine the association between psychosocial variables of both parents (acculturative stress, anxiety, and depression) and infants' HCC among immigrant Arab American families. A sample of 31 immigrant Arab American triads (mother-father-infant) was recruited. During one home visit, each parent completed the study questionnaires separately when the baby was 6-24 months old and a hair sample was collected from the infant for HCC. Parents reported significant symptoms of anxiety (33% mothers; 45% fathers) and depression (33% mothers; 35.5% fathers). Paternal acculturative stress, anxiety, and depressive symptoms were significantly correlated to infants' HCC. Acculturative stress, anxiety, and depressive symptoms were significantly correlated between mother-father dyads. Future research should continue to focus on immigrant families and include both parents to better understand and improve infant health.
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Affiliation(s)
- Dalia Khalil
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Carmen, Orlando, Florida, USA
| | - Dawn P Misra
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Thomas Templin
- College of Nursing, Wayne State University, Detroit, Michigan, USA
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Brittain K, Zerbe A, Phillips TK, Gomba Y, Mellins CA, Myer L, Abrams EJ. Impact of adverse childhood experiences on women's psychosocial and HIV-related outcomes and early child development in their offspring. Glob Public Health 2022; 17:2779-2791. [PMID: 34613893 PMCID: PMC8983791 DOI: 10.1080/17441692.2021.1986735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022]
Abstract
Adverse childhood experiences (ACEs) may have a critical influence on adult outcomes and subsequent offspring development, but few data have explored the effects of ACEs in low-resource settings where the burdens of childhood adversity and HIV are high. Among mothers living with HIV in Cape Town, we examined the effects of ACEs on maternal psychosocial and HIV-related outcomes, as well as early child development in their offspring aged 36-60 months. The World Health Organization's Adverse Childhood Experiences International Questionnaire was used to measure maternal reports of ACEs, and the Ages & Stages Questionnaire to screen for developmental delays in their offspring. Among 353 women (median age: 32 years), 84% reported ≥1 ACEs. Increased report of ACEs was strongly associated with depressive symptoms, hazardous alcohol use, intimate partner violence and self-reported suboptimal adherence to antiretroviral therapy. These associations were driven by more severe childhood experiences, including abuse, neglect and exposure to collective violence. Among 255 women who reported on their child's development, maternal ACEs were associated with poorer socioemotional development. These data suggest that childhood adversity has long-term effects on maternal outcomes as well as their children's socioemotional development and point to ACEs that might be targeted for screening and intervention.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Tamsin K. Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Yolanda Gomba
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
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Masiano SP, Yu X, Tembo T, Wetzel E, Mphande M, Khama I, Mkandawire A, Chitani M, Liwimbi O, Udedi M, Mazenga A, Nyasulu P, Abrams E, Ahmed S, Kim MH. The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi. J Affect Disord 2022; 312:159-168. [PMID: 35752220 PMCID: PMC9892657 DOI: 10.1016/j.jad.2022.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/28/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi-an HIV endemic resource-limited setting. METHODS This is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association. RESULTS The mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms-even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse. LIMITATIONS Data on maternal ACEs were self-reported and could suffer from measurement error because of recall bias. CONCLUSIONS ACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.
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Affiliation(s)
- Steven P Masiano
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public Health and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Tapiwa Tembo
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elizabeth Wetzel
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Innocent Khama
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike Chitani
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Olive Liwimbi
- Ministry of Health, Zomba Mental Hospital, Zomba, Malawi
| | - Michael Udedi
- Ministry of Health, NCDs and Mental Health Unit, Lilongwe, Malawi; University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA
| | - Alick Mazenga
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Phoebe Nyasulu
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elaine Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Buchheim A, Ziegenhain U, Kindler H, Waller C, Gündel H, Karabatsiakis A, Fegert J. Identifying Risk and Resilience Factors in the Intergenerational Cycle of Maltreatment: Results From the TRANS-GEN Study Investigating the Effects of Maternal Attachment and Social Support on Child Attachment and Cardiovascular Stress Physiology. Front Hum Neurosci 2022; 16:890262. [PMID: 35923749 PMCID: PMC9341217 DOI: 10.3389/fnhum.2022.890262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning, health, and development in the next generation. A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle. This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans-disciplinary approach. Methods Mother-child dyads (N = 158) participated shortly after parturition (t 0), after 3 months (t 1), and 12 months later (t 2). Mothers' CM experiences were assessed at t 0, attachment representation at t 1 and psychosocial risk and social support were assessed at t 1 and t 2. At t 2, dyads participated in the Strange Situation Procedure (SSP). Children's attachmen status were classified as organized vs. disorganized, including their level of disorganized behavior, and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system. Maternal caregiving during SSP was assessed using the AMBIANCE scale. Child's single nucleotide polymorphisms rs2254298 within the oxytocin receptor (OXTR) and rs2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood. Results Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status, higher perceived stress and more psychological symptoms. These negative effects of CM were attenuated by social support. As expected, maternal unresolved attachment and child disorganized attachment were significantly associated. Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children's HR and RSA response and disorganized behavior. Moreover, the rs2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM. Children carrying the rs2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences. Conclusion We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk.
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Affiliation(s)
- Anna Buchheim
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | | | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nürnberg, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Alexander Karabatsiakis
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Jörg Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany
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10
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Perinatal Depression in Australian Women during the COVID-19 Pandemic: The Birth in the Time of COVID-19 (BITTOC) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095062. [PMID: 35564456 PMCID: PMC9103175 DOI: 10.3390/ijerph19095062] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic has impacted perinatal mental health globally. We determined the maternal factors and pandemic-related experiences associated with clinically significant perinatal (pregnant and post-partum) depressive symptoms in Australian women. Participants (n = 2638; pregnant n = 1219, postnatal n = 1419) completed an online survey (August 2020 through February 2021) and self-reported on depression, social support, and COVID-19 related experiences. We found elevated depressive symptoms amongst 26.5% (pregnant) and 19% (postnatal) women. Multiple logistic regression analyses showed higher likelihood of elevated depression associated with residence in Victoria, lower education, past/current mental health problems, greater non-pandemic prenatal stress, age ≥ 35 years (pregnant women) and existing physical health issues or disability in self or others (postnatal women). Greater family stress/discord and lower social support (friends) was associated with higher odds of elevated perinatal depression, while lower social support (family) was significantly associated with elevated depressive symptoms in pregnant women. Greater depression was associated with social distancing, pandemic-related news exposure and changes to prenatal care (pregnant women). Single postnatal women showed lower odds of elevated depression than partnered women. Our findings underscore the importance of universal screening for depression and targeted support during a pandemic for perinatal women displaying vulnerability factors.
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11
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Hitzler M, Bach AM, Köhler-Dauner F, Gündel H, Kolassa IT. Long-Term Consequences of Childhood Maltreatment Among Postpartum Women-Prevalence of Psychosocial Risk Factors for Child Welfare: An Independent Replication Study. Front Psychiatry 2022; 13:836077. [PMID: 35360143 PMCID: PMC8964057 DOI: 10.3389/fpsyt.2022.836077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction As an especially burdensome experience, childhood maltreatment (CM) can have lifelong consequences on the mental health and wellbeing of an individual well into adulthood. We have previously reported that CM constitutes a central risk factor not only for the development of mental problems, but also for facing additional psychosocial risks, endangering healthy development of mother and offspring throughout life (e.g., financial problems, intimate partner violence, substance use). This study was designed to replicate these findings in a larger, independent study cohort. Method In this cross-sectional replication study an independent cohort of 533 healthy postpartum women was interviewed within seven days after parturition. CM experiences were assessed retrospectively using the German version of the Childhood Trauma Questionnaire (CTQ) and current psychosocial risk factors for child welfare were assessed using the Konstanzer Index (KINDEX). Results Of all women, 16.1% experienced emotional and 10.1% physical abuse, 28.5% emotional neglect, 9.4% physical neglect and 10.3% experienced sexual abuse. Most importantly, the higher the CM load the more psychosocial stressors existed in women's life. In Particular, women with higher CM load had a higher risk for mental health problems, intimate partner violence, financial problems, and a higher postnatal stress load. Conclusions In an independent sample, this study replicated the previous findings that CM and psychosocial risk factors for child welfare were strongly associated in a dose-response manner. Our results emphasize the higher vulnerability of women with a CM history in the postpartum period. To avoid negative consequences for mother and child, a regular and evidence-based screening for CM and psychosocial risk factors during pregnancy and puerperium is needed to identify at-risk mothers early during pregnancy and to provide appropriate support. Hence, our findings highlight the mandatory requirement for an interdisciplinary collaboration of gynecological practices, hospitals and midwifes, along with psychologists and psychotherapists and child and youth welfare services.
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Affiliation(s)
- Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Alexandra M. Bach
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Franziska Köhler-Dauner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Iris-Tatjana Kolassa
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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12
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MacMillan KK, Lewis AJ, Watson SJ, Bourke D, Galbally M. Maternal social support, depression and emotional availability in early mother-infant interaction: Findings from a pregnancy cohort. J Affect Disord 2021; 292:757-765. [PMID: 34167025 DOI: 10.1016/j.jad.2021.05.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Social support theory suggests that parental social support may influence the nature of early parenting behaviours and specifically the mother-infant relationship. This study examines whether support from a partner, friends or family is associated with differences in quality of mother-infant interactions in the context of maternal depression. METHODS 210 women were followed from early pregnancy to six months postpartum within Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). Mother-infant interactions within a standardised observation at six months postpartum were measured by the Emotional Availability (EA) Scales using total scores of the parental scales. In early and late pregnancy and at six months postpartum, mothers rated perceived maternal social support from a partner, family and friends using subscales of the Multidimensional Scale of Perceived Social Support. Depression was measured in early pregnancy and at six months postpartum using the Structured Clinical Interview for the DSM-IV-TR, with repeated measurement of depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). Data was analysed using structural equation models. RESULTS There were significant interactions between depressive symptoms in early pregnancy and perceived maternal support from a partner (B = .18, 95% CI = 03, .31) and separately from family (B = .12, 95% CI = .03, .32) in predicting maternal emotional availability. No such interaction was found for support from friends. While partner and family support moderated the association between early depressive symptoms and emotional availability, there were no direct associations between maternal depressive disorder in early pregnancy and perceived support, and further, maternal depression was not a significant predictor of emotional availability. LIMITATIONS Future studies should consider extending measurement of the mother-infant relationship beyond the EA Scales, inclusion of a measure of maternal childhood trauma, and replicating our findings. CONCLUSION Maternal perception of partner and family support in the postpartum is a predictor of the association between early pregnancy depressive symptoms and maternal emotional availability.
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Affiliation(s)
- Kelli K MacMillan
- School of Medicine, University of Notre Dame, Fremantle, Australia; Psychology, Murdoch University, Perth, Australia; Women's Health, Genetics and Mental Health Directorate, King Edward Memorial Hospital for Women, Subiaco, Australia
| | | | - Stuart J Watson
- School of Medicine, University of Notre Dame, Fremantle, Australia; Psychology, Murdoch University, Perth, Australia
| | | | - Megan Galbally
- School of Medicine, University of Notre Dame, Fremantle, Australia; Psychology, Murdoch University, Perth, Australia; Women's Health, Genetics and Mental Health Directorate, King Edward Memorial Hospital for Women, Subiaco, Australia; Faculty of Health and Medicine Sciences, University of Western Australia, Perth, Australia.
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13
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Husain MI, Umer M, Chaudhry IB, Husain MO, Rahman R, Shakoor S, Khaliq A, Ali WM, Zaheer J, Bassett P, Mulsant BH, Chaudhry N, Husain N. Relationship between childhood trauma, personality, social support and depression in women attending general medical clinics in a low and middle-income country. J Affect Disord 2021; 292:526-533. [PMID: 34147964 DOI: 10.1016/j.jad.2021.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Associations between childhood trauma, personality, and Major Depressive Disorder (MDD) have been well established in studies conducted in high-income countries. However, there are limited studies on these associations in low and middle-income countries (LMICs), where MDD is highly prevalent. We assessed the relationships between childhood trauma, personality, and MDD in women in Karachi, Pakistan. METHOD In this cross-sectional study of 455 female patients attending general medical outpatient clinics, a diagnosis of MDD was confirmed using the Structured Clinical Interview for DSM-IV (SCID); retrospective reports of childhood trauma were collected using the childhood trauma questionnaire (CTQ); and Big Five personality traits were assessed using the NEO Personality Inventory Revised (NEO PI-R). Other measures included the Life Events Questionnaire (LEQ) and the Multidimensional Scale of Perceived Social Support (MSPSS). Factors independently associated with MDD were determined using logistic regression analyses. RESULTS Of the 455 women recruited between August 1, 2011 and July 31, 2013, 242 (53%) had a diagnosis of MDD. Women with MDD were significantly more likely to be separated, had more stressful life events and higher CTQ scores. Higher perceived social support, conscientiousness and extraversion were independently associated with significantly reduced odds of MDD. There were no significant associations between CTQ scores and any of the NEO PI-R subscales. LIMITATIONS Ratings of childhood trauma were based on retrospective recall. CONCLUSION MDD and a history of childhood trauma were highly prevalent in Pakistani women attending general medical clinics. Interventions to prevent childhood trauma and promote social support in women may improve public mental health in LMICs like Pakistan.
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Affiliation(s)
- Muhammad Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Madeha Umer
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Imran B Chaudhry
- University of Manchester, Manchester, UK; Ziauddin University, Karachi, Pakistan; Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Omair Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raza Rahman
- Dow University of Health Sciences, Karachi, Pakistan
| | - Suleman Shakoor
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Ayesha Khaliq
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Juveria Zaheer
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Benoit H Mulsant
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nasim Chaudhry
- Dow University of Health Sciences, Karachi, Pakistan; Pakistan Institute of Living and Learning, Karachi, Pakistan
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14
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Schneiderman JU, Prindle J, Putnam-Hornstein E. Infant Deaths From Medical Causes After a Maltreatment Report. Pediatrics 2021; 148:peds.2020-048389. [PMID: 34426532 DOI: 10.1542/peds.2020-048389] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine whether postneonatal infants reported for maltreatment face a heightened risk of deaths attributable to medical causes. METHODS Birth and death records for all children born in California between 2010 and 2016 (N = 3 455 985) were linked to administrative child protection system records. Infants were prospectively followed from birth through death or age 1 year. Reports of maltreatment and foster care placement episodes were modeled as time-varying covariates; sociodemographic characteristics at birth were modeled as baseline covariates. Stratified, multivariable competing risk models were used to estimate the adjusted relative hazard of postneonatal infant death attributed to a medical cause (n = 1051). RESULTS After adjusting for baseline risk factors, and compared with infants never reported for maltreatment, the medical-related mortality risk was almost twice as great among infants reported once for maltreatment (hazard ratio: 1.77; 95% confidence interval: 1.36-2.30) and 3 times greater if there was >1 maltreatment report (hazard ratio: 3.27; 95% confidence interval: 2.48, 4.30). Among infants reported for maltreatment, periods of foster care placement reduced the risk of death by roughly half. CONCLUSION Infants reported for alleged maltreatment had a higher risk of death from medical causes, with foster care emerging as protective. Targeted support services for parents and improved communication between the child protection system and the pediatric health care community is needed, especially when infants who may be medically fragile remain at home after an allegation of abuse or neglect.
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Affiliation(s)
- Janet U Schneiderman
- Department of Nursing, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Emily Putnam-Hornstein
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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15
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Abraham E, Letkiewicz AM, Wickramaratne PJ, Bunyan M, van Dijk MT, Gameroff MJ, Posner J, Talati A, Weissman MM. Major depression, temperament, and social support as psychosocial mechanisms of the intergenerational transmission of parenting styles. Dev Psychopathol 2021; 34:1-15. [PMID: 34099080 DOI: 10.1017/s0954579421000420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this three-generation longitudinal study of familial depression, we investigated the continuity of parenting styles, and major depressive disorder (MDD), temperament, and social support during childrearing as potential mechanisms. Each generation independently completed the Parental Bonding Instrument (PBI), measuring individuals' experiences of care and overprotection received from parents during childhood. MDD was assessed prospectively, up to 38 years, using the semi-structured Schedule for Affective Disorders and Schizophrenia (SADS). Social support and temperament were assessed using the Social Adjustment Scale - Self-Report (SAS-SR) and Dimensions of Temperament Scales - Revised, respectively. We first assessed transmission of parenting styles in the generation 1 to generation 2 cycle (G1→G2), including 133 G1 and their 229 G2 children (367 pairs), and found continuity of both care and overprotection. G1 MDD accounted for the association between G1→G2 experiences of care, and G1 social support and temperament moderated the transmission of overprotection. The findings were largely similar when examining these psychosocial mechanisms in 111 G2 and their spouses (G2+S) and their 136 children (G3) (a total of 223 pairs). Finally, in a subsample of families with three successive generations (G1→G2→G3), G2 experiences of overprotection accounted for the association between G1→G3 experiences of overprotection. The results of this study highlight the roles of MDD, temperament, and social support in the intergenerational continuity of parenting, which should be considered in interventions to "break the cycle" of poor parenting practices across generations.
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Affiliation(s)
- Eyal Abraham
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Allison M Letkiewicz
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA
| | - Priya J Wickramaratne
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Departments of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Maya Bunyan
- Departments of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Milenna T van Dijk
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Marc J Gameroff
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Jonathan Posner
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Division of Child Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Ardesheer Talati
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Myrna M Weissman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Departments of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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16
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Weigl T, Garthus-Niegel S. [Questionnaires for the Assessment of Birth Expectancy and Birth Experience (Part 2 of a series on psychological assessment during the peripartum period)]. Z Geburtshilfe Neonatol 2021; 225:392-396. [PMID: 34058777 DOI: 10.1055/a-1471-7714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Giving birth is an intense experience and typically accompanied by severe pain. In addition to medical complications, subjective factors are likely to affect the birth experience. These include previous experiences with pregnancy and birth, previous traumatic experiences as well as birth expectations. Various questionnaires allow a standardized assessment of birth expectations and the birth experience. However, to date there is no questionnaire available in the German language that is based on diagnostic symptoms of birth-related posttraumatic stress disorder. Furthermore, current screening-tools were developed for women while men's perspectives have been neglected in research on the parental birth experience. Nonetheless, questionnaires seem to be well suited for the assessment of the birth experience of both mothers and fathers. In this way, support services could be expanded, since parents sometimes report a negative birth experience even in medically uncomplicated births. Along with the goal of enabling parents to have a positive birth experience, the prevention of the development of subclinical or even full-blown posttraumatic stress disorder after birth also plays an important role.
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Affiliation(s)
- Tobias Weigl
- Psychology School, Hochschule Fresenius - University of Applied Sciences, Düsseldorf, Deutschland
| | - Susan Garthus-Niegel
- Fakultät Medizin, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Hamburg, Deutschland.,Institut und Poliklinik für Arbeits- und Sozialmedizin, TU Dresden, Dresden, Deutschland
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17
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Abraham E, Posner J, Wickramaratne PJ, Aw N, van Dijk MT, Cha J, Weissman MM, Talati A. Concordance in parent and offspring cortico-basal ganglia white matter connectivity varies by parental history of major depressive disorder and early parental care. Soc Cogn Affect Neurosci 2020; 15:889-903. [PMID: 33031555 PMCID: PMC7543940 DOI: 10.1093/scan/nsaa118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/23/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022] Open
Abstract
Social behavior is transmitted cross-generationally through coordinated behavior within attachment bonds. Parental depression and poor parental care are major risks for disruptions of such coordination and are associated with offspring's psychopathology and interpersonal dysfunction. Given the key role of the cortico-basal ganglia (CBG) circuits in social communication, we examined similarities (concordance) of parent-offspring CBG white matter (WM) connections and how parental history of major depressive disorder (MDD) and early parental care moderate these similarities. We imaged 44 parent-offspring dyads and investigated WM connections between basal-ganglia seeds and selected regions in temporal cortex using diffusion tensor imaging (DTI) tractography. We found significant concordance in parent-offspring strength of CBG WM connections, moderated by parental lifetime-MDD and care. The results showed diminished neural concordance among dyads with a depressed parent and that better parental care predicted greater concordance, which also provided a protective buffer against attenuated concordance among dyads with a depressed parent. Our findings provide the first neurobiological evidence of concordance between parents-offspring in WM tracts and that concordance is diminished in families where parents have lifetime-MDD. This disruption may be a risk factor for intergenerational transmission of psychopathology. Findings emphasize the long-term role of early caregiving in shaping the neural concordance among at-risk and affected dyads.
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Affiliation(s)
- Eyal Abraham
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Divisions of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Jonathan Posner
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Child Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Priya J Wickramaratne
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Divisions of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Natalie Aw
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Child Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Milenna T van Dijk
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Divisions of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Jiook Cha
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Child Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Myrna M Weissman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Divisions of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Departments of Epidemiology, New York, NY, USA
| | - Ardesheer Talati
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Divisions of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
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Childhood Neglect and Psychological Distress Among Pregnant Women: The Chain Multiple Mediation Effect of Perceived Social Support and Positive Coping. J Nerv Ment Dis 2020; 208:764-770. [PMID: 32740144 DOI: 10.1097/nmd.0000000000001210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the association between childhood neglect and psychological distress in pregnant women and to assess whether perceived social support and coping styles mediated this association. Pregnant women (N = 276) recruited from the prenatal clinic of a comprehensive hospital in China participated in this study. Participants reported their experiences of childhood neglect and abuse, depression, anxiety, perceived social support, and coping styles. Childhood neglect was positively associated with psychological distress. Perceived social support mediated the relationship between childhood neglect and psychological distress. Perceived social support and positive coping acted as chain mediators between childhood neglect and psychological distress. Childhood neglect is a risk factor for psychological distress during pregnancy independent of childhood abuse; perceived social support and positive coping can influence this relationship.
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19
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Xiang Y, Cao Y, Dong X. Childhood maltreatment and moral sensitivity: An interpretation based on schema theory. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.109924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Boeck C, Gumpp AM, Koenig AM, Radermacher P, Karabatsiakis A, Kolassa IT. The Association of Childhood Maltreatment With Lipid Peroxidation and DNA Damage in Postpartum Women. Front Psychiatry 2019; 10:23. [PMID: 30833908 PMCID: PMC6387959 DOI: 10.3389/fpsyt.2019.00023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/14/2019] [Indexed: 12/21/2022] Open
Abstract
Childhood maltreatment (CM) is associated with an increased risk for the development of psychiatric and somatic disorders in later life. A potential link could be oxidative stress, which is defined as the imbalance between the amount of reactive oxygen species (ROS) and the neutralizing capacity of anti-oxidative defense systems. However, the findings linking CM with oxidative stress have been inconsistent so far. In this study, we aimed to further explore this association by investigating biological markers of DNA and lipid damage due to oxidation in a comprehensive approach over two study cohorts of postpartum women (study cohort I and study cohort II). The severity of CM experiences (maltreatment load) was assessed in both studies using the Childhood Trauma Questionnaire. In study cohort I (N = 30), we investigated whether CM was associated with higher levels of structural DNA damage in peripheral blood mononuclear cells (PBMC) by two methods that are highly sensitive for detecting nuclear DNA strand breaks (comet assay and γH2AX staining). In study cohort II (N = 117), we then assessed in a larger cohort, that was specifically controlled for potential confounders for oxidative stress measurements, two established serum and plasma biomarkers of oxidative stress, one representing oxidative DNA and RNA damage (8-hydroxy-2'-deoxyguanosine and 8-hydroxyguanosine; 8-OH(d)G) and the other representing lipid peroxidation (8-isoprostane). In study cohort I, the analyses revealed no significant main effects of maltreatment load on cellular measures of nuclear DNA damage. The analyses of peripheral oxidative stress biomarkers in study cohort II revealed a significant main effect of maltreatment load on free 8-isoprostane plasma levels, but not on total 8-isprostane plasma levels and 8-OH(d)G serum levels. Taken together, by combining different methods and two study cohorts, we found no indications for higher oxidative DNA damages with higher maltreatment load in postpartum women. Further research is needed to investigate whether this increase in free 8-isoprostane is a marker for oxidative stress or whether it is instead functionally involved in ROS-related signaling pathways that potentially regulate inflammatory processes following a history of CM.
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Affiliation(s)
- Christina Boeck
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anja M Gumpp
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Alexandra M Koenig
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Peter Radermacher
- Institute of Anesthesiological Pathophysiology and Process Engineering, University Hospital Ulm, Ulm, Germany
| | - Alexander Karabatsiakis
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Iris-Tatjana Kolassa
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Boeck C, Gumpp AM, Calzia E, Radermacher P, Waller C, Karabatsiakis A, Kolassa IT. The association between cortisol, oxytocin, and immune cell mitochondrial oxygen consumption in postpartum women with childhood maltreatment. Psychoneuroendocrinology 2018; 96:69-77. [PMID: 29908404 DOI: 10.1016/j.psyneuen.2018.05.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 04/28/2018] [Accepted: 05/29/2018] [Indexed: 01/03/2023]
Abstract
Childhood maltreatment (CM) is associated with an increased risk for the development of psychiatric and somatic diseases in later life. Individual risk and resilience factors may, however, influence how deep psychological stress gets under the skin. We hypothesized that the stress-related hormone cortisol and the attachment-related hormone oxytocin constitute biological factors that might moderate the biological sequelae and long-term health outcomes associated with CM. As biological outcome, we thereby focused on immunocellular oxygen consumption, which we previously found to be increased with a higher severity of CM experiences. In a study cohort of N = 49 postpartum women, we investigated the interaction between CM experiences, serum cortisol and plasma oxytocin levels, and the cellular oxygen consumption of intact peripheral blood mononuclear cells (PBMC) by high-resolution respirometry. Regression analyses revealed a significant interaction between the severity of CM experiences and cortisol as well as oxytocin on cellular oxygen consumption of PBMC three months postpartum: higher cortisol levels were thereby associated with an increase in oxygen consumption related to basal mitochondrial respiration and ATP turnover, while oxygen consumption related to basal mitochondrial respiration and ATP turnover were reduced with higher oxytocin levels in individuals with higher CM severity. These associations were not seen among women with no or low CM experiences. Together, the results suggest that cortisol and oxytocin might be associated with opposite effects on CM-related alterations in the bioenergetic profile of peripheral immune cells.
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Affiliation(s)
- Christina Boeck
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany.
| | - Anja Maria Gumpp
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany
| | - Enrico Calzia
- Institute of Anesthesiological Pathophysiology and Process Engineering, University Hospital Ulm, Helmholtzstrasse 8/1, 89081, Ulm, Germany
| | - Peter Radermacher
- Institute of Anesthesiological Pathophysiology and Process Engineering, University Hospital Ulm, Helmholtzstrasse 8/1, 89081, Ulm, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany; Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, 90419, Nuremberg, Germany
| | - Alexander Karabatsiakis
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany
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Koenig AM, Gao W, Umlauft M, Schury K, Reister F, Kirschbaum C, Karabatsiakis A, Kolassa IT. Altered hair endocannabinoid levels in mothers with childhood maltreatment and their newborns. Biol Psychol 2018; 135:93-101. [DOI: 10.1016/j.biopsycho.2018.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 02/26/2018] [Accepted: 03/15/2018] [Indexed: 12/28/2022]
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Pauly M, Umlauft M, Ünlü A. Resampling-Based Inference Methods for Comparing Two Coefficients Alpha. PSYCHOMETRIKA 2018; 83:203-222. [PMID: 29297150 DOI: 10.1007/s11336-017-9601-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Indexed: 06/07/2023]
Abstract
The two-sample problem for Cronbach's coefficient [Formula: see text], as an estimate of test or composite score reliability, has attracted little attention compared to the extensive treatment of the one-sample case. It is necessary to compare the reliability of a test for different subgroups, for different tests or the short and long forms of a test. In this paper, we study statistical procedures of comparing two coefficients [Formula: see text] and [Formula: see text]. The null hypothesis of interest is [Formula: see text], which we test against one-or two-sided alternatives. For this purpose, resampling-based permutation and bootstrap tests are proposed for two-group multivariate non-normal models under the general asymptotically distribution-free (ADF) setting. These statistical tests ensure a better control of the type-I error, in finite or very small sample sizes, when the state-of-affairs ADF large-sample test may fail to properly attain the nominal significance level. By proper choice of a studentized test statistic, the resampling tests are modified in order to be valid asymptotically even in non-exchangeable data frameworks. Moreover, extensions of this approach to other designs and reliability measures are discussed as well. Finally, the usefulness of the proposed resampling-based testing strategies is demonstrated in an extensive simulation study and illustrated by real data applications.
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Affiliation(s)
- Markus Pauly
- Institute of Statistics, Ulm University, Ulm, Germany.
| | - Maria Umlauft
- Institute of Statistics, Ulm University, Ulm, Germany
| | - Ali Ünlü
- Technical University of Munich, Munich, Germany
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Landers AL, McLuckie A, Cann R, Shapiro V, Visintini S, MacLaurin B, Trocmé N, Saini M, Carrey NJ. A scoping review of evidence-based interventions available to parents of maltreated children ages 0-5 involved with child welfare services. CHILD ABUSE & NEGLECT 2018; 76:546-560. [PMID: 28985958 DOI: 10.1016/j.chiabu.2017.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 09/05/2017] [Accepted: 09/10/2017] [Indexed: 06/07/2023]
Abstract
Parents referred to child welfare services for child maltreatment often struggle against chronic risk factors including violence, substance abuse, mental health concerns, and poverty, which impinge upon their ability to be sensitive caregivers. The first line of intervention within the child welfare context is to modify parenting behavior. This scoping review comprehensively surveyed all available literature to map the extent and range of research activity around the types of interventions available within a child welfare context to parents of infants and toddlers (0-5 years of age), to identify the facilitators and/or barriers to the uptake of interventions, and to check that interventions match the risk factors faced by parents. This scoping review engaged in stringent screening of studies based upon inclusion/exclusion criteria. Sixty-five articles involving forty-two interventions met inclusion criteria. Interventions generally aimed to improve parenting practices, the relationship between parent and child, and/or attachment security, along with reducing child abuse and/or neglect. A notable finding of this scoping review is that at present, interventions for parents of children ages 0-5 involved with the child welfare system are most frequently measured via case study and quasi-experimental designs, with randomized control trials making up 26.2% of included study designs.
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Affiliation(s)
- Ashley L Landers
- Virginia Polytechnic Institute & State University, United States.
| | | | - Robin Cann
- IWK Health Centre, Halifax, Nova Scotia, Canada
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Zhang H, Zhao Q, Cao P, Ren G. Resilience and Quality of Life: Exploring the Mediator Role of Social Support in Patients with Breast Cancer. Med Sci Monit 2017; 23:5969-5979. [PMID: 29248937 PMCID: PMC5744469 DOI: 10.12659/msm.907730] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of breast cancer can provoke a series of negative emotional changes in patients, further affecting their quality of life. It has been shown that patients with higher resilience have better quality of life. Social support systems are important protective factors that are necessary for the process of resilience to occur. Hence, this study aimed to investigate the role of social support in the relationship between resilience and quality of life among Chinese patients with breast cancer. MATERIAL AND METHODS A demographic-disease survey, the Chinese version of the Connor-Davidson Resilience Scale 25, Medical Outcomes Study Social Support Survey, and Functional Assessment of Cancer Therapy Breast Cancer Version 3 were used to interview 98 patients with breast cancer from a teaching hospital in Chongqing, China. Data analysis was performed by descriptive statistics, independent-sample t test, one-way ANOVA, and regression analyses. RESULTS The mean scores of resilience, social support, and quality of life were 54.68, 61.73, and 80.74 respectively, which were in the moderate range. Participants with stronger social support had higher resilience and better quality of life. Social support played a partial mediator role in the relationship between resilience and quality of life. The mediation effect ratio was 28.0%. CONCLUSIONS Social support is essential for the development of resilience and the improvement of quality of life in Chinese patients with breast cancer. Health professionals should provide appropriate guidelines to help patients seek effective support and enhance their resilience to improve their quality of life after breast cancer.
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Affiliation(s)
- Hailing Zhang
- Department of Nursing, First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Qinghua Zhao
- Department of Nursing, First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Peiye Cao
- Department of Nursing, First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Guosheng Ren
- Department of the Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
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History of child maltreatment and telomere length in immune cell subsets: Associations with stress- and attachment-related hormones. Dev Psychopathol 2017; 30:539-551. [PMID: 28803568 DOI: 10.1017/s0954579417001055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Experiencing maltreatment during childhood can have long-lasting consequences for both mental and physical health. Immune cell telomere length (TL) shortening might be one link between child maltreatment (CM) experiences and adverse health outcomes later in life. While the stress hormone cortisol has been associated with TL attrition, the attachment-related hormone oxytocin may promote resilience. In 15 mothers with and 15 age- and body mass index-matched mothers without CM, we assessed TL in peripheral blood mononuclear cells and selected immune cell subsets (monocytes, naive, and memory cytotoxic T cells) by quantitative fluorescence in situ hybridization, as well as peripheral cortisol and oxytocin levels. Memory cytotoxic T cells showed significantly shorter TL in association with CM, whereas TL in monocytes and naive cytotoxic T cells did not significantly differ between the two groups. Across both groups, cortisol was negatively associated with TL, while oxytocin was positively associated with TL in memory cytotoxic T cells. These results indicate that long-lived memory cytotoxic T cells are most affected by the increased biological stress state associated with CM. Keeping in mind the correlational and preliminary nature of the results, the data suggest that cortisol may have a damaging and oxytocin a protective function on TL.
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