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Nowak J, Nikendei C, Rollmann I, Orth M, Friederich HC, Kindermann D. Characterization of different types of anxiety disorders in relation to structural integration of personality and adverse and protective childhood experiences in psychotherapy outpatients - a cross-sectional study. BMC Psychiatry 2023; 23:501. [PMID: 37438712 DOI: 10.1186/s12888-023-04988-2] [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: 03/19/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Current research has emphasized the role of structural integration of personality and childhood experiences for the understanding of anxiety disorders. In this study, we examined the relationship between anxiety disorders (generalized anxiety disorder vs. panic disorder vs. phobic disorders), the level of structural integration of personality, and negative and protective childhood experiences at the beginning of outpatient psychodynamic psychotherapy treatment. Differences were characterized in comparison to patients with no anxiety disorders. METHODS The sample included a total of 1646 outpatient psychodynamic psychotherapy treatments, of which 695 treatments included the diagnosis of at least one anxiety disorder. Levels of structural integration of personality were assessed according to the Operationalized Psychodynamic Diagnosis (OPD-2) system. Self-reported negative and protective childhood experiences were examined by using the Questionnaire for the Assessment of Adverse and Protective Childhood Experiences (APC). Associations were tested using single factor ANOVAs. RESULTS Patients with anxiety disorders showed lower levels of structural integration of personality and reported more adverse childhood experiences than patients with no anxiety disorders. Regarding the subscales of structural integration of personality, phobic disorders were associated with impaired external communication, whereas for generalized anxiety disorder, an (uncorrected) association with impaired self-regulation was found. Also, generalized anxiety disorder was associated with sexual abuse and other traumatization (accidents etc.) during childhood, while panic disorder and phobic disorders were associated with emotional neglect, abuse, and fewer protective childhood experiences. CONCLUSIONS Our findings emphasize the need of considering structural integration of personality and childhood experiences in order to understand and treat various types of anxiety disorders.
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Affiliation(s)
- Jonathan Nowak
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany.
| | - Christoph Nikendei
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Ivo Rollmann
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Maximilian Orth
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - David Kindermann
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
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Palmer AR, Foster RA, Distefano R, Masten AS. Emotional reactivity and parenting in families experiencing homelessness. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2022; 36:636-641. [PMID: 34498891 PMCID: PMC9364434 DOI: 10.1037/fam0000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Parents are key protective systems in the lives of children experiencing homelessness. Evidence suggests that parent emotional reactivity, expression, and regulation play a critical role in promoting adaptive parenting behaviors. Studies of emotional reactivity in parents utilize different methods, including self-report, observations, and physiological measures. However, these methods are rarely evaluated together, particularly among disadvantaged families. The present study examined how subjective (i.e., self-report), observed, and physiological measures of parent emotional reactivity relate to each other and to observed parenting behaviors in problem-solving and teaching parent-child interaction tasks. Participants included fifty 4- to 7-year-old children and their caregivers staying in an emergency homeless shelter. Observed and subjective emotional reactivity were largely uncorrelated, except for positive emotions during problem-solving tasks. Adaptive parenting behavior was related to lower scores on measures of subjective and observed negative emotions and higher observed scores for positive emotions during problem-solving tasks, as well as higher observed scores of positive emotions during teaching tasks. Physiological reactivity was not related to parenting behaviors. Results suggest that associations of emotional reactivity with parenting behavior depend on the context of the parent-child interaction and how emotional reactivity is measured. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Galano MM, Grogan-Kaylor A, Clark HM, Stein SF, Graham-Bermann SA. Profiles of Traumatic Stress Symptoms in Children Exposed to Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP10863-NP10885. [PMID: 31566059 DOI: 10.1177/0886260519877938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Childhood exposure to intimate partner violence (IPV) is associated with a host of problems, including the development of posttraumatic stress symptoms (PTSS). PTSS include a wide range of unique symptomatology and as a result, clinical presentations of PTSS can vary in both distribution and overall number of symptoms. Work in child and adolescent samples has largely focused on factors predicting the total number of symptoms (i.e., symptom severity), with less work focused on both patterns of symptom number and distribution. Furthermore, few studies have examined how functional impairment varies in relation to PTSS presentation. The goal of the current study is to (a) document patterns of PTSS severity and distribution in children with histories of witnessing IPV, (b) examine the factors that predict different PTSS presentations, and (c) investigate how PTSS presentation is associated with functional impairment. Data for this study were drawn from a sample of 236 children between the ages of 4 and 12 years and their mothers who had experienced recent IPV. Families reported high levels of IPV in the past year, and children reported moderate levels of PTSS. A latent profile analysis of PTSS revealed that three profiles were the best-fitting model for the data. The three profiles were differentiated between low, moderate, and high levels of PTSS, and membership in the profiles varied by children's age and trauma history. The results of this study give important information about the potential development of PTSS as well as clinically useful information about the relationship between children's PTSS and their functioning following exposure to IPV.
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Zhang Y, Chen Y, Zhang W. Community Violence Exposure and Externalizing Problem Behavior Among Chinese High School Students: The Moderating Role of Parental Knowledge. Front Psychol 2021; 12:612237. [PMID: 33959066 PMCID: PMC8095249 DOI: 10.3389/fpsyg.2021.612237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Adolescents' community violence exposure (CVE) has been demonstrated with a range of behavioral and psychological problems, but the processes that explain these correlations are not clear. In our 2017 study, the mediating role of deviant peer affiliation in the relationship between CVE and externalizing problem behaviors has been confirmed. However, the moderating effect of parental factors is still unclear. Therefore, a new group (high school group) was adopted in this study to further explore the moderating effect of parental knowledge based on also confirming the mediating effect of deviant peer affiliation. Stratified-cluster sampling was used to recruit 1,797 volunteers who completed questionnaires on CVE, deviant peer affiliation, parental knowledge, and externalizing problem behaviors. The results of the structural equation modeling were: on the basis of our previous research, we further analyzed the mediating role of deviant peer affiliation, and the mediated association was moderated by parental knowledge. Especially when the school climate is added as a covariate, the moderating effect of parental knowledge has changed, that is, the positive association between CVE and externalizing problem behaviors was much stronger for adolescents who reported lower levels of parental knowledge than for those who reported higher levels of parental knowledge. The results support the assumptions of social learning theory and have implications for interventions of community violence.
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Affiliation(s)
- Yibo Zhang
- School of Psychology & Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Yuanyuan Chen
- School of Psychology & Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Wei Zhang
- School of Psychology & Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
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Bradley C, McGowan J, Michelson D. How Does Homelessness Affect Parenting Behaviour? A Systematic Critical Review and Thematic Synthesis of Qualitative Research. Clin Child Fam Psychol Rev 2019; 21:94-108. [PMID: 28932919 DOI: 10.1007/s10567-017-0244-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The adverse social and physical conditions of homelessness pose significant developmental risks for children, which may be compounded or buffered by the quality of parenting behaviour they are exposed to. There is currently a limited understanding of how parents approach their care-giving role and responsibilities while adjusting to the experience of homelessness. Advancing knowledge in this area is essential for developing acceptable, appropriate and effective interventions to support highly marginalised and vulnerable homeless families. This review explored homeless parents' perceptions of how homelessness affects their parenting behaviour and identified adaptive strategies that parents may use to mitigate the potentially negative impacts of homelessness on the quality of care-giving. A systematic search of four electronic databases (ASSIA, PsycINFO, Web of Science and MEDLINE) identified 13 published qualitative studies, all originating from the USA, which explored parenting behaviour in homeless contexts. The studies were critically appraised using the CASP qualitative assessment tool. Thematic synthesis identified the following determinants of parenting behaviour; negative self-concept in the parental role, parental mental health, material resources, challenges to autonomy and self-efficacy, daily hassles, physical environment and service context, stigma, child characteristics and lack of support. These were synthesised thematically using existing models of parenting determinants and positive parenting. Findings indicate substantive impacts of homelessness on parental mental health, parenting authority, material resources, parenting environments and social support. Parents developed a number of adaptive methods to negotiate the challenges of homeless parenting such as maintaining a positive mindset, cherishing the parental role and developing practical strategies. We conclude with recommendations that service providers should tailor parenting support to resource-constrained circumstances and that further research is required in order to better understand experiences of homeless parents in other international contexts.
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Affiliation(s)
- Caroline Bradley
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, 1 Meadow Road, Tunbridge Wells, TN1 2YG, Kent, UK. .,The Tavistock Centre, 120 Belsize Lane, London, NW3 5BA, UK.
| | - John McGowan
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, 1 Meadow Road, Tunbridge Wells, TN1 2YG, Kent, UK
| | - Daniel Michelson
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Resilience in Children Exposed to Violence: A Meta-analysis of Protective Factors Across Ecological Contexts. Clin Child Fam Psychol Rev 2019; 22:406-431. [DOI: 10.1007/s10567-019-00293-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Narayan A, Cicchetti D, Rogosch FA, Toth SL. Interrelations of maternal expressed emotion, maltreatment, and separation/divorce and links to family conflict and children's externalizing behavior. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 43:217-28. [PMID: 25037461 DOI: 10.1007/s10802-014-9911-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Research has documented that maternal expressed emotion-criticism (EE-Crit) from the Five-Minute Speech Sample (FMSS) predicts family conflict and children's externalizing behavior in clinical and community samples. However, studies have not examined EE-Crit in maltreating or separated/divorced families, or whether these family risks exacerbate the links between EE-Crit and family conflict and externalizing behavior. The current study examined the associations between maternal EE-Crit, maltreatment, and separation/divorce, and whether maltreatment and separation/divorce moderated associations between EE-Crit and children's externalizing problems, and EE-Crit and family conflict. Participants included 123 children (M = 8.01 years, SD = 1.58; 64.2 % males) from maltreating (n = 83) or low-income, comparison (n = 40) families, and 123 mothers (n = 48 separated/divorced). Mothers completed the FMSS for EE-Crit and the Family Environment Scale for family conflict. Maltreatment was coded with the Maltreatment Classification System using information from official Child Protection Services (CPS) reports from the Department of Human Services (DHS). Trained summer camp counselors rated children's externalizing behavior. Maltreatment was directly associated with higher externalizing problems, and separation/divorce, but not maltreatment, moderated the association between EE-Crit and externalizing behavior. Analyses pertaining to family conflict were not significant. Findings indicate that maltreatment is a direct risk factor for children's externalizing behavior and separation/divorce is a vulnerability factor for externalizing behavior in family contexts with high maternal EE-Crit. Intervention, prevention, and policy efforts to promote resilience in high-risk families may be effective in targeting maltreating and critical parents, especially those with co-occurring separation/divorce. Key Words: expressed emotion, EE-Crit, Five-Minute Speech Sample; maltreatment, divorce, externalizing behavior.
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Affiliation(s)
- Angela Narayan
- Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN, 55455, USA,
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Personal, dyadic, and contextual resilience in parents experiencing homelessness. Clin Psychol Rev 2015; 36:56-69. [PMID: 25687153 DOI: 10.1016/j.cpr.2015.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/21/2022]
Abstract
Adopting a developmental psychopathology (DP) perspective, the present study systematically reviewed the quantitative literature on positive functioning and outcomes in parents experiencing homelessness. Studies were identified from PubMed, PsycInfo, and Web of Science using an exhaustive list of key terms. Of 3443 total studies screened, 219 were inspected, 176 were excluded, and 43 were included. Included studies fell into three outcome categories: the ability to function well personally (cope effectively, meet basic family needs, experience reduced psychopathology); dyadically (demonstrate positive parenting practices and promote child adjustment); and contextually (exit episodes of homelessness and avoid shelter re-entry). Results also reflected personal, dyadic, and contextual independent variables associated with each positive outcome category. Many parents experiencing homelessness display positive outcomes, and many factors support positive functioning. Future research should replicate these findings and examine multilevel parental functioning to help bridge the gap between the DP theoretical perspective and the quantitative evidence for parental resilience as a process.
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Masten AS, Cutuli JJ, Herbers JE, Hinz E, Obradović J, Wenzel AJ. Academic Risk and Resilience in the Context of Homelessness. CHILD DEVELOPMENT PERSPECTIVES 2014; 8:201-206. [PMID: 29623104 DOI: 10.1111/cdep.12088] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Family homelessness in the United States has increased over the past two decades, raising concerns about associated risks for child development. In this article, we describe a translational research program focused on academic risk and resilience in homeless and highly mobile children. We find that although these children share many risk factors with other disadvantaged children, they are higher on an underlying continuum of risk. Additionally, marked variability has been observed among children who experience homelessness, both in risk level and achievement, with many children manifesting resilience. We discuss implications for research and efforts to address disparities in achievement.
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Affiliation(s)
- Ann S Masten
- Institute of Child Development, University of Minnesota, Twin Cities
| | - J J Cutuli
- Department of Psychology, Rutgers University-Camden
| | | | - Elizabeth Hinz
- Liaison for Homeless and Highly Mobile Students, Minneapolis Public Schools
| | | | - Amanda J Wenzel
- Institute of Child Development, University of Minnesota, Twin Cities
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