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Ye H, Jiang N, He S, Fan F. Sleep disturbance and internalizing symptoms in adolescents: a moderated mediation model of self-control and mindfulness. BMC Psychiatry 2024; 24:310. [PMID: 38658904 PMCID: PMC11040859 DOI: 10.1186/s12888-024-05750-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES Despite accumulating evidence regarding the impact of sleep disturbance on internalizing symptoms among adolescents, the underlying psychological mechanisms remain inadequately explored. This study aimed to investigate a conceptual framework elucidating how sleep disturbance influences internalizing symptoms in adolescents through the mediating role of self-control, with mindfulness as a moderator. METHODS In this cross-sectional study, 1876 Chinese adolescents (Mage = 14.88 years, SD = 1.47 years, range = 12-19 years, 44.7% boys) completed the Youth Self-Rating Insomnia Scale (YSIS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Brief Self-control Scale (BSCS), and Mindful Attention Awareness Scale-Children (MAAS-C) to provide data on sleep-related variables, internalizing symptoms (anxiety and depression), self-control, and mindfulness, respectively. The PROCESS macro for SPSS was applied to perform moderated mediation analysis. RESULTS Sleep disturbance demonstrated a significant positive correlation with internalizing symptoms in adolescents, including anxiety (β = 0.481, p < 0.001) and depression (β = 0.543, p < 0.001). Self-control served as a mediator between sleep disturbance and two forms of internalizing symptoms. Moreover, mindfulness moderated the pathways from self-control to internalizing symptoms (for anxiety symptoms: β = 0.007, p < 0.001; for depression symptoms: β = 0.006, p < 0.001), and the mediating relationships were weaker for adolescents exhibiting higher levels of mindfulness. CONCLUSIONS Our findings enhance understanding of the impact, pathways, and influencing factors of sleep disturbance on adolescent internalizing symptoms, suggesting the importance of enhancing mindfulness levels in addressing self-control deficits and subsequently reducing internalizing symptoms among adolescents.
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Affiliation(s)
- Haoxian Ye
- Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, School of Psychology, South China Normal University, Shipai Road, 510631, Guangzhou, China
| | - Nan Jiang
- Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, School of Psychology, South China Normal University, Shipai Road, 510631, Guangzhou, China
| | - Sisi He
- Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, School of Psychology, South China Normal University, Shipai Road, 510631, Guangzhou, China
| | - Fang Fan
- Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, School of Psychology, South China Normal University, Shipai Road, 510631, Guangzhou, China.
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2
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Thompson EJ, Richards M, Ploubidis GB, Fonagy P, Patalay P. Changes in the adult consequences of adolescent mental ill-health: findings from the 1958 and 1970 British birth cohorts. Psychol Med 2023; 53:1074-1083. [PMID: 34282721 DOI: 10.1017/s0033291721002506] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adolescent mental health difficulties are increasing over time. However, it is not known whether their adulthood health and socio-economic sequelae are changing over time. METHODS Participants (N = 31 349) are from two prospective national birth cohort studies: 1958 National Child Development Study (n = 16 091) and the 1970 British Cohort Study (n = 15 258). Adolescent mental health was operationalised both as traditional internalising and externalising factors and a hierarchical bi-factor. Associations between adolescent psychopathology and age 42 health and wellbeing (mental health, general health, life satisfaction), social (cohabitation, voting behaviour) and economic (education and employment) outcomes are estimated using linear and logistic multivariable regressions across cohorts, controlling for a wide range of early life potential confounding factors. RESULTS The prevalence of adolescent mental health difficulties increased and their associations with midlife health, wellbeing, social and economic outcomes became more severe or remained similar between those born in 1958 and 1970. For instance, a stronger association with adolescent mental health difficulties was found for those born in 1970 for midlife psychological distress [odds ratio (OR) 1970 = 1.82 (1.65-1.99), OR 1958 = 1.60 (1.43-1.79)], cohabitation [OR 1970 = 0.64 (0.59-0.70), OR 1958 = 0.79 (0.72-0.87)], and professional occupations [OR 1970 = 0.75 (0.67-0.84), OR 1958 = 1.05 (0.88-1.24)]. The associations of externalising symptoms with later outcomes were mainly explained by their shared variance with internalising symptoms. CONCLUSION The widening of mental health-based inequalities in midlife outcomes further supports the need to recognise that secular increases in adolescent mental health symptoms is a public health challenge with measurable negative consequences through the life-course. Increased public health efforts to minimise adverse outcomes are needed.
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Affiliation(s)
- Ellen J Thompson
- UCL Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - George B Ploubidis
- UCL Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Praveetha Patalay
- UCL Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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Gong Z, Reinhardt JD, Han Z, Ba Z, Lei S. Associations between school bullying and anxiety in children and adolescents from an ethnic autonomous county in China. Psychiatry Res 2022; 314:114649. [PMID: 35643051 DOI: 10.1016/j.psychres.2022.114649] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 11/16/2022]
Abstract
School bullying is a widespread public health issue that negatively impacts the mental health of children and adolescents. This study aimed to investigate associations between school bullying involvement and anxiety of children and adolescents. A survey covering all types of pre-college schools (primary, middle, high, and vocational school) was conducted in an ethnic autonomous county in China. 1,943 students participated in this study. Being a victim of verbal (OR=3.08, 95%CI = [2.43,3.91]), physical (OR=3.24, 95%CI = [2.46,4.27]), relational (OR=3.72, 95%CI = [2.90,4.76]), or cyberbullying (OR=3.47, 95%CI = [2.61,4.61]) were associated with increased symptoms of generalized anxiety. Similarly, being a perpetrator of verbal (OR=2.12, 95%CI = [1.45,3.10]), physical (OR=1.85, 95%CI = [1.22,2.79]), relational (OR=1.78, 95%CI = [1.15,2.74]), or cyber-bullying (OR=1.59, 95%CI = [1.08,2.33]) were related to a higher degree of anxiety. Moreover, in both victims and perpetrators higher levels of anxiety were associated with a greater number of types of bullying they were involved in, suggesting a dose-response relation between school bullying involvement and anxiety. Therefore, both bullying victims and perpetrators need mental health support and anti-bullying strategies should address different forms of bullying evenhandedly.
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Affiliation(s)
- Zepeng Gong
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, China; Shenzhen Institute for Advanced Study, University of Electronic Science and Technology of China, Shenzhen, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu, China; Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Ziqiang Han
- School of Political Science and Public Administration, Shandong University, Qingdao, China
| | - Zhanlong Ba
- School of Sociology, Beijing Normal University, Beijing, China
| | - Shangqing Lei
- School of Public Administration, Sichuan University, Chengdu, China.
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4
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Dunn A, Alvarez J, Arbon A, Bremner S, Elsby-Pearson C, Emsley R, Jones C, Lawrence P, Lester KJ, Majdandžić M, Morson N, Perry N, Simner J, Thomson A, Cartwright-Hatton S. Effectiveness of an Online Intervention to Prevent Anxiety in the Children of Anxious Parents: A Study Protocol for a Randomised Controlled Trial. (Preprint). JMIR Res Protoc 2022; 11:e40707. [PMID: 36355406 PMCID: PMC9693706 DOI: 10.2196/40707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks. Objective This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms. Methods This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors. Results Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022. Conclusions The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety. Trial Registration ClinicalTrials.gov NCT04755933; https://clinicaltrials.gov/ct2/show/NCT04755933 International Registered Report Identifier (IRRID) DERR1-10.2196/40707
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Affiliation(s)
- Abigail Dunn
- Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - James Alvarez
- Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Amy Arbon
- University Hospitals Sussex NHS Foundation Trust, The Brighton and Sussex Clinical Trials Unit, Brighton, United Kingdom
| | - Stephen Bremner
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Peter Lawrence
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Kathryn J Lester
- Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Mirjana Majdandžić
- Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Natalie Morson
- Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Nicky Perry
- University Hospitals Sussex NHS Foundation Trust, The Brighton and Sussex Clinical Trials Unit, Brighton, United Kingdom
| | - Julia Simner
- Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Abigail Thomson
- Department of Psychology, University of Sussex, Brighton, United Kingdom
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5
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Baourda VC, Brouzos A, Mavridis D, Vassilopoulos SP, Vatkali E, Boumpouli C. Group Psychoeducation for Anxiety Symptoms in Youth: Systematic Review and Meta-analysis. JOURNAL FOR SPECIALISTS IN GROUP WORK 2021. [DOI: 10.1080/01933922.2021.1950881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Change patterns of sleep problems predict mental health problems among adolescents: a 10-year cohort study of Chinese Wenchuan earthquake. J Affect Disord 2021; 287:138-144. [PMID: 33780829 DOI: 10.1016/j.jad.2021.02.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/02/2021] [Accepted: 02/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The predictive effects of change patterns of sleep problems on mental health after a long-term disaster remain poorly known. We examined the change patterns of sleep problems after the Wenchuan earthquake, and tested whether specific sleep-related change patterns could predict mental health problems (posttraumatic stress disorder [PTSD], anxiety, and depression) in the 10 years after Wenchuan earthquake. METHODS 1357 adolescents exposed to the Wenchuan earthquake were surveyed on potential sleep problems at 18 months (T18m) and 30 months (T30m) post-earthquake. Among them, 799 participants completed the followed-up survey online 10 years after the earthquake (T10y). Since some participants did not provide sleep problems data at both T18m and T30m, 707 samples were included in final analyses. Linear regression analysis was performed. RESULTS Four different patterns of sleep problems were identified: stable-low pattern (61.1%), stable-high pattern (15.3%), decreasing pattern (13.2%), and increasing pattern (10.5%). Additionally, we found that individuals in stable-high and increasing patterns were more likely to experience PTSD, anxiety, and depression at T10y in the crude model. After controlling for confounders (e.g., earthquake exposure), these patterns were strongly predictive of depression at T10y. LIMITATIONS Only two waves of sleep problems were collected and subjective sleep outcomes methods were used to collect data instead of objective methods. CONCLUSIONS Sleep problems had heterogeneity after a deadly earthquake. Individuals in stable-high and increasing patterns should be given more attention. Timely assessment and targeted interventions on specific sleep problems are necessary for preventing an escalation of adverse mental health outcomes.
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Clayborne ZM, Kingsbury M, Sampasa-Kinyaga H, Sikora L, Lalande KM, Colman I. Parenting practices in childhood and depression, anxiety, and internalizing symptoms in adolescence: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:619-638. [PMID: 32892249 DOI: 10.1007/s00127-020-01956-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE Parenting practices represent important and modifiable factors for health and wellbeing in children and adolescents; however, strength and quality of studies examining relationships between parenting practices in childhood and risk of depression and anxiety in adolescence are unclear. The objective of this systematic review was to synthesize the longitudinal literature that describes these associations. METHODS Six electronic databases were searched for articles published through March 2018. Eligible articles were published in the English language, peer-reviewed, and had prospective cohort study designs. Articles eligible for inclusion examined positive and negative parenting practices of parents and/or guardians when study subjects were between 0 and 9 years of age, and symptoms of depression, anxiety, and internalizing symptoms when subjects were between 10 and 19 years of age. Heterogeneity of included articles precluded meta-analysis: findings were reported narratively. RESULTS 4558 references were screened for inclusion, and 19 articles met eligibility criteria and were included for review. Ten articles examined positive parenting practices, and four demonstrated statistically significant associations between positive parenting practices and lower risk of adolescent depression, anxiety, and/or internalizing symptoms. Fifteen articles examined negative parenting practices, and five demonstrated significant associations between negative parenting practices and higher risk of adolescent depression, anxiety, and/or internalizing symptoms. CONCLUSION This review demonstrates that the evidence base supporting longitudinal associations between parenting practices in childhood and adolescent symptoms of depression, anxiety, and internalizing problems is inconsistent. Findings from this review highlight limitations of the existing literature and identify understudied parenting dimensions that require further investigation.
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Affiliation(s)
- Zahra M Clayborne
- School of Epidemiology and Public Health, University of Ottawa, Room 308C, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Room 308C, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Hugues Sampasa-Kinyaga
- School of Epidemiology and Public Health, University of Ottawa, Room 308C, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Kathleen M Lalande
- School of Epidemiology and Public Health, University of Ottawa, Room 308C, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Room 308C, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
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8
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Liu Z, Li P, Yin H, Li M, Yan J, Ma C, Ding H, Li Q, Huang Z, Yan Y, Kou C, Hu M, Wen J, Chen S, Jia C, Huang Y, Xu G. Future Trends in Disability and Its Determinants Among Chinese Community Patients With Anxiety Disorders: Evidence From a 5-Year Follow-Up Study. Front Psychiatry 2021; 12:777236. [PMID: 34955923 PMCID: PMC8695844 DOI: 10.3389/fpsyt.2021.777236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anxiety disorders (ADs) are a group of disorders with a high disability rate and bring a huge social burden. In China, information on future trends in the disability among community ADs patients and its determinants are rare. The objectives of this study are to describe the future trends in the disability among ADs patients living in community and to investigate the determinants of the disability. Methods: Participants diagnosed with 12-month ADs in the China Mental Health Survey (CMHS) were followed up by telephone from April to June 2018 to assess the future trends in the disability in a 5-year interval using the World Health Organization's Disability Assessment Schedule 2.0. The disability rate was reported and its determinants were analyzed by complex sample design multivariate logistic regression. Results: Totally 271 patients were interviewed by telephone and 33 informants finished proxy interviews. The disability rates were 45.9% and 14.3% among ADs patients at baseline and during the follow-up. Patients with general anxiety disorder (GAD) or agoraphobia with/without panic disorder (AGP) had the lower decrease and higher disability during the follow-up than patients with other subtypes. Patients aged in middle age (aged 40-49 years old, OR = 11.12, 95% CI: 4.16-29.72), having disability at baseline (OR = 7.18, 95% CI: 1.37-37.73), having comorbidity with three or more physical diseases (OR = 9.27, 95% CI: 2.48-34.71), and having comorbidity with other mental disorders (OR = 3.97, 95% CI: 1.13-13.96) had higher disability during the follow-up. Conclusions: The disability rate tends to decrease among ADs patients living in communities. Treatment priority should be given for ADs patients with disability and those in middle age. Treatments for the comorbidity of other mental disorders or physical diseases should be considered when treating anxiety.
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Affiliation(s)
- Zhaorui Liu
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Peking University Sixth Hospital (Institute of Mental Health), Ministry of Health (Peking University), Beijing, China
| | - Peijun Li
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Huifang Yin
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Minghui Li
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Jie Yan
- School of Government, Peking University, Beijing, China
| | - Chao Ma
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Peking University Sixth Hospital (Institute of Mental Health), Ministry of Health (Peking University), Beijing, China
| | - Hua Ding
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Qiang Li
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China
| | - Yongping Yan
- Department of Epidemiology, The Fourth Military Medical University, Xi'an, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Mi Hu
- Xiangya School of Public Health, Changsha, China
| | - Jing Wen
- Department of Epidemiology and Health Statistics, School of Public Health and Management at Ningxia Medical University, Yinchuan, China
| | - Shulin Chen
- Department of Psychological and Behavior Science, Zhejiang University, Hangzhou, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, China
| | - Yueqin Huang
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Peking University Sixth Hospital (Institute of Mental Health), Ministry of Health (Peking University), Beijing, China
| | - Guangming Xu
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
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9
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Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
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10
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Rasing SPA, Braam MWG, Brunwasser SM, Janssens JMAM, Creemers DHM, Scholte RHJ. Depression and Anxiety Symptoms in Female Adolescents: Relations with Parental Psychopathology and Parenting Behavior. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30:298-313. [PMID: 31355507 DOI: 10.1111/jora.12525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Parental psychopathology and parenting behavior are known to be related to adolescents depression and anxiety, but unique roles of mothers and fathers are not clear. Our aim was to examine the relation of maternal and paternal psychopathology, emotional support, and respect for autonomy, and their interaction to depression and anxiety symptoms in adolescents. In total, 142 female adolescents participated, together with 138 mothers and 113 fathers. Data were analyzed using latent growth curve modeling. Paternal emotional support was negatively related to adolescent baseline level of depression and anxiety symptoms. Further, we found that there was a positive association between respect for autonomy and depression symptoms in adolescents for higher levels of paternal symptoms of psychological problems.
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Lucas-Thompson RG, Seiter NS, Broderick PC, Coatsworth JD. Mindfulness Interventions to Reduce Impact of Interparental Conflict on Adolescents. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:392-402. [PMID: 34447238 PMCID: PMC8386821 DOI: 10.1007/s10826-019-01599-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Exposure to frequent, intense, and poorly resolved interparental conflict puts adolescents at risk for problems in many domains, including internalizing and externalizing problems, and stress physiological dysfunction. Existing intervention strategies to target these adolescents focus almost solely on improving marital dynamics, for example, through relationship education or couples therapy. However, interventions that aim to enhance marital communication require high levels of parental commitment and motivation for change, and may be expensive and time-consuming. In the current paper, we argue that it is essential to also apply intervention strategies that directly promote the regulatory capabilities of adolescents to improve outcomes for youth from high-conflict homes. Mindfulness, or present-moment, nonjudgemental awareness, is associated with myriad positive outcomes in adults (e.g., lower levels of depression and anxiety, and greater emotion regulation). We propose that mindfulness interventions are an ideal intervention strategy for adolescents from high conflict homes. Mindfulness interventions may target the mechanisms whereby destructive marital interaction impacts youth, by providing distance between experiences and evaluations, training regulation of attention, and enhancing self-compassion and nonjudgement, as well as by enhancing relationships. We also provide an example of a specific intervention model designed to increase mindfulness in youth, Learning to Breathe (L2B).
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Affiliation(s)
- Rachel G. Lucas-Thompson
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Natasha S. Seiter
- Department of Human Development & Family Studies and Prevention Research Center, Colorado State University, Fort Collins, CO, USA
| | - Patricia C. Broderick
- Bennett-Pierce Prevention Research Center, Pennsylvania State University, State College, PA, USA
| | - J. Douglas Coatsworth
- Department of Human Development & Family Studies and Prevention Research Center, Colorado State University, Fort Collins, CO, USA
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12
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Mo PKH, Xin M, Lau JTF. Testing the vulnerability and scar model of the relationship between self-concept, social support and anxiety symptoms among children of HIV-infected parents in China: A 3-year longitudinal study. J Affect Disord 2019; 259:441-450. [PMID: 31611002 DOI: 10.1016/j.jad.2019.08.036] [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: 12/29/2018] [Revised: 06/18/2019] [Accepted: 08/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mental illness is a great concern among children of HIV-infected parents (COHIP), who are at their crucial stage of psychosocial development. It has been shown that self-concept (SC) and social support (SS) are important correlates of anxiety symptoms (AS), however, nature of the causality remained unclear. METHODS A 3-year longitudinal study was conducted in rural Central China, where many people were infected with HIV through unhygienic blood donation. A total of 195 COHIP (mean age: 12.6 years, 49.2% male) completed the baseline assessment and were followed for three years. Cross-lagged structural equation modeling analyses were used to test competing theoretical models: vulnerability model (low SC/SS contributes to AS), scar model (AS erodes SC/SS) and reciprocity model (low SC/SS and AS predict each other). RESULTS At each wave, 104 (53.3%) and 67 (41.6%) participants presented with anxiety disorders respectively. Nested-model comparison supported the superiority of scar models wherein AS significantly predicted subsequent low SC (β=-0.24, p=0.013) and SS (β=-0.31, p= 0.033), controlling for synchronous and autoregressive effects of all measures. The most parsimonious multivariate model that included significant relations was finally identified with a good model fit. LIMITATIONS Findings might be subject to reporting bias; and could not inform the temporal relationship between SC and SS. CONCLUSION Prevalence of anxiety was high among Chinese COHIP. The present study provides empirical evidence for scarring effects of AS; thus, highlighted the importance of identifying and treating COHIP's anxiety to mitigate long-term negative impacts on their psychosocial development.
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Affiliation(s)
- Phoenix K H Mo
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Meiqi Xin
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Joseph T F Lau
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China.
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Lucas-Thompson R, Seiter N, Broderick PC, Coatsworth JD, Henry KL, McKernan CJ, Smyth JM. Moving 2 Mindful (M2M) study protocol: testing a mindfulness group plus ecological momentary intervention to decrease stress and anxiety in adolescents from high-conflict homes with a mixed-method longitudinal design. BMJ Open 2019; 9:e030948. [PMID: 31784436 PMCID: PMC6924786 DOI: 10.1136/bmjopen-2019-030948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Interparental conflict exposure places adolescents at risk for problems with stress and anxiety; existing prevention/intervention strategies focus on reducing interparental conflict. Mindfulness-based programmes may be a promising treatment strategy for this population, but studies have not yet tested whether they are effective in this high-conflict context. In addition, evidence suggests that extensions to traditional treatments, such as delivering components in daily life that are tailored to moments of need, can increase treatment efficacy, particularly when combined with in-person treatments and particularly for adolescents. However, there are no such extensions to mindfulness interventions available. The Moving 2 Mindful study aims to (1) develop an ecological momentary intervention (EMI) supplement to Learning to BREATHE (L2B), an evidence-based mindfulness intervention for adolescents; (2) refine the EMI programme and determine the best delivery plan; (3) examine the feasibility and acceptability of L2B Plus (L2B plus the developed supplement) and (4) examine the potential for L2B Plus to reduce stress and anxiety for adolescents from high-conflict homes. METHODS AND ANALYSIS The Moving 2 Mindful study proposes a mixed-methods approach to developing and refining a multimethod adaptive supplement to L2B. Feasibility, acceptability and potential effectiveness will be tested in a sample of 38 families, who will be randomly assigned to receive L2B Plus or an active health and wellness control condition and followed until 3 months postintervention. A range of psychosocial and physiological factors will be assessed at multiple time points. This study is registered with clinicaltrials.gov (ID NCT03869749; pre-results). ETHICS AND DISSEMINATION The Institutional Review Board at Colorado State University has approved this study. Findings will be disseminated in scientific journals and conferences, whether they are positive, negative or inconclusive.
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Affiliation(s)
- Rachel Lucas-Thompson
- Human Development and Family Studies, Colorado State University College of Health and Human Sciences, Fort Collins, Colorado, USA
- Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Natasha Seiter
- Human Development and Family Studies, Colorado State University College of Health and Human Sciences, Fort Collins, Colorado, USA
| | - Patricia C Broderick
- Biobehavioral Health & Medicine, Pennsylvania State University, University Park, Pennsylvania, USA
| | - James Douglas Coatsworth
- Human Development and Family Studies, Colorado State University College of Health and Human Sciences, Fort Collins, Colorado, USA
| | - Kimberly L Henry
- Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Charlotte J McKernan
- Human Development and Family Studies, Colorado State University College of Health and Human Sciences, Fort Collins, Colorado, USA
| | - Joshua M Smyth
- Biobehavioral Health & Medicine, Pennsylvania State University, University Park, Pennsylvania, USA
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Guo Y, Sun J, Hu S, Nicholas S, Wang J. Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193526. [PMID: 31547207 PMCID: PMC6801864 DOI: 10.3390/ijerph16193526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 01/24/2023]
Abstract
Background: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families’ financial burden. Methods: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital’s information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. Results: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children’s mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). Conclusions: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty—insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China’s health insurance schemes—especially to allow migrant families to gain basic medical insurance.
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Affiliation(s)
- Yawei Guo
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China.
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jian 250014, China.
| | - Simeng Hu
- Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China.
| | - Stephen Nicholas
- School of Management and School of Economics, Tianjin Normal University, West Bin Shui Avenue, Tianjin 300074, China.
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2038, Australia.
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun, Guangzhou, Guangdong 510420, China.
- Top Education Institute, 1 Central Avenue, Australian Technology Park, Eveleigh, Sydney, NSW 2015, Australia.
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, No.54 Dongsi Lishi Hutong, Dongcheng District, Beijing 100010, China.
- Center for Health Economics and Management at School of Economics and Management, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, Hubei Province 430072, China.
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Kertz SJ, Sylvester C, Tillman R, Luby JL. Latent Class Profiles of Anxiety Symptom Trajectories From Preschool Through School Age. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2019; 48:316-331. [PMID: 28318338 PMCID: PMC5607092 DOI: 10.1080/15374416.2017.1295380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anxiety typically arises early in childhood and decreases during school age. However, little is known about the earlier developmental course of anxiety in preschool, especially in at risk children, posing a clinically important problem. Given that anxiety in youth has a chronic course for some and also predicts later development of other mental health problems, it is important to identify factors early in development that may predict chronic anxiety symptoms. At-risk children (oversampled for depression) and caregivers completed 6 assessment waves beginning at preschool age (between 3-5.11 years of age) up through 6.5 years later. Growth mixture models revealed 4 distinct trajectories: 2 stable groups (high and moderate) and 2 decreasing groups (high and low). Important to note, the high stable anxiety group had greater baseline depression and social adversity/risk, higher average maternal depression over time, and poorer average social functioning over time compared to the high decreasing group. The high decreasing group also had greater externalizing/attention deficit hyperactivity disorder scores than the low decreasing group. Children with anxiety in early childhood who also experience high depression, social adversity/risk, maternal depression, and poor social functioning may be at risk for chronic symptoms over time.
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Affiliation(s)
- Sarah J Kertz
- a Department of Psychology , Southern Illinois University-Carbondale
| | - Chad Sylvester
- b Department of Psychiatry , Washington University School of Medicine
| | - Rebecca Tillman
- b Department of Psychiatry , Washington University School of Medicine
| | - Joan L Luby
- b Department of Psychiatry , Washington University School of Medicine
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16
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Swan AJ, Kendall PC, Olino T, Ginsburg G, Keeton C, Compton S, Piacentini J, Peris T, Sakolsky D, Birmaher B, Albano AM. Results from the Child/Adolescent Anxiety Multimodal Longitudinal Study (CAMELS): Functional outcomes. J Consult Clin Psychol 2018; 86:738-750. [PMID: 30138013 DOI: 10.1037/ccp0000334] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To report functional outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which examined the impact of youth anxiety treatment (cognitive-behavioral therapy [CBT], coping cat; Sertraline, SRT; COMB [CBT + SRT]; pill placebo) on (a) global and (b) domain-specific functioning assessed an average of 3.1 times, 3- to 12-years postrandomization (first assessment = mean 6.5 years postrandomization). METHOD Three-hundred and 19 of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated. Growth curve modeling examined the impact of treatment condition and acute treatment outcomes (i.e., response, remission) on global functioning, global and domain-specific impairment, and life satisfaction across follow-up visits. Logistic regressions explored the impact of treatment remission and condition on low frequency events (arrests/convictions) and education. RESULTS Treatment responders and remitters demonstrated better global functioning, decreased overall impairment, and increased life satisfaction at follow-up. Treatment remission, but not response, predicted decreased domain-specific impairment (social relationships, self-care/independence, academic functioning), and maintenance of increased life satisfaction across follow-ups. Participants in the CBT condition, compared with pill placebo, demonstrated improved trajectories pertaining to life satisfaction, overall impairment, and impairment in academic functioning. Randomization to CBT or COMB treatment was associated with increasing employment rates. Trajectories for participants randomized to SRT was not significantly different from placebo. Treatment outcome and condition did not predict legal outcomes, school/work variables, or family life. CONCLUSION Positive early intervention outcomes are associated with improved overall functioning, life satisfaction, and functioning within specific domains 6.5 years posttreatment. Treatment type differentially predicted trajectories of functioning. Findings support the positive impact of pediatric anxiety treatment into adolescence and early adulthood. (PsycINFO Database Record
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Affiliation(s)
- Anna J Swan
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone
| | | | | | - Golda Ginsburg
- Child Division of Department of Psychiatry, University of Connecticut Health
| | - Courtney Keeton
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles
| | - Tara Peris
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles
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Beato A, Barros L, Pereira AI. Father's and mother's beliefs about children's anxiety. Child Care Health Dev 2018; 44:784-793. [PMID: 30133771 DOI: 10.1111/cch.12603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/05/2017] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous research has focused on parenting styles and parental behaviors associated with children's anxiety. Parental beliefs about their child's anxiety have scarcely been studied, in spite of their probable influence in parents seeking help. The present study intended to fil that gap, by exploring what parents think about their children's anxiety and whether these cognitions are related or not to their use of professional help. METHOD In-depth semistructured interviews were conducted with 48 parents (50% fathers) of children (9-12 years old) with anxiety problems. Theoretical thematic analysis was performed on the transcripts. RESULTS Three dimensions were derived from the analysis, concerning (a) the causes of child's anxiety, (b) the impact of anxiety in the child's functioning, and (c) the evolution of anxiety. Most parents perceived the child's anxiety as a permanent condition, attributing it to external and parental factors and considering that the anxiety problems have a negative impact on the child's well-being. Plus, parents who had previously sought professional help for the child's emotional problems tended to believe that anxiety could improve with child's or parents' efforts and with professional guidance, contrarily to those who had not. Implications for research and clinical practice are discussed. CONCLUSION The present study highlighted important parental beliefs about their children's anxiety that might influence their attitudes and decisions (e.g., seek for professional help). Other parental cognitions should be investigated in order to understand parenting in the context of childhood anxiety.
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Affiliation(s)
- Ana Beato
- Faculty of Psychology, University of Lisbon, Lisbon, Portugal
| | - Luísa Barros
- Faculty of Psychology, University of Lisbon, Lisbon, Portugal
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions. Cochrane Database Syst Rev 2018; 8:CD012489. [PMID: 30110718 PMCID: PMC6513202 DOI: 10.1002/14651858.cd012489.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term physical conditions affect 10% to 12% of children and adolescents worldwide; these individuals are at greater risk of developing psychological problems, particularly anxiety and depression. Access to face-to-face treatment for such problems is often limited, and available interventions usually have not been tested with this population. As technology improves, e-health interventions (delivered via digital means, such as computers and smart phones and ranging from simple text-based programmes through to multimedia and interactive programmes, serious games, virtual reality and biofeedback programmes) offer a potential solution to address the psychological needs of this group of young people. OBJECTIVES To assess the effectiveness of e-health interventions in comparison with attention placebos, psychological placebos, treatment as usual, waiting-list controls, or non-psychological treatments for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group's Controlled Trials Register (CCMDTR to May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2017), Web of Science (1900 - 18 August 2016, updated 31 August 2017) and Ovid MEDLINE, Embase, PsycINFO (cross-search 2016 to 18 Aug 2017). We hand-searched relevant conference proceedings, reference lists of included articles, and the grey literature to May 2016. We also searched international trial registries to identify unpublished or ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-randomised trials, and cross-over trials of e-health interventions for treating any type of long-term physical condition in children and adolescents (aged 0 to 18 years), and that measured changes in symptoms or diagnoses of anxiety, depression, or subthreshold depression. We defined long-term physical conditions as those that were more than three-months' duration. We assessed symptoms of anxiety and depression using patient- or clinician-administered validated rating scales based on DSM III, IV or 5 (American Psychological Association 2013), or ICD 9 or 10 criteria (World Health Organization 1992). Formal depressive and anxiety disorders were diagnosed using structured clinical interviews. Attention placebo, treatment as usual, waiting list, psychological placebo, and other non-psychological therapies were eligible comparators. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed titles, abstracts, and full-text articles; discrepancies were resolved through discussion or addressed by a third author. When available, we used odds ratio (OR) to compare dichotomous data and standardised mean differences (SMD) to analyse continuous data, both with 95% confidence intervals (CI). We undertook meta-analysis when treatments, participants, and the underlying clinical question were adequately similar. Otherwise, we undertook a narrative analysis. MAIN RESULTS We included five trials of three interventions (Breathe Easier Online, Web-MAP, and multimodal cognitive behavioural therapy (CBT)), which included 463 participants aged 10 to 18 years. Each trial contributed to at least one meta-analysis. Trials involved children and adolescents with long-term physical conditions, such as chronic headache (migraine, tension headache, and others), chronic pain conditions (abdominal, musculoskeletal, and others), chronic respiratory illness (asthma, cystic fibrosis, and others), and symptoms of anxiety or depression. Participants were recruited from community settings and hospital clinics in high income countries.For the primary outcome of change in depression symptoms versus any control, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.06, 95% CI -0.35 to 0.23; five RCTs, 441 participants). For the primary outcome of change in anxiety symptoms versus any comparator, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.07, 95% CI -0.29 to 0.14; two RCTs, 324 participants). For the primary outcome of treatment acceptability, there was very low-quality evidence that e-health interventions were less acceptable than any comparator (SMD 0.46, 95% CI 0.23 to 0.69; two RCTs, 304 participants).For the secondary outcome of quality of life, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.83, 95% CI -1.53 to -0.12; one RCT, 34 participants). For the secondary outcome of functioning, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.08, 95% CI -0.33 to 0.18; three RCTs, 368 participants). For the secondary outcome of status of long-term physical condition, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD 0.06, 95% CI -0.12 to 0.24; five RCTs, 463 participants).The risk of selection bias was considered low in most trials. However, the risk of bias due to inadequate blinding of participants or outcome assessors was considered unclear or high in all trials. Only one study had a published protocol; two trials had incomplete outcome data. All trials were conducted by the intervention developers, introducing another possible bias. No adverse effects were reported by any authors. AUTHORS' CONCLUSIONS At present, the field of e-health interventions for the treatment of anxiety or depression in children and adolescents with long-term physical conditions is limited to five low quality trials. The very low-quality of the evidence means the effects of e-health interventions are uncertain at this time, especially in children aged under 10 years.Although it is too early to recommend e-health interventions for this clinical population, given their growing number, and the global improvement in access to technology, there appears to be room for the development and evaluation of acceptable and effective technologically-based treatments to suit children and adolescents with long-term physical conditions.
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Affiliation(s)
- Hiran Thabrew
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Karolina Stasiak
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
| | - Stephen Wong
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Jessica H Huss
- University of KasselDepartment of PsychologyKasselGermany
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
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Wald N, Carthy T, Shenaar-Golan V, Tadmor-Zisman Y, Ziskind M. Influence of maternal negative emotion reactivity and cognitive reappraisal on child anxiety disorder. Depress Anxiety 2018; 35:353-359. [PMID: 29624211 DOI: 10.1002/da.22745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/26/2017] [Accepted: 02/09/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Anxiety disorders are among the most common psychopathologies in childhood. Two underlying contributors to child anxiety disorders (ADs) are negative emotional hyper-reactivity and deficits in reappraisal, a cognitive strategy of emotion regulation. Given that emotion regulation develops in the context of parent-child interaction, the aim of this study was to fill a research gap regarding the association between maternal negative emotional reactivity (NER) and reappraisal and child anxiety by examining (a) whether mothers of children with ADs display abnormalities in emotional reactivity and reappraisal compared to mothers of children without ADs; (b) whether maternal NER and reappraisal are associated with child anxiety; and (c) whether maternal reactivity and reappraisal significantly explain the variance in the level of child anxiety beyond the level of maternal anxiety. METHOD Forty-nine mothers and their AD children (aged 10-17) were assessed at admission to an anxiety disorder clinic and were compared to a control group of 42 mothers and their non-anxious (NA) children. Child and maternal anxiety were assessed, as well as maternal NER and reappraisal. RESULTS Mothers of AD children showed a higher NER as well as reappraisal deficits compared to the control group. Self-rated child anxiety was associated with maternal deficits in reappraisal. The variance in child anxiety was significantly explained by the level of maternal anxiety as well as maternal reappraisal deficits. CONCLUSIONS This study suggests that maternal NER and reappraisal play an important role in child anxiety and should be considered in prevention and intervention of childhood ADs.
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Affiliation(s)
- Nava Wald
- Bar-Ilan University, Ramat Gan, Israel.,Ziv Medical Center, Zefat, Israel.,Tel-Hai College, Tel-Hai, Israel
| | - Tal Carthy
- Interdisciplinary Center (IDC), Herzliya, Israel
| | | | - Yael Tadmor-Zisman
- Bar-Ilan University, Ramat Gan, Israel.,Schneider's Children Medical Center of Israel, Petah Tikva, Israel.,Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Cartwright-Hatton S, Ewing D, Dash S, Hughes Z, Thompson EJ, Hazell CM, Field AP, Startup H. Preventing family transmission of anxiety: Feasibility RCT of a brief intervention for parents. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:351-366. [DOI: 10.1111/bjc.12177] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Donna Ewing
- School of Psychology; University of Sussex; Brighton UK
| | - Suzanne Dash
- School of Psychology; University of Sussex; Brighton UK
| | - Zoe Hughes
- School of Psychology; University of Sussex; Brighton UK
| | | | | | - Andy P. Field
- School of Psychology; University of Sussex; Brighton UK
| | - Helen Startup
- Research and Development; Sussex Education Centre; Mill View Hospital; Hove UK
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21
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Essau CA, Lewinsohn PM, Lim JX, Moon-Ho RH, Rohde P. Incidence, recurrence and comorbidity of anxiety disorders in four major developmental stages. J Affect Disord 2018; 228:248-253. [PMID: 29304469 PMCID: PMC5807150 DOI: 10.1016/j.jad.2017.12.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/19/2017] [Accepted: 12/06/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Anxiety disorders are common in childhood, adolescence, and adulthood, and frequently comorbid with other mental disorders. OBJECTIVE The main aim of the present study was to examine the incidence, recurrence and comorbidity rates of anxiety disorders across four developmental periods, namely, during childhood (5 - 12.9 years), adolescence (13 - 17.9 years), emerging adulthood (18 - 23.9 years), and adulthood (24 - 30 years). METHOD Eight hundred and sixteen participants from a large community sample were interviewed twice during adolescence, at age 24, and at age 30. They completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and adulthood. RESULTS The result showed first incidence of anxiety disorders to be significantly higher in childhood and adulthood than in adolescence and emerging adulthood. Female gender was associated with first incidence, but not with recurrence. Significant comorbidity was found between anxiety disorders and major depressive disorder (MDD) across the four developmental periods. The comorbidity between anxiety and substance use disorders (SUD) was significant in childhood, emerging adulthood and adulthood, but not in adolescence. The presence of anxiety disorders during childhood and adolescence significantly increased the probability of having an anxiety disorder during emerging adulthood. LIMITATIONS The participants are ethically and geographically homogenous. CONCLUSION Incidence and recurrence rates of anxiety disorders differed across four diverse developmental periods. The magnitude of comorbidity between anxiety disorders and MDD was comparable across periods.
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Affiliation(s)
- Cecilia A. Essau
- Department of Psychology, University of Roehampton, Whitelands College, Holybourne Avenue, London SW15 4JD, UK
| | - Peter M. Lewinsohn
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403-1983, USA
| | - Jie Xin Lim
- Psychology, School of Social Sciences, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798
| | - Ringo Ho Moon-Ho
- Psychology, School of Social Sciences, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798
| | - Paul Rohde
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403-1983, USA
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Yap MBH, Mahtani S, Rapee RM, Nicolas C, Lawrence KA, Mackinnon A, Jorm AF. A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial. J Med Internet Res 2018; 20:e17. [PMID: 29351895 PMCID: PMC5797292 DOI: 10.2196/jmir.9139] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 01/04/2023] Open
Abstract
Background Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. Objective This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms. Methods A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children’s Anxiety Scale (anxiety symptoms). Results Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions. Conclusions The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents’ mental health. Trial Registration Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj)
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Affiliation(s)
- Marie Bee Hui Yap
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Shireen Mahtani
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, New South Wales, Australia
| | - Claire Nicolas
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Katherine A Lawrence
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Andrew Mackinnon
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Castagna PJ, Calamia M, Davis TE. Childhood ADHD and Negative Self-Statements: Important Differences Associated With Subtype and Anxiety Symptoms. Behav Ther 2017; 48:793-807. [PMID: 29029676 DOI: 10.1016/j.beth.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/15/2022]
Abstract
The current study examined the role negative self-statements have on the comorbidity between anxious symptomatology and ADHD-combined presentation (ADHD-C) and ADHD-predominantly inattentive (ADHD-I). A total of 114 children and adolescents with ADHD (M age = 10.15; SD = 2.30; range = 7-16) from a clinic-referred sample were grouped based on a semistructured diagnostic interview and consensus approach (ADHD-C, n = 62; ADHD-I, n = 52). Negative self-statements were measured using the Children's Automatic Thoughts Scale and the total score from the Multidimensional Anxiety Scale for Children was used to measure anxious symptomatology. Findings indicated youth diagnosed with ADHD-C, compared to those diagnosed with ADHD-I, had more frequent personal failure (Cohen's d =.40) and hostile intent negative self-statements (Cohen's d =.47). The association of ADHD subtype and negative self-statements was moderated by anxiety; negative self-statements of personal failure were highest in anxious ADHD-C children (β =.31). A second sample of 137 children and adolescents (M age = 10.61; SD = 2.26; range = 7-16) from a larger clinic-referred sample was utilized to replicate our results dimensionally. Results indicated that both hyperactivity/impulsivity (β = .23, p < .01) and the interaction of hyperactivity/impulsivity and anxiety (β = .17, p < .05) were significant predictors of negative self-statements regarding personal failure, while holding child age, child gender, oppositional symptoms, and inattention constant. In all, negative self-statements should be considered in the treatment and assessment of ADHD with particular attention paid to ADHD subtype and internalizing comorbidity.
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions. Hippokratia 2017. [DOI: 10.1002/14651858.cd012488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hiran Thabrew
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Karolina Stasiak
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne; 35 Poplar Road Parkville Melbourne Victoria Australia 3054
| | - Stephen Wong
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Jessica H Huss
- University of Kassel; Department of Psychology; Kassel Germany
| | - Sally N Merry
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
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25
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. eHealth interventions for anxiety and depression in children and adolescents with long-term physical conditions. Hippokratia 2017. [DOI: 10.1002/14651858.cd012489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiran Thabrew
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Karolina Stasiak
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne; 35 Poplar Road Parkville Melbourne Victoria Australia 3054
| | - Stephen Wong
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Jessica H Huss
- University of Kassel; Department of Psychology; Kassel Germany
| | - Sally N Merry
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
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Shi X, Zhou Y, Fan F. Longitudinal trajectories and predictors of anxiety symptoms among adolescent survivors exposed to Wenchuan earthquake. J Adolesc 2016; 53:55-63. [DOI: 10.1016/j.adolescence.2016.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/27/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
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Swan AJ, Kendall PC. Fear and missing out: Youth anxiety and functional outcomes. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/cpsp.12169] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yap MBH, Morgan AJ, Cairns K, Jorm AF, Hetrick SE, Merry S. Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18. Clin Psychol Rev 2016; 50:138-158. [PMID: 27969003 DOI: 10.1016/j.cpr.2016.10.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE OF THE RESEARCH Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term. PRINCIPAL RESULTS Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6months up to 15years for internalizing measures, 5.5years for depressive measures, and 11years for anxiety measures. MAJOR CONCLUSIONS Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people.
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Affiliation(s)
- Marie B H Yap
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Amy J Morgan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kathryn Cairns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Centre of Excellence in Youth Mental Health, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sally Merry
- School of Medicine, University of Auckland, New Zealand
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Grierson AB, Hickie IB, Naismith SL, Scott J. The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models. Psychol Med 2016; 46:2467-2484. [PMID: 27352637 PMCID: PMC4988274 DOI: 10.1017/s0033291716001392] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 01/04/2023]
Abstract
Research in developmental psychopathology and clinical staging models has increasingly sought to identify trans-diagnostic biomarkers or neurocognitive deficits that may play a role in the onset and trajectory of mental disorders and could represent modifiable treatment targets. Less attention has been directed at the potential role of cognitive-emotional regulation processes such as ruminative response style. Maladaptive rumination (toxic brooding) is a known mediator of the association between gender and internalizing disorders in adolescents and is increased in individuals with a history of early adversity. Furthermore, rumination shows moderate levels of genetic heritability and is linked to abnormalities in neural networks associated with emotional regulation and executive functioning. This review explores the potential role of rumination in exacerbating the symptoms of alcohol and substance misuse, and bipolar and psychotic disorders during the peak age range for illness onset. Evidence shows that rumination not only amplifies levels of distress and suicidal ideation, but also extends physiological responses to stress, which may partly explain the high prevalence of physical and mental co-morbidity in youth presenting to mental health services. In summary, the normative developmental trajectory of rumination and its role in the evolution of mental disorders and physical illness demonstrates that rumination presents a detectable, modifiable trans-diagnostic risk factor in youth.
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Affiliation(s)
- A. B. Grierson
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - I. B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - S. L. Naismith
- Charles Perkins Centre & Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - J. Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Observing Interactions between Children and Adolescents and their Parents: The Effects of Anxiety Disorder and Age. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:1079-91. [PMID: 25788041 PMCID: PMC4494040 DOI: 10.1007/s10802-015-0005-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Parental behaviors, most notably overcontrol, lack of warmth and expressed anxiety, have been implicated in models of the development and maintenance of anxiety disorders in children and young people. Theories of normative development have proposed that different parental responses are required to support emotional development in childhood and adolescence, yet age has not typically been taken into account in studies of parenting and anxiety disorders. In order to identify whether associations between anxiety disorder status and parenting differ in children and adolescents, we compared observed behaviors of parents of children (7-10 years) and adolescents (13-16 years) with and without anxiety disorders (n = 120), while they undertook a series of mildly anxiety-provoking tasks. Parents of adolescents showed significantly lower levels of expressed anxiety, intrusiveness and warm engagement than parents of children. Furthermore, offspring age moderated the association between anxiety disorder status and parenting behaviors. Specifically, parents of adolescents with anxiety disorders showed higher intrusiveness and lower warm engagement than parents of non-anxious adolescents. A similar relationship between these parenting behaviors and anxiety disorder status was not observed among parents of children. The findings suggest that theoretical accounts of the role of parental behaviors in anxiety disorders in children and adolescents should distinguish between these different developmental periods. Further experimental research to establish causality, however, would be required before committing additional resources to targeting parenting factors within treatment.
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31
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Prevention and Intervention for Anxiety Disorders in Children and Adolescents: A Whole School Approach. ACTA ACUST UNITED AC 2016. [DOI: 10.1017/s1037291100004738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper explores a whole school approach to the prevention and intervention for anxiety disorders in children and adolescents. Anxiety disorders are the most prevalent psychopathology in childhood and adolescence. In addition to having serious consequences for academic, social and family life, anxiety has also been shown to be a precursor to depression, substance abuse and eating disorders. School counsellors are well placed to identify students with anxiety disorders, instigate prevention programs and treat or refer anxious students. Prevention and early intervention for anxiety disorders needs to be coordinated and integrated into the regular curriculum as well as into the life of the classroom and the school. Barriers to schools working well in this area are identified and discussed.
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Gordon-Hollingsworth AT, Becker EM, Ginsburg GS, Keeton C, Compton SN, Birmaher BB, Sakolsky DJ, Piacentini J, Albano AM, Kendall PC, Suveg CM, March JS. Anxiety Disorders in Caucasian and African American Children: A Comparison of Clinical Characteristics, Treatment Process Variables, and Treatment Outcomes. Child Psychiatry Hum Dev 2015; 46:643-55. [PMID: 25293650 PMCID: PMC4390415 DOI: 10.1007/s10578-014-0507-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined racial differences in anxious youth using data from the Child/Adolescent Anxiety Multimodal Study (CAMS) [1]. Specifically, the study aims addressed whether African American (n = 44) versus Caucasian (n = 359) children varied on (1) baseline clinical characteristics, (2) treatment process variables, and (3) treatment outcomes. Participants were ages 7-17 and met DSM-IV-TR criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Baseline data, as well as outcome data at 12 and 24 weeks, were obtained by independent evaluators. Weekly treatment process variables were collected by therapists. Results indicated no racial differences on baseline clinical characteristics. However, African American participants attended fewer psychotherapy and pharmacotherapy sessions, and were rated by therapists as less involved and compliant, in addition to showing lower mastery of CBT. Once these and other demographic factors were accounted for, race was not a significant predictor of response, remission, or relapse. Implications of these findings suggest African American and Caucasian youth are more similar than different with respect to the manifestations of anxiety and differences in outcomes are likely due to treatment barriers to session attendance and therapist engagement.
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Affiliation(s)
- Arlene T. Gordon-Hollingsworth
- Department of Pediatrics, Psychology Section, Baylor College of Medicine, 6701 Fannin Street, CC1630, Houston, TX 77030, USA
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, USA
| | - Emily M. Becker
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, 65 Kane Street, Room 1005, West Hartford, CT 06119, USA
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, USA
| | - Scott N. Compton
- Department of Psychiatry, Duke University Medical Center, Suite 3527, Durham, NC 27710, USA
| | - Boris B. Birmaher
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburg, PA 15213, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburg, PA, USA
| | - Dara J. Sakolsky
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburg, PA 15213, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburg, PA, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Anne M. Albano
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Philip C. Kendall
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA
| | - Cynthia M. Suveg
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA
| | - John S. March
- Division of Neurosciences Medicine, Duke Research Institute, 2400 Pratt Street, Durham, NC 27710, USA
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Yap MBH, Fowler M, Reavley N, Jorm AF. Parenting strategies for reducing the risk of childhood depression and anxiety disorders: A Delphi consensus study. J Affect Disord 2015; 183:330-8. [PMID: 26047961 DOI: 10.1016/j.jad.2015.05.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Substantial evidence that some modifiable parental factors are associated with childhood depression and anxiety indicates that parents can play a crucial role in the prevention of these disorders in their children. However, more effective translation of research evidence is required. METHODS This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing depression or anxiety disorders in children aged 5-11 years. A literature search identified 289 recommendations for parents. These were presented to a panel of 44 international experts over three survey rounds, who rated their preventive importance. RESULTS 171 strategies were endorsed as important or essential for preventing childhood depression or anxiety disorders by ≥90% of the panel. These were written into a parenting guidelines document, with 11 subheadings: Establish and maintain a good relationship with your child, Be involved and support increasing autonomy, Encourage supportive relationships, Establish family rules and consequences, Encourage good health habits, Minimise conflict in the home, Help your child to manage emotions, Help your child to set goals and solve problems, Support your child when something is bothering them, Help your child to manage anxiety, and Encourage professional help seeking when needed. LIMITATIONS This study relied on experts from Western countries; hence the strategies identified may not be relevant for all ethnic groups. CONCLUSIONS This study produced new parenting guidelines that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their children from depression and anxiety disorders.
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Affiliation(s)
- Marie Bee Hui Yap
- School of Psychological Sciences, Monash University, Bld 17, 18 Innovation Walk, Clayton, Victoria 3800, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Michelle Fowler
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Nicola Reavley
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Anthony Francis Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Australia
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Hale DR, Bevilacqua L, Viner RM. Adolescent Health and Adult Education and Employment: A Systematic Review. Pediatrics 2015; 136:128-40. [PMID: 26101362 DOI: 10.1542/peds.2014-2105] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Poor health in adolescence has the potential to disrupt education and employment pathways. This study is the first systematic review of the literature examining education and employment outcomes in adulthood of poor adolescent mental and physical health. METHODS We conducted searches using a standardized search protocol in 8 electronic databases: PsycINFO, Medline, Embase, ERIC, British Education Index, Australian Education Index, Social Sciences Citation Index, and CINAHL Plus. We identified studies that longitudinally compared adult education and employment outcomes of those with an adolescent chronic condition of clinical severity with healthy controls. We conducted meta-analyses using odds ratios (for dichotomous variables) and Cohen's d (for continuous variables) as our main summary statistics. RESULTS We identified 27 studies incorporating 70 relevant analyses. Our meta-analyses suggested that overall, poor health in adolescence was associated with poorer education and employment outcomes in adulthood. However, evidence was much stronger for mental health conditions than for physical health conditions, for which less evidence was available and mixed findings emerged. Compared with mental health conditions, we identified few studies investigating the long-term outcomes of physical health conditions. Age and follow-up times varied considerably across our studies, which potentially resulted in some heterogeneity in effect sizes. The majority of included studies were conducted in the United States, raising questions about the generalizability of the results internationally. CONCLUSIONS Health in adolescence contributes to adult attainment and life chances. The results suggest that investment in health may improve life chances and that policy interventions may improve outcomes for those with adolescent chronic conditions.
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Affiliation(s)
- Daniel R Hale
- University College London Institute of Child Health, London, UK
| | | | - Russell M Viner
- University College London Institute of Child Health, London, UK
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Yap MBH, Jorm AF. Parental factors associated with childhood anxiety, depression, and internalizing problems: a systematic review and meta-analysis. J Affect Disord 2015; 175:424-40. [PMID: 25679197 DOI: 10.1016/j.jad.2015.01.050] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in children. However, there is hitherto no systematic review of this complex literature with a focus on the 5-11 years age range, when there is a steep increase in onset of these disorders. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required. METHODS Employing the PRISMA method, we conducted a systematic review of parental factors associated with anxiety, depression, and internalizing problems in children which parents can potentially modify. RESULTS We identified 141 articles altogether, with 53 examining anxiety, 50 examining depression, and 70 examining internalizing outcomes. Stouffer׳s method of combining p-values was used to determine whether associations between variables were reliable, and meta-analyses were conducted with a subset of eligible studies to estimate the mean effect sizes of associations between each parental factor and outcome. LIMITATIONS Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, the lack of generalizability across cultures, and the inability to conduct a meta-analysis on all included studies. CONCLUSIONS Parental factors with a sound evidence base indicating increased risk for both depression and internalizing problems include more inter-parental conflict and aversiveness; and for internalizing outcomes additionally, they include less warmth and more abusive parenting and over-involvement. No sound evidence linking any parental factor with anxiety outcomes was found.
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Affiliation(s)
- Marie Bee Hui Yap
- School of Psychological Sciences, Monash University, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Anthony Francis Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Australia
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36
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Knapp AA, Blumenthal H, Mischel ER, Badour CL, Leen-Feldner EW. Anxiety Sensitivity and Its Factors in Relation to Generalized Anxiety Disorder among Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 44:233-44. [DOI: 10.1007/s10802-015-9991-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2015; 2015:CD004690. [PMID: 25692403 PMCID: PMC6491167 DOI: 10.1002/14651858.cd004690.pub4] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND A previous Cochrane review (James 2005) showed that cognitive behavioural therapy (CBT) was effective in treating childhood anxiety disorders; however, questions remain regarding (1) the relative efficacy of CBT versus non-CBT active treatments; (2) the relative efficacy of CBT versus medication and the combination of CBT and medication versus placebo; and (3) the long-term effects of CBT. OBJECTIVES To examine (1) whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison with (a) wait-list controls; (b) active non-CBT treatments (i.e. psychological placebo, bibliotherapy and treatment as usual (TAU)); and (c) medication and the combination of medication and CBT versus placebo; and (2) the long-term effects of CBT. SEARCH METHODS Searches for this review included the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Group Register, which consists of relevant randomised controlled trials from the bibliographic databases-The Cochrane Library (1970 to July 2012), EMBASE, (1970 to July 2012) MEDLINE (1970 to July 2012) and PsycINFO (1970 to July 2012). SELECTION CRITERIA All randomised controlled trials (RCTs) of CBT versus waiting list, active control conditions, TAU or medication were reviewed. All participants must have met the criteria of the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD) for an anxiety diagnosis, excluding simple phobia, obsessive-compulsive disorder, post-traumatic stress disorder and elective mutism. DATA COLLECTION AND ANALYSIS The methodological quality of included trials was assessed by three reviewers independently. For the dichotomous outcome of remission of anxiety diagnosis, the odds ratio (OR) with 95% confidence interval (CI) based on the random-effects model, with pooling of data via the inverse variance method of weighting, was used. Significance was set at P < 0.05. Continuous data on each child's anxiety symptoms were pooled using the standardised mean difference (SMD). MAIN RESULTS Forty-one studies consisting of 1806 participants were included in the analyses. The studies involved children and adolescents with anxiety of mild to moderate severity in university and community clinics and school settings. For the primary outcome of remission of any anxiety diagnosis for CBT versus waiting list controls, intention-to-treat (ITT) analyses with 26 studies and 1350 participants showed an OR of 7.85 (95% CI 5.31 to 11.60, Z = 10.26, P < 0.0001), but with evidence of moderate heterogeneity (P = 0.04, I² = 33%). The number needed to treat (NNT) was 6.0 (95% CI 7.5 to 4.6). No difference in outcome was noted between individual, group and family/parental formats. ITT analyses revealed that CBT was no more effective than non-CBT active control treatments (six studies, 426 participants) or TAU in reducing anxiety diagnoses (two studies, 88 participants). The few controlled follow-up studies (n = 4) indicate that treatment gains in the remission of anxiety diagnosis are not statistically significant. AUTHORS' CONCLUSIONS Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow-up, is limited and inconclusive.
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Affiliation(s)
- Anthony C James
- University of Oxford Department of Psychiatry, University of Oxford, Oxford, UK, OX3 7JX.
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Abstract
Anxiety disorders belong to the most frequent mental disorders and are often characterized by an early onset and a progressive, persistent/chronic, or recurrent course. Several individual, familial, and environmental risk factors for adverse course characteristics of anxiety disorders (including higher persistence, lower probability of remission, and increased risk of recurrence) have been identified, and previous research suggests that clinical features of anxiety (e.g., higher severity, duration, and avoidance) as well as comorbid other mental disorders are particularly useful for predicting an unfavorable course of anxiety disorders. However, additional studies are needed to identify risk factors for individual course trajectories of anxiety disorders in general as well as specific diagnoses. Doing so is essential in order to more precisely identify individuals with anxiety disorders who are at increased risk for adverse long-term outcomes and might thus particularly profit from targeted early interventions.
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Waite P, Creswell C. Children and adolescents referred for treatment of anxiety disorders: differences in clinical characteristics. J Affect Disord 2014; 167:326-32. [PMID: 25016489 PMCID: PMC4147961 DOI: 10.1016/j.jad.2014.06.028] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 12/02/2022]
Abstract
BACKGROUND Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful. METHODS A consecutive series of children (n=100, aged 6-12 years) and adolescents (n=100, aged 13-18 years), referred to a routine clinical service, were assessed for anxiety and comorbid disorders, school refusal and parental symptoms of psychopathology. RESULTS Children with a primary anxiety disorder were significantly more likely to be diagnosed with separation anxiety disorder than adolescents. Adolescents with a primary anxiety disorder had significantly higher self and clinician rated anxiety symptoms and had more frequent primary diagnoses of social anxiety disorder, diagnoses and symptoms of mood disorders, and irregular school attendance. LIMITATIONS Childhood and adolescence were considered categorically as distinct, developmental periods; in reality changes would be unlikely to occur in such a discrete manner. CONCLUSIONS The finding that children and adolescents with anxiety disorders have distinct clinical characteristics has clear implications for treatment. Simply adapting treatments designed for children to make the materials more 'adolescent-friendly' is unlikely to sufficiently meet the needs of adolescents.
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Affiliation(s)
- Polly Waite
- School of Psychology and Clinical Language Sciences, Whiteknights, University of Reading, Reading RG6 6AL, UK.
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Adler Nevo GW, Avery D, Fiksenbaum L, Kiss A, Mendlowitz S, Monga S, Manassis K. Eight years later: outcomes of CBT-treated versus untreated anxious children. Brain Behav 2014; 4:765-74. [PMID: 25328851 PMCID: PMC4188368 DOI: 10.1002/brb3.274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/21/2014] [Accepted: 07/27/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric disorders of childhood, generate significant distress, are considered precursors to diverse psychiatric disorders, and lead to poor social and employment outcomes in adulthood. Although childhood anxiety has a significant impact on a child's developmental trajectory, only a handful of studies examined the long-term impact of treatment and none included a control group. The aim of this study was to conduct a long-term follow-up (LTFU) of anxious children who were treated with Cognitive-Behavioral Therapy (CBT) compared to a matched group of children who were not. METHODS Subjects comprised 120 children: a treatment group which included the first 60 consecutive consenting children who were diagnosed with an anxiety disorder and treated with CBT between the years 1997 and 2003 and a control group, 60 matched children who were assessed but not treated with CBT. An "ex-post-facto" design was used to compare the two groups. RESULTS Children showed lower rates of anxiety diagnosis (about 50% for both groups) and significantly improved functioning at LTFU (time effect P < 0.0001; no group difference). Anxiety levels were significantly lower in the nontreatment group at LTFU as compared to initial assessment (P = 0.02), but not in the treatment group, and a significant between-group difference was found (P = 0.01) according to child. An inverse relationship was found between self-efficacy/self-esteem and anxiety outcome ([P = 0.0008] and [P = 0.04], respectively). CONCLUSIONS This study supports the assumption that childhood anxiety disorders may improve without treatment and highlights self-efficacy/self-esteem as potential factors in recovery.
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Affiliation(s)
- Gili W Adler Nevo
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, Sunnybrook Health Sciences Centre Toronto, ON, Canada
| | - David Avery
- Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | | | - Alex Kiss
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, Sunnybrook Health Sciences Centre Toronto, ON, Canada
| | - Sandra Mendlowitz
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | - Suneeta Monga
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | - Katharina Manassis
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
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Abstract
AbstractObjectives: To examine the prevalence and persistence of psychological problems in older adolescents.Methods: This study is a one year follow-up of 110 adolescents, 64 girls and 46 boys attending three secondary schools in Ireland. All were 16 at initial testing. The Youth Self Report (YSR) was the measure used.Results: Over a fifth of adolescents have problems in the clinical range. These problems persisted from 16 to 17. Females reported more problems than males at both ages. Some females showed a slight reduction in internalising problems at 17. Both males and females showed an increase in externalising problems at 17. Odds ratios indicate that those in the clinical ranges of the YSR at 16, had increased risk of being in the clinical range at 17 compared to those in the no problem range at 16. In comparison to those with no suicidal feeling, those with suicidal feelings at 16 were at an increased risk of still feeling suicidal at 17. More males remained psychologically healthy than girls.Conclusions: A large proportion of adolescents in this sample have psychological problems and these appear to persist over a one year period. These problems impact substantially on the adolescents themselves, their families and society. Given the increasing suicide rate in young people and the persistence of suicidal feelings in this cohort, the inadequacy of mental health services in Ireland for adolescents, particularly those ages 16-18 is highlighted. The challenge of developing and providing adolescent friendly services is addressed.
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Riglin L, Petrides KV, Frederickson N, Rice F. The relationship between emotional problems and subsequent school attainment: a meta-analysis. J Adolesc 2014; 37:335-46. [PMID: 24793380 DOI: 10.1016/j.adolescence.2014.02.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 02/10/2014] [Accepted: 02/17/2014] [Indexed: 12/30/2022]
Abstract
Longitudinal studies have provided mixed findings regarding the relationship between emotional problems and subsequent poor school attainment. A meta-analysis of 26 community-based studies of children and adolescents was performed. Results revealed a prospective association between emotional problems and poor school attainment. More consistent associations were found for depression than anxiety. Moderator analyses indicated that some of the heterogeneity between studies may be due to age and gender, with reduced heterogeneity particularly notable for school grades during early adolescence and for anxiety by gender. Findings suggest that early identification and provision of support for young people with emotional problems may be helpful for improving academic outcomes such as school attainment.
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Affiliation(s)
- Lucy Riglin
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - K V Petrides
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Norah Frederickson
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Frances Rice
- Department of Clinical, Educational and Health Psychology, University College London, UK.
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Yap MBH, Pilkington PD, Ryan SM, Kelly CM, Jorm AF. Parenting strategies for reducing the risk of adolescent depression and anxiety disorders: a Delphi consensus study. J Affect Disord 2014; 156:67-75. [PMID: 24359862 DOI: 10.1016/j.jad.2013.11.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/20/2013] [Accepted: 11/21/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The family setting, particularly parents, is a strategic target for preventive interventions for youth depression and anxiety disorders. However, more effective translation of relevant research evidence is required. METHOD This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing adolescent depression or anxiety disorders. A literature search identified 402 recommendations for parents. These were presented to a panel of 27 international experts over three survey rounds, who rated their preventive importance. RESULTS One-hundred and ninety parenting strategies were endorsed as important or essential in reducing adolescents' risk of developing depression or anxiety disorders by ≥90% of the panel. These strategies were written into a document suitable for parents, categorised under 11 sub-headings: You can reduce your child's risk of depression and anxiety problems, Establish and maintain a good relationship with your teenager, Be involved and support increasing autonomy, Establish family rules and consequences, Minimise conflict in the home, Encourage supportive relationships, Help your teenager deal with problems, Encourage good health habits, Help your teenager to deal with anxiety, Encourage professional help seeking when needed, and Don׳t blame yourself. LIMITATIONS This study utilised an international panel of experts from Western countries, hence the strategies identified may not be relevant for families from other cultural groups. CONCLUSIONS This study produced a set of parenting strategies that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their adolescents from depression and anxiety disorders.
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Affiliation(s)
- Marie B H Yap
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia.
| | - Pamela D Pilkington
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Siobhan M Ryan
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Claire M Kelly
- Mental Health First Aid Australia, Australia; School of Psychology, Deakin University, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
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Yap MBH, Pilkington PD, Ryan SM, Jorm AF. Parental factors associated with depression and anxiety in young people: a systematic review and meta-analysis. J Affect Disord 2014; 156:8-23. [PMID: 24308895 DOI: 10.1016/j.jad.2013.11.007] [Citation(s) in RCA: 319] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 09/16/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in young people. However, there is hitherto no systematic review of this complex literature with a focus on the 12-18 years age range, when the first onset for these disorders peaks. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required. METHODS Employing the PRISMA method, we conducted a systematic review of parental factors associated with depression and anxiety disorders in young people which parents can potentially modify. RESULTS We identified 181 articles altogether, with 140 examining depression, 17 examining anxiety problems, and 24 examining both outcomes. Stouffer's method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations between each parental factor and outcome. LIMITATIONS Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, not systematically reviewing moderators and mediators, the lack of generalizability across cultures and to younger or adult children, and the inability to conduct a meta-analysis on all included studies. CONCLUSIONS Parental factors with a sound evidence base indicating increased risk for both depression and anxiety include less warmth, more inter-parental conflict, over-involvement, and aversiveness; and for depression additionally, they include less autonomy granting and monitoring.
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Affiliation(s)
- Marie Bee Hui Yap
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Pamela Doreen Pilkington
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Siobhan Mary Ryan
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Anthony Francis Jorm
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia
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Kushnir J, Gothelf D, Sadeh A. Nighttime fears of preschool children: a potential disposition marker for anxiety? Compr Psychiatry 2014; 55:336-41. [PMID: 24262125 DOI: 10.1016/j.comppsych.2013.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 07/15/2013] [Accepted: 08/11/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine if children who suffer from significant Nighttime Fears (NF) experience higher degree of general fears and behavioral problems and to explore whether effortful control mediates NF association with internalizing problems. METHODS One-hundred and nine preschool children (64 boys) between the ages 4 and 6years suffering from significant NF and 30 healthy children (16 boys) were evaluated using parental reports of behavioral problems [Child Behavior Checklist (CBCL)], parental and child report of fears [Fear Survey Revised for Parents (FSS-PC), Koala Fear Questionnaire (KFQ)], and a measure of effortful control derived from the Child Behavior Questionnaire (CBQ). RESULTS Children with severe NF also suffer from an increased level of a wide variety of fears other than NF, and exhibit more behavioral problems than controls both on parental and children's measures of general fears, and main CBCL scale scores (Internalizing, Externalizing, Total score). Additionally, children with NF had lower abilities of effortful control (as manifested in CBQ attention and inhibitory control scales). Attention control mediated NF association to internalizing problems scale. CONCLUSIONS NF may serve as a marker for anxiety vulnerability, and this vulnerability might be mediated by abnormal attentional control. Our finding also highlights the need for a more comprehensive assessment of behavioral problems, fears and anxiety phenomena among children referred with NF.
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Affiliation(s)
- Jonathan Kushnir
- The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Doron Gothelf
- The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Avi Sadeh
- The School of Psychological Sciences, Tel-Aviv University, Israel
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Perceived school safety is strongly associated with adolescent mental health problems. Community Ment Health J 2014; 50:127-34. [PMID: 23354812 DOI: 10.1007/s10597-013-9599-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 01/17/2013] [Indexed: 11/25/2022]
Abstract
School environment is an important determinant of psychosocial function and may also be related to mental health. We therefore investigated whether perceived school safety, a simple measure of this environment, is related to mental health problems. In a population-based sample of 11,130 secondary school students, we analysed the relationship of perceived school safety with mental health problems using multiple logistic regression analyses to adjust for potential confounders. Mental health problems were defined using the clinical cut-off of the self-reported Strengths and Difficulties Questionnaire. School safety showed an exposure-response relationship with mental health problems after adjustment for confounders. Odds ratios increased from 2.48 ("sometimes unsafe") to 8.05 ("very often unsafe"). The association was strongest in girls and young and middle-aged adolescents. Irrespective of the causal background of this association, school safety deserves attention either as a risk factor or as an indicator of mental health problems.
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47
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Kozina A. Developmental and time-related trends of anxiety from childhood to early adolescence: Two-wave cohort study. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2014. [DOI: 10.1080/17405629.2014.881284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Salum GA, Desousa DA, do Rosário MC, Pine DS, Manfro GG. Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35 Suppl 1:S03-21. [PMID: 24142122 DOI: 10.1590/1516-4446-2013-s108] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.
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Affiliation(s)
- Giovanni Abrahão Salum
- Universidade Federal do Rio Grande do Sul, Anxiety Disorders Outpatient Program for Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, Porto AlegreRS, Brazil
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Rapee RM. Treatments for childhood anxiety disorders: integrating physiological and psychosocial interventions. Expert Rev Neurother 2014; 11:1095-7. [DOI: 10.1586/ern.11.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Rooney RM, Morrison D, Hassan S, Kane R, Roberts C, Mancini V. Prevention of internalizing disorders in 9-10 year old children: efficacy of the Aussie Optimism Positive Thinking Skills Program at 30-month follow-up. Front Psychol 2013; 4:988. [PMID: 24421776 PMCID: PMC3872743 DOI: 10.3389/fpsyg.2013.00988] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/11/2013] [Indexed: 11/13/2022] Open
Abstract
THE AUSSIE OPTIMISM Positive Thinking Skills Program (AOPTP) is a school-based prevention program aimed at addressing anxious and depressive symptoms in children aged 9-10 years. Nine-hundred and ten students from 22 Australian primary schools situated in low socio-economic areas were randomly assigned to either an intervention or control group, and assessed at a 30-month follow up. Those in the intervention group received the AOPTP program, where the control group continued to receive the regular health education course. Students completed self-report measures regarding their levels of depression, anxiety, and attribution style. Parents also reported on their children's externalizing and internalizing problems outside of school. There were no significant differences between groups in regard to anxiety or depression, as well as no significant differences in attributional styles. Parents reported significantly less hyperactive behaviors from children in the intervention group. This finding suggests that AOP-PTS has the capacity to treat externalizing problems at a medium term effect. The decrease in the externalizing problems provides evidence of a partial medium term intervention effect. Future studies should continue to evaluate the program at a long term follow up.
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Affiliation(s)
- Rosanna M Rooney
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University Perth, WA, Australia
| | - David Morrison
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University Perth, WA, Australia
| | - Sharinaz Hassan
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University Perth, WA, Australia
| | - Robert Kane
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University Perth, WA, Australia
| | - Clare Roberts
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University Perth, WA, Australia
| | - Vincent Mancini
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University Perth, WA, Australia
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