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Furlong M, McGuinness C, Mulligan CM, McGarr SL, McGilloway S. Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness: a randomised controlled trial and cost analysis. Front Psychiatry 2024; 15:1287378. [PMID: 38606410 PMCID: PMC11007704 DOI: 10.3389/fpsyt.2024.1287378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/31/2024] [Indexed: 04/13/2024] Open
Abstract
Background Parental mental illness (PMI) is common and places children at high risk of developing psychological disorders. Family Talk (FT) is a well-known, whole-family, 7-session intervention designed to reduce the risk of transgenerational psychopathology. However, very few larger-scale evaluations of FT (across only a limited number of settings) have been conducted to date while there have been no cost analyses. This study aimed to assess the effectiveness and costs of delivering FT in improving child and family psychosocial functioning in families with PMI within routine mental health settings. Methods A total of 83 families with PMI, with children aged 5-18 years, were randomly assigned on a 2:1 ratio to receive either the FT intervention (n=55 families) or usual services (n=28 families) across 10 adult, child and primary care mental health sites in Ireland. Parental disorders included anxiety/depression (57%), Bipolar Disorder (20%), Borderline Personality Disorder (12%), Post-Traumatic Stress Disorder (8%) and psychosis (2%). Detailed assessments with parents were conducted at baseline and 6-month follow up. Results FT led to significant improvements in family functioning and child behaviour at 6-month follow up when compared to usual services, with medium effect sizes indicated. Parent participants with lower mental health literacy at baseline also showed significant post-intervention improvements. Those parents with less severe mental illness at baseline, and families with more partner and economic supports, reported additional significant post-intervention improvements in child depression/anxiety and parental mental health symptoms. The cost of FT amounted to €761.50 per family, although this decreased to €415.31 when recurring costs only were included. Conclusion The findings from this study, which was conducted within the context of a national programme to introduce family-focused practice in Ireland, demonstrate that FT is a low-cost intervention that improved child and family psychosocial functioning across different mental health disorders within routine adult, child and primary care mental health services. The findings contribute to the growing evidence base for FT, and provide a robust basis to inform practice and policy development for families with parental mental illness both in Ireland and elsewhere. Clinical trial registration https://www.isrctn.com/ISRCTN13365858, identifier ISRCTN13365858.
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Affiliation(s)
- Mairead Furlong
- Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland
| | | | - Christine Marie Mulligan
- Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland
| | - Sharon Lisa McGarr
- Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Maynooth University Department of Psychology and Social Sciences Institute, Maynooth, Ireland
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Bauer A, Cartagena-Farias J, Christiansen H, Goodyear M, Schamschula M, Zechmeister-Koss I, Paul J. Acceptability, engagement and exploratory outcomes and costs of a co-designed intervention to support children of parents with a mental illness: Mixed-methods evaluation and descriptive analysis. Int J Ment Health Nurs 2024. [PMID: 38500242 DOI: 10.1111/inm.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Children whose parents have a mental illness are much more likely to experience mental health problems and other adverse long-term impacts. Child-centred psychosocial interventions can be effective, but not much is known about how to design and implement them in different settings. A pre-post, mixed methods, single-arm evaluation of a co-designed social support intervention with parents and children (4-18 years) measured parents' mental health (PHQ-9), perceived social support (ENRICHD), parental self-efficacy (PSAM) and children's mental health (SDQ), quality of life (Kidscreen-27), and child service use (CAMHSRI-EU) at baseline and 6 months. Qualitative data were gathered at 6 months to explore parents' and children's experience with the intervention. Twenty-nine parents and 21 children completed baseline and follow-up questionnaires; 22 parents and 17 children participated in interviews. Parents' depression (MD -1.36, SD 8.08), perceived social support (MD 1, SD 5.91), and children's mental health potentially improved, and children's service use and costs potentially reduced (€224.6 vs. €122.2, MD 112.4). Parental self-efficacy was potentially reduced (MD -0.11, SD 3.33). The sample was too small to perform statistical analysis. Favourable themes emerged describing the high satisfaction with the intervention, parents' improved understanding of the impact of their mental health problems on children, and improvements in parent-child relationships. This study contributes to an emerging evidence base for co-designed child-centred interventions to prevent the transgenerational transmission of poor mental health.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, Victoria, Australia
| | - Mona Schamschula
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Wien, Austria
| | | | - Jean Paul
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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3
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Bluth K, Lathren C, Park J, Lynch C, Curry J, Harris-Britt A, Gaylord S. Feasibility, acceptability, and depression outcomes of a randomized controlled trial of Mindful Self-Compassion for Teens (MSC-T) for adolescents with subsyndromal depression. J Adolesc 2024; 96:322-336. [PMID: 38010232 PMCID: PMC10948004 DOI: 10.1002/jad.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/26/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Adolescents are experiencing high rates of depressive symptoms, with negative consequences to their long-term health. Group-based, mindful self-compassion programs show promise in mitigating the development of more significant depression in at-risk adolescents. However, the lack of well-designed, active control conditions has limited the ability to examine the efficacy of such interventions. METHODS Fifty-nine adolescents (Mage = 15.81, 70% female) with subsyndromal depressive symptoms from the Southeastern US were randomized to group-based Mindful Self-Compassion for Teens (N = 30) or a newly developed active control Healthy Lifestyles group (N = 29) during 2018 and 2019. Participants attended 8 weekly "main" sessions followed by 6 monthly continuation sessions. The feasibility and acceptability of participation in both groups were measured using attrition, attendance, credibility, and satisfaction data. Depression scores were collected weekly, and self-compassion scores were collected five times across 36 weeks. RESULTS Both groups were equally feasible and acceptable during the 8-week program period; however, monthly continuation sessions were poorly attended in both groups. The risk of developing clinically significant depression was 2.6 times higher in the control group compared with the self-compassion group (p = .037) across 36 weeks. Depression significantly decreased in the self-compassion group, while it significantly increased in the control group. Both groups increased significantly in reports of self-compassion. These findings are on par with results noting the efficacy of cognitive-based interventions for high-risk adolescents; follow-up studies with larger sample sizes should be conducted to confirm these findings. CONCLUSIONS Initial examination suggests Mindful Self-Compassion for Teens programming is feasible, acceptable, and efficacious in preventing the development of clinically significant depression in adolescents with subsyndromal depression. Future studies may benefit from refinements to the self-compassion measurement and/or the attention control condition; moreover, larger sample sizes are needed to confirm results.
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Affiliation(s)
- Karen Bluth
- Department of Psychiatry, University of North Carolina School of Medicine, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christine Lathren
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jinyoung Park
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Chanee Lynch
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - John Curry
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - April Harris-Britt
- AHB Center for Behavioral Health and Wellness, Durham, North Carolina, USA
| | - Susan Gaylord
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Gladstone TRG, Zhong C, Lowther M, Feinstein RT, Fitzgibbon ML, Gussin HA, Schiffer L, Diviak K, Berbaum ML, Rusiewski C, Ramirez P, Lefaiver C, Canel J, Mitchell J, Buchholz KR, Van Voorhees BW. PATHway: Intervention optimization of a prevention program for adolescents at-risk for depression in the primary care setting. Contemp Clin Trials 2024; 137:107413. [PMID: 38114047 PMCID: PMC10923135 DOI: 10.1016/j.cct.2023.107413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
With as many as 13% of adolescents diagnosed with depressive disorders each year, prevention of depressive disorders has become a key priority for the National Institute of Mental Health (NIMH). Currently, we have no widely available interventions to prevent these disorders. To address this need, we developed a multi-health system collaboration to develop and evaluate the primary care based technology "behavioral vaccine," Competent Adulthood Transition with Cognitive-Behavioral Humanistic and Interpersonal Therapy (CATCH-IT). The full CATCH-IT program demonstrated evidence of efficacy in prevention of depressive episodes in clinical trials. However, CATCH-IT became larger and more complex across trials, creating issues with adherence and scalability. We will use a multiphase optimization strategy approach to optimize CATCH-IT. The theoretically grounded components of CATCH-IT include: behavioral activation, cognitive-behavioral therapy, interpersonal psychotherapy, and parent program. We will use a 4-factor (2x2x2x2) fully crossed factorial design with N = 16 cells (25 per cell, after allowing 15% dropout) to evaluate the contribution of each component. Eligible at-risk youth will be high school students 13 through 18 years old, with subsyndromal symptoms of depression. The study design will enable us to eliminate non-contributing components while preserving efficacy and to optimize CATCH-IT by strengthening tolerability and scalability by reducing resource use. By reducing resource use, we anticipate satisfaction and acceptability will also increase, preparing the way for an implementation trial.
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Affiliation(s)
- Tracy R G Gladstone
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02903, USA.
| | - Cordelia Zhong
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Matthew Lowther
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Rebecca T Feinstein
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Marian L Fitzgibbon
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA; Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois, Chicago, IL 60612, USA; Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Hélène A Gussin
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Linda Schiffer
- Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Kathleen Diviak
- Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA; University of Illinois, Cancer Center, Chicago, Il 60612, USA
| | - Calvin Rusiewski
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Paula Ramirez
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Cheryl Lefaiver
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL 60515, USA
| | - Jason Canel
- NorthShore University Health System, Evanston, IL 60201, USA
| | - James Mitchell
- Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL 60637, USA
| | | | - Benjamin W Van Voorhees
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
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Ayoub M, Udo C, Årestedt K, Kreicbergs U, Lövgren M. The Family Talk Intervention in Pediatric Oncology: Potential Effects Reported by Parents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:95. [PMID: 38255408 PMCID: PMC10814711 DOI: 10.3390/children11010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Childhood cancer impacts the family system and has psychosocial consequences for all family members. For the parents, the ill child, and the siblings to be able to adjust to this challenging situation, the whole family needs access to psychosocial support. However, only a few such family interventions in pediatric oncology have been evaluated. The aim of this study was to explore the potential effects of a family-centered intervention, the Family Talk Intervention (FTI), in pediatric oncology from the parents' perspectives. METHODS A concurrent mixed methods design was used for this study. Data were derived from a pilot study of 26 families recruited from one pediatric oncology center in Sweden. This study focused on questionnaire and interview data from 52 parents. RESULTS After participation in FTI, the parents felt more satisfied with the conversations within the family about the illness. FTI also contributed to strengthened family togetherness, including more open communication and improved family relations, as described by the parents. Parents further expressed that they felt more empowered in their parenting role following FTI. CONCLUSIONS The findings regarding FTI's ability to improve family communication and family relations, thus strengthening family togetherness in families with childhood cancer, are promising. This provides motivation for a large-scale study of FTIs in pediatric oncology.
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Affiliation(s)
- Maria Ayoub
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden;
| | - Camilla Udo
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden;
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden; (U.K.); (M.L.)
- Center for Clinical Research Dalarna, Uppsala University, 791 82 Falun, Sweden
| | - Kristofer Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Science, Linnaeus University, 352 52 Växjö, Sweden;
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden; (U.K.); (M.L.)
- Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institute, 171 77 Solna, Sweden
- Louis Dundas Center, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden; (U.K.); (M.L.)
- Advanced Pediatric Home Care, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, 171 64 Solna, Sweden
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Holm M, Lundberg T, Lövgren M, Ljungman L. Parenting a child with cancer and maintaining a healthy couple relationship: Findings from the Family Talk Intervention. Pediatr Blood Cancer 2024; 71:e30709. [PMID: 37817346 DOI: 10.1002/pbc.30709] [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: 06/13/2023] [Revised: 09/07/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Despite the challenges that caring for a child with cancer brings for parents, little knowledge is available concerning the effects on the parents' couple relationship. Furthermore, few interventions have been designed to support parents in their couple relationship. The aim of this paper was, therefore, to explore parents' experiences of their couple relationship while having a dependent child with cancer and the support they received from a family-based intervention, the Family Talk Intervention (FTI). METHODS Data for this paper were taken from semi-structured interviews performed in a pilot study of the FTI in the context of pediatric oncology. In total, 22 couples were interviewed after participating in the FTI. The interviews were transcribed and analyzed using qualitative content analysis. RESULTS Parents described how maintaining a couple relationship while living with childhood cancer could be very challenging and was not given the highest priority. The FTI was considered a way of providing important support to the couple and a chance for them to sit down together and listen to each other's perspectives on the situation. Parents described that the FTI had helped them gain an increased mutual understanding, sometimes also helping them to realize that they needed more extensive professional support in their relationship. CONCLUSIONS Living with childhood cancer and upholding a healthy couple relationship is challenging for parents. The FTI has the potential to support couples, mainly by providing opportunities for parents to communicate with each other. However, some couples may be in need of a tailored clinical intervention.
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Affiliation(s)
- Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Tina Lundberg
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Advanced Pediatric Home Care, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Mukumbang FC, Beima-Sofie K, Neary J, Li H, Agot K, Healy E, Wilson KS, Badia J, Kibugi J, Inwani I, Chhun N, John-Stewart G, Kohler P, Shah SK. 'I feel that I should decide on my own….': who should be involved in the decision-making process for adolescent involvement in HIV research? BMJ Glob Health 2023; 8:e012966. [PMID: 37963612 PMCID: PMC10649498 DOI: 10.1136/bmjgh-2023-012966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Efforts to improve health outcomes among adolescents and young adults living with HIV (ALHs) are hampered by limited adolescent engagement in HIV-related research. We sought to understand the views of adolescents, caregivers and healthcare workers (HCWs) about who should make decisions regarding ALHs' research participation. METHODS We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with ALHs (aged 14-24 years), caregivers of ALHs and HCWs from six HIV care clinics in Western Kenya. We used semi-structured guides to explore ALHs' involvement in research decisions. Transcripts were analysed using thematic analysis; perspectives were triangulated between groups. RESULTS We conducted 24 FGDs and 44 IDIs: 12 FGDs with ALHs, 12 with caregivers, and 44 IDIs with HCWs, involving 216 participants. HCWs often suggested that HIV research decision-making should involve caregivers and ALHs deciding together. In contrast, ALHs and parents generally thought decisions should be made individually, whether by HCWs/research teams (although this is likely ethically problematic), adolescents or caregivers. Caregiver and ALH preferences depended on ALHs' age, with younger ALHs requiring more support. A few caregivers felt that ALHs should consult with the research team/HCWs due to their greater knowledge of clinical care. ALHs emphasised that they should independently decide because they thought they had the right to do so and the capacity to consent. Poor communication and parental non-disclosure of HIV status influenced ALHs' views to exclude caregivers from decision-making. Regarding influences on research decision-making, ALHs were more willing to participate based on perceived contribution to science and less interested in participating in studies with potential risks, including loss of confidentiality. DISCUSSION While research teams and HCWs felt that adolescents and caregivers should jointly make research decisions, ALHs and caregivers generally felt individuals should make decisions. As ALHs sometimes find caregiver support lacking, improving family dynamics might enhance research engagement.
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Affiliation(s)
| | - Kristen Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jillian Neary
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Huangqianyu Li
- Department of Health Services, University of Washington-Seattle Campus, Seattle, Washington, USA
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Elise Healy
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kate S Wilson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jacinta Badia
- Impact Research and Development Organization, Kisumu, Kenya
| | - James Kibugi
- Impact Research and Development Organization, Kisumu, Kenya
| | - Irene Inwani
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Nok Chhun
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Seema K Shah
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
- Bioethics Program, Lurie Children's Hospital Chicago, Chicago, Illinois, USA
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Marlotte L, Klomhaus A, Ijadi-Maghsoodi R, Aralis H, Lester P, Griffin Esperon K, Kataoka S. Implementing depression care in under-resourced communities: a school-based family resilience skill-building pilot randomized controlled trial in the United States. Front Psychol 2023; 14:1233901. [PMID: 37790229 PMCID: PMC10542892 DOI: 10.3389/fpsyg.2023.1233901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Youth in under-resourced communities are more likely to have greater social risk factors for mental health needs yet have less access to needed care. School-based mental health services are effective in treating common disorders such as adolescent depression; however, few have a family-centered approach, which may especially benefit specific populations. Methods Utilizing a community-partnered approach, we adapted an established, trauma-informed, resilience skill-building family intervention for adolescents with depression. We conducted a small randomized controlled feasibility pilot of an adapted intervention in a large school district that serves predominately low-income, Latinx students in the Southwest United States between 2014-2017. Youth between the ages of 12-18 years old with a Patient Health Questionnaire (PHQ-8) score of 10 or higher, who spoke English or Spanish, were recruited from 12 school mental health clinics. Twenty-five eligible adolescents with depression and their participating caregivers were enrolled and randomly assigned to receive either the adapted intervention, Families OverComing Under Stress for Families with Adolescent Depression (FOCUS-AD), or usual care, Cognitive Behavioral Therapy (CBT) only. Most of the sample was Latinx and female. We evaluated feasibility, acceptability, and preliminary effectiveness. Results Among participants who completed standardized assessments administered at baseline and approximately five months post-randomization (n = 10 FOCUS-AD, n = 11 CBT only), effectiveness was explored by identifying significant changes over time in adolescent mental health within the FOCUS-AD and CBT only groups and comparing the magnitude of these changes between groups. Nonparametric statistical tests were used. We found the FOCUS-AD intervention to be feasible and acceptable; participant retention was high. Adolescent symptoms of depression (measured by the PHQ-8) improved significantly from baseline to follow-up for youth in both FOCUS-AD (median decrease [MD] = 10, p = 0.02) and control (MD = 6, p = 0.01) groups, with no significant difference across the two groups. Results were similar for symptoms of PTSD (measured by the Child PTSD Symptom Scale; FOCUS-AD MD = 12.5, p = 0.01; CBT only MD = 7, p = 0.04; no significant difference between groups). Conclusion Family-centered approaches to depression treatment among adolescents living in under-resourced communities may lead to improved mental health, although further research is warranted.
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Affiliation(s)
- Lauren Marlotte
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roya Ijadi-Maghsoodi
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- VA Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Hilary Aralis
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Patricia Lester
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Sheryl Kataoka
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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Burkhouse KL, Dao A, Argiros A, Granros M, Cárdenas E, Dickey L, Feurer C, Hill K, Pegg S, Venanzi L, Kujawa A. Targeting positive valence systems function in children of mothers with depressive symptoms: A pilot randomized trial of an RDoC-Informed preventive intervention. Behav Res Ther 2023; 168:104384. [PMID: 37591042 PMCID: PMC10542884 DOI: 10.1016/j.brat.2023.104384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
Reduced activation of the Research Domain Criteria (RDoC) positive valence systems (PVS) is observed in high-risk (HR) children of depressed mothers and predictive of future psychopathologies. We developed a dyadic, neuroscience-informed preventive intervention, Family Promoting Positive Emotions (FPPE), designed to prevent psychopathology in HR children by targeting PVS processes. We evaluated the initial efficacy of FPPE compared to written information (WI) psychoeducation in engaging PVS-related targets and reducing perceived stress and emotional distress symptoms in HR youth. Participants included 74 children ages 8-12 years and their biological mothers reporting elevated depressive symptoms. Following random assignment, 55 dyads completed FPPE (n = 29) or WI (n = 26) and pre-post assessments of child clinical symptoms. Youth completed a reinforcement learning task and 10 days of positive affect ratings to assess PVS-related targets. Results revealed a small within-subjects increase in child daily positive affect in FPPE, but not WI. Further, FPPE resulted in reductions in mother-reported child perceived stress and symptoms of anger, anxiety, and depression with medium-to-large within-subjects effects. Intervention effects on reinforcement learning and child-rated clinical symptoms were not observed. This study suggests FPPE shows promise in enhancing positive affect and reducing the emergence of clinical symptoms in HR children. CLINICALTRIALS.GOV IDENTIFIER: NCT05223842.
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Affiliation(s)
- Katie L Burkhouse
- The Research Institute, Nationwide Children's Hospital, USA; The Ohio State University, Department of Psychiatry and Behavioral Health, USA
| | - Anh Dao
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Alexandra Argiros
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Maria Granros
- University of Illinois at Chicago, Department of Psychiatry, USA
| | - Emilia Cárdenas
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Lindsay Dickey
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Cope Feurer
- University of Illinois at Chicago, Department of Psychiatry, USA
| | - Kaylin Hill
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Samantha Pegg
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Lisa Venanzi
- Vanderbilt University, Department of Psychology and Human Development, USA
| | - Autumn Kujawa
- Vanderbilt University, Department of Psychology and Human Development, USA.
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10
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Guo J, Liu X, Huang N, Yang F, Bai Y, Zhang B, Lodder P. School-based Psychosocial interventions on mental health among Chinese rural children with traumatic experiences: a protocol using cluster randomized controlled trial. BMC Psychol 2023; 11:148. [PMID: 37143099 PMCID: PMC10157979 DOI: 10.1186/s40359-023-01182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The first aim of this study is to test the effectiveness of school-based psychosocial interventions for improving mental health in rural Chinese children with traumatic experiences. The second aim is to examine which individual, family and school related factors could explain the effectiveness of school-based psychosocial interventions. Third, we will investigate whether individual, family, and school related conditions play a moderator role on the effectiveness of school-based psychosocial interventions. METHODS This study will conduct a cluster randomized controlled trial (RCT) in a large sample of Chinese rural children. Four rural counties in Shandong (Central China), Henan (Central China), Inner Mongolia (Northern China), and Xinjiang (Western China) will be selected as study settings from which schools will be sampled. Each sampled school will be randomly allocated either the intervention groups or a control group. Randomization will be performed by the research member who is not involved in the intervention stage. In each school students in grade 5 or higher will be recruited to ensure that approximately 50 children aged 10 to 18 years will be included. In each county, one high school, one middle school, and one primary school will be randomly chosen as the intervention group, and the other three similar schools will be chosen as control (waiting list) groups. A standardized and uniform research protocol will be applied in all intervention schools. All school social workers and psychological teachers would receive one week of in-person training following procedures. School-based psychosocial interventions included 14 group sessions for 14 consecutive weeks. DISCUSSION This study would develop school-based mental health promotion policy recommendations to improve Chinese rural children's mental health. This study can provide solid evidence for the promotion of school-based intervention in general. TRIAL REGISTRATION ChiCTR2300069405, Registered on 15 March 2023.
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Affiliation(s)
- Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, P. R. China.
| | - Xiaohan Liu
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, P. R. China
| | - Ning Huang
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, P. R. China
| | - Fan Yang
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, P. R. China
| | - Yashuang Bai
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, P. R. China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
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11
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Myers TL, Gladstone TRG, Beardslee WR. The Transition to Adulthood in Children of Depressed Parents: Long-Term Follow-Up Data from the Family Talk Preventive Intervention Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3313. [PMID: 36834008 PMCID: PMC9965635 DOI: 10.3390/ijerph20043313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Little is known about the effects of parental depression on offspring as they transition to adulthood-a challenging time developmentally, when late adolescents must separate from home, achieve intimate relationships, and develop a sense of identity. We present long-term quantitative and qualitative data from early adolescents with a depressed parent who were randomized to one of two family-based preventive interventions and followed over time, across the transition to young adulthood. Specifically, we present clinical measures of psychopathology and Likert-scale questionnaire data from young adults and their parents regarding the transition to adulthood and perceptions of the interventions. We also report in-depth qualitative interview data from young adults about the effects of parental depression on their transition to adulthood. Findings suggest that leaving home, establishing relationships, and coping with stressors may be challenging for emerging adults. Furthermore, the interviews highlight the importance of siblings, the burden of parental depression, and the development of self-understanding and empathy in young adults who grew up with a depressed parent. Data suggest that clinicians, policy makers, educators, and employers must address the preventive and clinical needs of young people and their families as they transition to young adulthood after growing up with depressed parents.
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Affiliation(s)
- Taylor L. Myers
- Wellesley Centers for Women, Wellesley College, 106 Central St., Wellesley, MA 02481, USA
| | - Tracy R. G. Gladstone
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 South Main St., Providence, RI 02903, USA
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12
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DiClemente-Bosco K, Neville SE, Berent JM, Farrar J, Mishra T, Abdi A, Beardslee WR, Creswell JW, Betancourt TS. Understanding mechanisms of change in a family-based preventive mental health intervention for refugees by refugees in New England. Transcult Psychiatry 2023; 60:142-155. [PMID: 35989681 PMCID: PMC9943782 DOI: 10.1177/13634615221111627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transnational migration of refugees is associated with poor mental health, particularly among children. We conducted a pilot trial of the Family Strengthening Intervention for Refugees (FSI-R), using a community-based participatory research (CBPR) approach to deliver a home-based intervention "for refugees by refugees" to improve family functioning and child mental health. N = 80 refugee families in the Greater Boston area participated in the study (n = 40 Somali Bantu families; n = 40 Bhutanese families) with n = 41 families randomized to care-as-usual. Of the 39 families who received FSI-R, n = 36 caregivers and children completed qualitative exit interviews. We present findings from these interviews to identify the mechanisms through which a family-strengthening intervention for refugees can be acceptable, feasible, and effective at improving family functioning and children's mental health outcomes. Authors applied Grounded Theory to code interview transcripts and detailed field notes and used an iterative process to arrive at final codes, themes, and a theoretical framework. The greatest contributors to acceptability and feasibility included flexibility in scheduling intervention sessions, the interventionist being a community member, and improvements to family communication and time spent together. All of these factors were made possible by the CBPR approach. Our findings suggest that given the socio-political context within the U.S. and the economic challenges faced by refugee families, the successful implementation of such interventions hinges on culturally-grounding the intervention design process, drawing heavily on community input, and prioritizing community members as interventionists.
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Affiliation(s)
- Kira DiClemente-Bosco
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Sarah Elizabeth Neville
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Jenna M. Berent
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Jordan Farrar
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Tej Mishra
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Abdirahman Abdi
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | | | - John W. Creswell
- Department of Family Medicine, University of Michigan Medical School, Dexter, MI, USA
| | - Theresa S. Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
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13
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Dean L, Buechner H, Moffett B, Maritze M, Dalton LJ, Hanna JR, Rapa E, Stein A, Tollman S, Kahn K. Obstacles and facilitators to communicating with children about their parents' mental illness: a qualitative study in a sub-district of Mpumalanga, South Africa. BMC Psychiatry 2023; 23:78. [PMID: 36707793 PMCID: PMC9883085 DOI: 10.1186/s12888-023-04569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents' symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts. METHODS A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis. RESULTS Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals' concerns for the wellbeing and future mental health of patients' children, as well as their hopes for increased mental health awareness amongst future generations. CONCLUSIONS This study provides insight into healthcare professionals' attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent's mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.
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Affiliation(s)
- Lucy Dean
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Hadassah Buechner
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Bianca Moffett
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meriam Maritze
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise J. Dalton
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jeffrey R. Hanna
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Alan Stein
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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14
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Wirehag Nordh EL, Grip K, Thorvaldsson V, Priebe G, Afzelius M, Axberg U. Preventive interventions for children of parents with depression, anxiety, or bipolar disorder: A quasi-experimental clinical trial. Acta Paediatr 2023; 112:132-142. [PMID: 36169579 PMCID: PMC10092553 DOI: 10.1111/apa.16555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
Abstract
AIM To investigate the effectiveness of preventive interventions for 8-17-year-old children of patients diagnosed with depression, anxiety, or bipolar disorder. METHODS Sixty-two families including 89 children received either the more extensive Family Talk Intervention (FTI; n = 35), the brief Let's Talk about Children (LTC; n = 16), or Interventions as Usual (IAU; n = 38) in routine care in adult psychiatry. Parent-rated questionnaire data were collected at baseline, after 6 and 12 months. We used growth curve models to investigate the effect of intervention on child mental health problems (SDQ-P Total Difficulties) and perceived parental control of child behaviour (PLOC-PPC). RESULTS Parents in the FTI and LTC groups, versus the IAU group, reported more favourable development in terms of preventing increase in child mental health problems with standardised intervention effects of d = -0.86 and -0.88 respectively, by study end, and reported improved perceived parental control, d = 1.08 and 0.71, respectively, by study end. No significant differences in effect were found when FTI and LTC were compared. CONCLUSIONS The results support continued use of FTI and LTC in adult psychiatry, and since LTC is a brief intervention, it might be useful as a minimum-level preventive intervention.
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Affiliation(s)
| | - Karin Grip
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | | | - Gisela Priebe
- Department of Social and Psychological Studies and CBU, Centre for Research on the Mental Health and Life Circumstances of Children and Youth, Karlstad University, Karlstad, Sweden
| | - Maria Afzelius
- Department of Social Work, Malmo University, Malmo, Sweden
| | - Ulf Axberg
- Faculty of Social Studies, VID Specialized University, Oslo, Norway
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15
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Wang SS, Glied S, Babcock C, Chaudry A. Changes in the Public Charge Rule and Health of Mothers and Infants Enrolled in New York State’s Medicaid Program, 2014‒2019. Am J Public Health 2022; 112:1747-1756. [DOI: 10.2105/ajph.2022.307066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives. To examine the effect of the January 2017 leak of the federal government’s intent to broaden the public charge rule (making participation in some public programs a barrier to citizenship) on immigrant mothers and newborns in New York State. Methods. We used New York State Medicaid data (2014–2019) to measure the effects of the rule leak (January 2017) on Medicaid enrollment, health care utilization, and severe maternal morbidity among women who joined Medicaid during their pregnancies and on the birth weight of their newborns. We repeated our analyses using simulated measures of citizenship status. Results. We observed an immediate statewide delay in prenatal Medicaid enrollment by immigrant mothers (odds ratio = 1.49). Using predicted citizenship, we observed significantly larger declines in birth weight (−56 grams) among infants of immigrant mothers. Conclusions. Leak of the public charge rule was associated with a significant delay in prenatal Medicaid enrollment among immigrant women and a significant decrease in birth weight among their newborns. Local public health officials should consider expanding health access and outreach programs to immigrant communities during times of pervasive antiimmigrant sentiment. (Am J Public Health. 2022; 112(12):1747–1756. https://doi.org/10.2105/AJPH.2022.307066 )
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Affiliation(s)
- Scarlett Sijia Wang
- The authors were affiliated with the Wagner School of Public Service at New York University, New York, NY, at the completion of the article
| | - Sherry Glied
- The authors were affiliated with the Wagner School of Public Service at New York University, New York, NY, at the completion of the article
| | - Claudia Babcock
- The authors were affiliated with the Wagner School of Public Service at New York University, New York, NY, at the completion of the article
| | - Ajay Chaudry
- The authors were affiliated with the Wagner School of Public Service at New York University, New York, NY, at the completion of the article
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16
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A Systematic Review of Evidence-Based Family Interventions for Trauma-Affected Refugees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159361. [PMID: 35954717 PMCID: PMC9367780 DOI: 10.3390/ijerph19159361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
Family connections are crucial for trauma-affected refugees from collectivistic cultures. Evidence-based family interventions are consistently promoted to support a host of mental and relational health needs of families exposed to traumatic stressors; however, there is still limited research focused on cultural adaptation and the testing of the effectiveness of these interventions on some of the most disenfranchised populations in the aftermath of forced displacement. This systematic review was conducted to examine the reach of existing evidence-based family interventions implemented with newly resettled refugees globally. Studies included in this review include those testing the effectiveness of a systemic treatment with pre and post intervention evaluation, studies with or without control groups, and studies that include at least one family member in addition to the target participants. Twelve studies met the inclusion criteria. Barriers to conducting randomized control trials with displaced refugee populations are discussed. Recommendations are made for future studies to include a focus on scientifically rigorous multi-method designs, specific cultural adaptation frameworks, and the integration of relational aspects rather than focusing only on individual adjustment. Global displacement continues to rise; therefore, it is imperative that the mental health and wellbeing of displaced populations be treated with a comprehensive, multi-level framework.
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17
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Eklund R, Lövgren M. The Family Talk Intervention in Pediatric Oncology: Ill Children's Descriptions of Feasibility and Potential Effects. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:143-154. [PMID: 35467434 DOI: 10.1177/27527530221068423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: There are few scientifically evaluated psychosocial interventions in pediatric oncology, despite the needs for families. The family-based psychosocial intervention "The Family Talk Intervention" (FTI) has shown promising results in other care contexts and was therefore pilot-tested in pediatric oncology. In this study, we examined the experiences of participating in FTI from ill children's perspectives regarding feasibility and potential effects. Methods: This pilot study involved 26 families in pediatric oncology that had participated in FTI. The paper is focused on those ill children who answered surveys (n = 19) and/or participated in interviews (n = 11) when FTI had ended. Data were analyzed with descriptive statistics and thematic analysis. Results: For most ill children, FTI came at the right time, included a reasonable number of meetings, and the length of the meetings was appropriate. The children felt listened to and understood by the interventionists and almost all children reported that FTI had helped them in some way. The children's perceptions indicated that FTI improved communication within the family and strengthened family relations. Children reported that the parents and their siblings seemed to feel better after participation and became more understanding. Discussion: The findings of this pilot study indicated that a full-scale study could be valuable from the ill children's perspective, as FTI was reported as feasible and had positive effects. The findings showed that FTI gave families an opportunity to open up communication about the illness, adjust their behaviors, and strengthen family relationships. Trial registration: ClinicalTrials.gov Identifier NCT03650530.
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Affiliation(s)
- Rakel Eklund
- 7643Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, 8097Uppsala University, Uppsala, Sweden
| | - Malin Lövgren
- 7643Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, Stockholm, Sweden
- Advanced Pediatric Home Care, Astrid Lindgren Children's Hospital, 59562Karolinska University Hospital, Stockholm, Sweden
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18
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Lövgren M, Udo C, Kreicbergs U. Is the family talk intervention feasible in paediatric oncology? An evaluation of a family-based psychosocial intervention. Acta Paediatr 2022; 111:684-692. [PMID: 34787928 DOI: 10.1111/apa.16190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
AIM To examine the feasibility of a family-based psychosocial intervention, Family Talk Intervention (FTI), in paediatric oncology in terms of recruitment, retention, delivery, response rate and acceptability from the parents' perspective. METHODS This study involved 26 families affected by childhood cancer. FTI encompasses six family meetings, with the main goal being to facilitate family communication about illness-related subjects. Meeting 5 is preferably moderated by the parents. Extra meetings (7-11) can be held if needed. This paper includes observational data and surveys, and interviews with parents. RESULTS All families who started FTI underwent the full intervention and the survey response rate varied between 100% and 71% over time. Extra meetings were held with most families. The parents stated that FTI filled a gap of support to the family as a unit and described FTI as a map they could follow. Since FTI was conducted at home, this created a safe environment, which contributed to their participation. The parents valued the children's perspectives being considered, but some felt uncomfortable moderating 'the family talk' (meeting 5). CONCLUSION Family talk intervention was valued by parents, but it would benefit from being slightly modified before a large trial can be developed.
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Affiliation(s)
- Malin Lövgren
- Palliative Research Centre Department of Health Care Sciences Ersta Sköndal Bräcke University College Stockholm Sweden
- Advanced Pediatric Home Care Karolinska University Hospital Stockholm Sweden
| | - Camilla Udo
- Palliative Research Centre Department of Health Care Sciences Ersta Sköndal Bräcke University College Stockholm Sweden
- School of Education, Health and Society Dalarna University College Falun Sweden
- Center for Clinical Research Dalarna‐Uppsala University Falun Sweden
| | - Ulrika Kreicbergs
- Palliative Research Centre Department of Health Care Sciences Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Women's and Children's Health Childhood Cancer Research Unit Karolinska Institute Stockholm Sweden
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19
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Ivéus K, Eklund R, Kreicbergs U, Lövgren M. Family bonding as a result of the family talk intervention in pediatric oncology: Siblings' experiences. Pediatr Blood Cancer 2022; 69:e29517. [PMID: 34971075 DOI: 10.1002/pbc.29517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood cancer affects the whole family. Illness-related stressors increase the risk for poor family communication, affecting the family's well-being. Siblings describe worry and poor illness-related information. As there are few evaluated family interventions in pediatric oncology, this study aimed to pilot-test a family-centered intervention, the family talk intervention (FTI), in pediatric oncology. This paper examined the feasibility in terms of acceptability from the siblings' perspectives. METHODS This study derives from a pilot study of 26 families including 37 siblings recruited from one pediatric oncology center. Standard FTI comprises six meetings with the family, led by two interventionists, with the main goal to facilitate family communication on illness-related topics (e.g., prognosis, the invisibility of healthy siblings). This paper focuses on interview and survey data from siblings after participation in FTI. The study is registered at ClinicalTrials.gov (Identifier NCT03650530). RESULTS The siblings, aged 6 to 24 years, stated that the interventionists made the meetings feel like a safe environment and that it was a relief for the siblings to talk. They reported that FTI helped the family talk openly about illness-related topics, which they felt led to increased family understanding and improved relationships. The siblings described that FTI also helped them with their school situation. The majority of the siblings reported that FTI came at the right time and involved an appropriate number of meetings. CONCLUSION According to the siblings, the timing, content, and structure of FTI were appropriate. FTI showed benefits for both the siblings and each family as a whole.
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Affiliation(s)
- Kerstin Ivéus
- Lilla Erstagården Children's and Youth Hospice, Ersta Hospital, Stockholm, Sweden
| | - Rakel Eklund
- National Centre for Disaster Psychiatry, Department of Medical Science, Uppsala University, Uppsala, Sweden.,Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Pediatric Oncology and Hematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Childhood Cancer Research Unit, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Advanced Pediatric Home Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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20
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Thorup AAE, Gantriis DL, Greve AN, Henriksen MT, Zahle KK, Stadsgaard H, Ellersgaard D, Burton BK, Christiani CJ, Spang K, Hemager N, Jepsen JRM, Plessen KJ, Nordentoft M, Mors O, Bliksted V. Exploring protective and risk factors in the home environment in high-risk families - results from the Danish High Risk and Resilience Study-VIA 7. BMC Psychiatry 2022; 22:100. [PMID: 35139818 PMCID: PMC8827286 DOI: 10.1186/s12888-022-03733-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Exposure to inadequate home environment may put the healthy development of familial high-risk children at risk. This study aimed to investigate associations between risk factors and an adequate home environment of children having a parent diagnosed with schizophrenia or bipolar disorder. METHODS From a cohort of 522 children, data from 463 7-year-old children was included. Of these 172 children had familial risk for schizophrenia, 109 children had familial risk for bipolar disorder, and 190 were population-based controls. As part of a comprehensive battery, all participants were assessed with the Middle Childhood-Home Observation for Measurement of the Environment Inventory (MC-HOME Inventory) measuring the quality of the home environment. RESULTS When analyzing all families together, we found that having a parent diagnosed with schizophrenia would have a negative impact on the home environment (ß = -1.08; 95% CI (-2.16;-0.01); p = 0.05), while familial risk for bipolar disorder did not show significant predictive value. Being a single caregiver and child having experienced severe life events from ages 4 to 7 showed significant negative impact, while child having a mental illness diagnosis did not. Being a female caregiver, good social functioning of the caregiver, high child IQ and not being a single caregiver were found to predict positive values for the home environment. We found similar results when analyzing caregivers with and without a diagnosis separately. CONCLUSIONS Knowledge of what predicts good home environment should be used to inform development of early interventions for families at risk.
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Affiliation(s)
- Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark. .,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Ditte Lou Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Skejby Psychiatry, Aarhus, Denmark
| | - Aja Neergaard Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Skejby Psychiatry, Aarhus, Denmark
| | - Maria Toft Henriksen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Skejby Psychiatry, Aarhus, Denmark
| | - Kate Kold Zahle
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Skejby Psychiatry, Aarhus, Denmark
| | - Henriette Stadsgaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Skejby Psychiatry, Aarhus, Denmark
| | - Ditte Ellersgaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Centre for Neuropsychiatric Schizophrenia Research & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitte Klee Burton
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Jerlang Christiani
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,CORE Copenhagen Research Unit, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Copenhagen, Denmark
| | - Katrine Spang
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,CORE Copenhagen Research Unit, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Copenhagen, Denmark
| | - Nicoline Hemager
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.,CORE Copenhagen Research Unit, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.,Centre for Neuropsychiatric Schizophrenia Research & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Copenhagen, Denmark.,CORE Copenhagen Research Unit, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Copenhagen, Denmark
| | - Kerstin J Plessen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, University Medical Center, University of Lausanne, Lausanne, Switzerland
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,CORE Copenhagen Research Unit, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Copenhagen, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Skejby Psychiatry, Aarhus, Denmark
| | - Vibeke Bliksted
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Skejby Psychiatry, Aarhus, Denmark
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21
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Uchida M, Hung Y, Green A, Kelberman C, Capella J, Gaillard SL, Gabrieli JDE, Biederman J. Association between frontal cortico-limbic white-matter microstructure and risk for pediatric depression. Psychiatry Res Neuroimaging 2021; 318:111396. [PMID: 34695702 PMCID: PMC9073702 DOI: 10.1016/j.pscychresns.2021.111396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
This study aimed to identify white-matter microstructural characteristics associated with risk for pediatric major depressive disorder (MDD) measured by the Child Behavior Checklist (CBCL) Anxiety/Depression scores. Children (N = 32) of both sexes, aged 6-12, underwent T1-weighted whole-head anatomical and diffusion-weighted imaging. Each participant's mean diffusion measure image was generated and thinned to create an alignment-invariant tract representation. Voxel-wise analysis on the resulting map was carried out in Track Based Spatial Statistics (TBSS) using general linear models by regressing the CBCL-Anxiety/Depression score against measures of diffusion tensor imaging (DTI). We also compared these results with prior DTI findings from the same children associated with CBCL-Emotion Dysregulation profile, an indicator for bipolar disorder. TBSS voxel-wise analysis showed a significant negative correlation between fractional anisotropy (FA) and CBCL-Anxiety/Depression scores localized in the right anterior cingulum and connected corpus callosal region. The negative FA correlations in these regions were greater in CBCL-Anxiety/ Depression scores compared to CBCL-Emotional Dysregulation scores. Reduced white-matter connectivity in the anterior cingulum and connected corpus callosal region may represent a biomarker of risk for pediatric MDD. These results may help identify brain differences associated with the development of MDD, and assist with earlier clinical identification of pediatric MDD.
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Affiliation(s)
- Mai Uchida
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Yuwen Hung
- MIT Integrated Learning Initiative, Department of Brain and Cognitive Sciences, and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, United States of America
| | - Caroline Kelberman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, United States of America
| | - James Capella
- MIT Integrated Learning Initiative, Department of Brain and Cognitive Sciences, and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Schuylar L Gaillard
- MIT Integrated Learning Initiative, Department of Brain and Cognitive Sciences, and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - John D E Gabrieli
- MIT Integrated Learning Initiative, Department of Brain and Cognitive Sciences, and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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22
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Patafio B, Miller P, Baldwin R, Taylor N, Hyder S. A systematic mapping review of interventions to improve adolescent mental health literacy, attitudes and behaviours. Early Interv Psychiatry 2021; 15:1470-1501. [PMID: 33393231 DOI: 10.1111/eip.13109] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/18/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022]
Abstract
AIM The onset of mental illness is most common in adolescence, therefore mental health promotion efforts frequently target this age group. Evaluation literature in this area is largely segmented into specific domains in terms of settings, countries, and/or groups of young people, but an overall understanding and comparison across these areas is lacking. The current review aims to provide such an overview of interventions/programs which attempt to improve adolescents' mental health literacy, attitudes/stigma and behaviours. METHODS A systematic mapping review synthesized the strengths and weaknesses of published interventions/programs to improve mental health outcomes in youth. Ten databases and grey literature sources were searched, and results were categorized according to sample, location/setting, type of information presented, delivery and testing procedures, mental health outcome/s evaluated, and limitations. RESULTS One hundred and forty articles met the inclusion criteria; 126 were original records and 14 were reviews. Mental health literacy and attitudes/stigma were examined most frequently, and studies were predominantly conducted in school-based environments and high income economies. Intervention/program effectiveness varied across outcome/s measured, setting, and control group usage, with mental health literacy exhibiting the most positive changes overall. Common limitations included no long-term follow up or control group inclusion. CONCLUSIONS Despite generally positive changes seen throughout studies in this area, effectiveness differed across a range of methodological domains. Most research is conducted in schools and higher income economies, but the lack of investigation in other contexts (i.e., internet or community) or lower income countries suggests our understanding in this area is constrained.
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Affiliation(s)
- Brittany Patafio
- School of Psychology, Faculty of Health, Deakin University Geelong, Waterfront Campus, Geelong, Victoria, Australia
| | - Peter Miller
- School of Psychology, Faculty of Health, Deakin University Geelong, Waterfront Campus, Geelong, Victoria, Australia
| | - Ryan Baldwin
- School of Psychology, Faculty of Health, Deakin University Geelong, Waterfront Campus, Geelong, Victoria, Australia
| | - Nicholas Taylor
- School of Psychology, Faculty of Health, Deakin University Geelong, Waterfront Campus, Geelong, Victoria, Australia
| | - Shannon Hyder
- School of Psychology, Faculty of Health, Deakin University Geelong, Waterfront Campus, Geelong, Victoria, Australia
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23
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Children in the Blind Spot of Social Medical Concerns: Supporting Children with Mentally Ill Parents in Korea. Community Ment Health J 2021; 57:1525-1536. [PMID: 33428033 DOI: 10.1007/s10597-020-00772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
Children whose parents have mental disorders are more likely to be vulnerable and exposed to an environment where they may not be cared for by parents or guardians in Korea. Particularly, young children often develop mental disorders or maladaptive behaviors. This study aimed to implement a structured program to enhance the resilience of school-aged children whose parents have mental disorders and to analyze its effectiveness through a single-group pretest-posttest experimental design. The Korean Child Personality Inventory for Self-Report self-resilience and clinical scales were used, and daily behavioral observation logs showed decreases in psychosis scores among all children, anxiety scores among girls, and somatization and physical development among boys. Self-efficacy, social competency, and acceptance toward families increased. Therefore, the improvement of resilience and clinical symptoms was confirmed through this program, suggesting it should be expanded and developed in local community healthcare sites to help support children with mentally ill parents.
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24
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Sell M, Radicke A, Adema B, Daubmann A, Kilian R, Stiawa M, Busmann M, Winter SM, Lambert M, Wegscheider K, Plass-Christl A, Wiegand-Grefe S. Parents With Mental Illness: Parental Coping Behavior and Its Association With Children's Mental Health. Front Psychiatry 2021; 12:737861. [PMID: 34733189 PMCID: PMC8558365 DOI: 10.3389/fpsyt.2021.737861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
The relevance of coping behavior for the individual's own mental health has been widely investigated. However, research on the association between coping of parents with a mental illness and their children's mental health is scarce. In the current study, we address the role of several parental coping strategies and their relation to child psychological symptoms. As part of the German randomized controlled multicenter study CHIMPS (children of mentally ill parents), parents with mental illness completed questionnaires on illness-related coping and child mental health symptoms. Children's diagnoses of a mental disorder were assessed with diagnostic interviews. The sample comprised n = 195 parents with mental illness and n = 290 children and adolescents aged 4-18 years. We conducted mixed models to investigate the associations of parental coping strategies with internalizing and externalizing symptoms as well as the diagnosis of a mental disorder in children controlling for sociodemographic factors and parental symptom severity. Parental coping characterized by religiosity and quest for meaning was significantly associated with fewer mental health symptoms and lower odds of a mental disorder in children, whereas a depressed processing style was related to increased internalizing problems in the children. Coping behavior in parents with mental illness is a relevant factor for the mental health of their children and should be considered in preventive interventions.
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Affiliation(s)
- Marlit Sell
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Radicke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bonnie Adema
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University at Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - Maja Stiawa
- Department of Psychiatry II, Ulm University at Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sibylle M. Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Plass-Christl
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Evangelical Hospital Hamburg Alsterdorf, Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Ferrara P, Franceschini G, Corsello G, Mestrovic J, Giardino I, Vural M, Pop TL, Namazova-Baranova L, Somekh E, Indrio F, Pettoello-Mantovani M. Effects of Coronavirus Disease 2019 (COVID-19) on Family Functioning. J Pediatr 2021; 237:322-323.e2. [PMID: 34224744 PMCID: PMC8253665 DOI: 10.1016/j.jpeds.2021.06.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Pietro Ferrara
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Italian Society of Pediatrics, Rome, Italy; Division of Pediatrics, University Campus BioMedico, Rome, Italy
| | | | - Giovanni Corsello
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Italian Society of Pediatrics, Rome, Italy
| | - Julije Mestrovic
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Division of Pediatrics, Medical School of Split, University Hospital of Split, Split, Croatia
| | - Ida Giardino
- Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Mehmet Vural
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Division of Pediatrics, Medical Faculty, University of Istanbul, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Tudor Lucian Pop
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Division of Pediatrics, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | - Leyla Namazova-Baranova
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Russian Academy of Pediatrics, Moscow, Russia
| | - Eli Somekh
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, Mayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | - Flavia Indrio
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy
| | - Massimo Pettoello-Mantovani
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza", Foggia, Italy.
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26
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Rusengamihigo D, Mutabaruka J, Biracyaza E, Magalakaki O, El'Husseini M. Parental mental illness and their offspring's mental health in Rwanda: neuropsychiatric hospital of Rwanda. BMC Psychol 2021; 9:135. [PMID: 34481518 PMCID: PMC8418748 DOI: 10.1186/s40359-021-00633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Offspring of the parents with mental disorders are at higher risk to have the mental diseases throughout the world. This study examined the association between psychopathology of parents and the mental health of their offspring in Neuropsychiatric Hospital of Rwanda, Butare Branch. METHODS A cross-sectional study made up of case and control offspring was conducted on the case group made up of 80 offspring born to parents with mental diseases and a control group of 80 offspring from parents without mental disease. Hamilton Rating Scale for Depression (HRSD, α = 0.82), Posttraumatic stress disorders scale (PTSD, α = 0.73) and the Test of Psychological Problems (TPP, α = 0.93) were used. STATISTICA version 8 was used for statistical analysis. RESULTS Results indicated a significance difference between the two groups on depressive symptoms, psychological problems and PTSD symptomatology. The case group seemed to experience high level symptoms than the control group. Results indicated that, among the offspring born to parents with mental disease, there was a significant correlation between anxiety and depression symptoms (r = 0.71, p < .001), PTSD and eating disorder (r = 0.75, p < .001), domestic violence and PTSD (r = 0.78, p < .001), aggressive behavior and PTSD (r = 0.79, p < .001), somatoform disorders and PTSD (r = 0.98, p < .001). No significant association between the low self-esteem, depression, anxiety, mental disorders induced drug abuse and PTSD was found. CONCLUSION Offspring of the parents with mental disorders had higher risk to develop mental diseases than the offspring born to the parents without mental diseases. Taking into account the assessment of parents' mental illness when taking care of the offspring's psychological disorders is needed in the neuropsychiatric hospital.
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Affiliation(s)
- Donat Rusengamihigo
- Department of Clinical Psychology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Jean Mutabaruka
- Department of Clinical Psychology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Emmanuel Biracyaza
- Pogramme of Sociotherapy, Prison Fellowship Rwanda (PFR), Member of Prison Fellowship International, Kigali, Rwanda
| | - Olga Magalakaki
- Department of Clinical Psychology, Université de Picardie Jules Verne (UPJV), Amiens, France
| | - Mayssa El'Husseini
- Department of Clinical Psychology, Université de Picardie Jules Verne (UPJV), Amiens, France
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27
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Breaking the silence about illness and death: Potential effects of a pilot study of the family talk intervention when a parent with dependent children receives specialized palliative home care. Palliat Support Care 2021; 20:512-518. [DOI: 10.1017/s1478951521001322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
The entire family is affected when a parent is severely ill. Parents often need and appreciate professional support when talking to children about illness and death. The family talk intervention (FTI) is family-centered and intends to promote communication about the illness and its consequences, support parenting to enhance family coping and help family members share experiences with each other to create a shared family history. This study aimed to explore potential effects of FTI in specialized palliative home care, as reported by parents.
Method
This pre-post test intervention pilot was conducted in specialized palliative home care. A convergent mixed-method design was used to analyze interview and questionnaire data. Twenty families with dependent children were recruited from two specialized palliative home care units in Stockholm, Sweden.
Results
Parents reported that family communication improved after participation in FTI as family members learned communication strategies that facilitated open sharing of thoughts and feelings. Increased open communication helped family members gain a better understanding of each other's perspectives. Parents reported that relationships with their partner and children had improved as they now shared several strategies for maintaining family relationships. Parents were also less worried following participation in FTI. The ill parents stated that they gained a sense of security and were less worried about the future.
Significance of results
This study adds to the evidence that FTI may be a useful intervention for families with dependent children and an ill parent in a palliative care setting. This trial is registered at ClinicalTrials.gov Identifier NCT03119545.
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28
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Racial/Ethnic Disparities in Depression Treatment for Caregivers Investigated by the US Child Welfare System. Acad Pediatr 2021; 21:1037-1045. [PMID: 33582310 DOI: 10.1016/j.acap.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/06/2020] [Accepted: 02/06/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether there are racial/ethnic differences in depression treatment for caregivers investigated by the US child welfare system. METHODS This cross-sectional study used baseline data from the Second National Survey of Child and Adolescent Well-being, a nationally representative sample of children and caregivers investigated by US child welfare agencies (February 2008-April 2009). We included permanent caregivers who met criteria for major depression and had available covariate data (n = 908). In multivariable logistic regression models, we estimated the associations between caregiver race/ethnicity and past-year receipt of: any depression treatment, minimally adequate depression treatment, and depression treatment from 4 sectors (general medical, psychiatry, nonpsychiatry mental health, and human services). We controlled for clinical need and access variables according to the Institute of Medicine's definition of health care disparities. RESULTS Black caregivers had the lowest rates of treatment receipt of any racial/ethnic group, with 42.2% receiving any depression treatment and 17.2% receiving minimally adequate depression treatment in the past year. In multivariable analyses controlling for clinical need and access variables, Black caregivers were less likely than White caregivers to receive any depression treatment (odds ratio [OR] = 0.49 [95% CI: 0.24-0.97]), minimally adequate depression treatment (OR = 0.37 [95% CI: 0.16-0.85]), and depression treatment from the general medical sector (OR = 0.40 [95% CI: 0.18-0.89]) in the past year (all P< .05). CONCLUSIONS Future research should examine the underlying mechanisms of Black-White disparities in depression treatment for caregivers involved with the US child welfare system and develop targeted interventions to promote equitable mental health care for this highly vulnerable population.
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29
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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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30
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Desrosiers A, Schafer C, Esliker R, Jambai M, Betancourt T. mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25443. [PMID: 33528371 PMCID: PMC7946434 DOI: 10.2196/25443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background Past trauma and exposure to violence have been related to poor emotion regulation and household violence, which can have persistent mental health effects across generations. The Family Strengthening Intervention for Early Childhood Development (FSI-ECD/called Sugira Muryango in Rwanda) is an evidence-based behavioral home-visiting intervention to promote caregiver mental health, positive parenting practices, and early childhood development among families facing adversity. In Sierra Leone and other lower- and middle-income countries, mobile health (mHealth) technology has the potential to improve health care delivery and health outcomes. Objective This study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the FSI-ECD and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care. Methods We will recruit and enroll CHWs, supervisors, and families with a child aged 6-36 months from community health clinics in Sierra Leone. CHWs and supervisors will participate in 1 problem analysis focus group and 2 user interface/user experience cycles to provide feedback on mHealth tool prototypes. Families will be randomized to mHealth-supported FSI-ECD or standard maternal and child health services. We will collect quantitative data on caregiver mental health, emotion regulation, caregiving behaviors, and family functioning at baseline, postintervention, and 3-month follow up. We will use a mixed methods approach to explore feasibility and acceptability of mHealth tools and the FSI-ECD. Mixed effects linear modeling will assess FSI-ECD effects on caregiver outcomes. Cost-effectiveness analysis will estimate costs across FSI-ECD versus standard care. Results Funding for this study was received from the National Institutes of Mental Health on August 17, 2020. Institutional Review Board approval was received on September 4, 2020. Data collection is projected to begin on December 15, 2020. Conclusions This study will provide important data on the feasibility, acceptability, and preliminary efficacy of mHealth-supported delivery of an evidence-based family home-visiting intervention in a postconflict LMIC. Trial Registration ClinicalTrials.gov NCT04481399; https://clinicaltrials.gov/ct2/show/NCT04481399. International Registered Report Identifier (IRRID) PRR1-10.2196/25443
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Affiliation(s)
| | - Carolyn Schafer
- Boston College, School of Social Work, Chestnut Hill, MA, United States
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Wiegand-Grefe S, Filter B, Busmann M, Kilian R, Kronmüller KT, Lambert M, Norra C, von Klitzing K, Albermann K, Winter SM, Daubmann A, Wegscheider K, Plass-Christl A. Evaluation of a Family-Based Intervention Program for Children of Mentally Ill Parents: Study Protocol for a Randomized Controlled Multicenter Trial. Front Psychiatry 2021; 11:561790. [PMID: 33551858 PMCID: PMC7854699 DOI: 10.3389/fpsyt.2020.561790] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/18/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Children of mentally ill parents have a three to seven times higher risk of developing mental disorders compared to the general population. For this high-risk group, specialized prevention and intervention programs have already been developed. However, there has been insufficient sytematic evaluation to date. Moreover, effectiveness and the cost-effectiveness data of the respective programs until today is very scarce and at the same time constitutes the pre-condition for the program's implementation into regular health care. Methods: The study consists of a two-group randomized controlled multicenter trial conducted at seven study sites throughout Germany and Switzerland. Participants are families with mentally ill parents and their children aged from 3 to 19 years. The intervention comprises 6 to 8 semi-structured sessions over a period of about 6 months. Topics discussed in the intervention include parental mental illness, coping, family relations and social support. Families in the control condition will receive treatment as usual. The children's mental health, assessed using the K-SADS-PL by blinded external raters will constitute the primary efficacy outcome. Further outcomes will be assessed from the parents' as well as from the children's perspectives. Participants are investigated at baseline, 6, 12, and 18 months after baseline assessment. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed. Discussion: This paper describes the evaluation of a family-based intervention program for children of mentally ill parents (CHIMPs) in the regular health care system in Germany and Switzerland. A methodically sophisticated study design has been developed to reflect the complexity of the actual health care situation. This trial will contribute to the regular health care for the high-risk group of children of mentally ill parents. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.
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Affiliation(s)
- Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bonnie Filter
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhold Kilian
- Section of Health Economics and Health Services Research, Department of Psychiatry and Psychotherapy II, Ulm University, Günzburg, Germany
| | - Klaus-Thomas Kronmüller
- Department of General Psychiatry, Landschaftsverband Westfalen-Lippe (LWL) Hospital Gütersloh, Gütersloh, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Norra
- Department of General Psychiatry and Psychotherapy, LWL Hospital Paderborn, Paderborn, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Leipzig, Germany
| | - Kurt Albermann
- Centre of Social Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Sibylle Maria Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Plass-Christl
- Department Child and Adolescent Psychiatry, Evangelical Hospital Hamburg Alsterdorf, Hamburg, Germany
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Havinga PJ, Maciejewski DF, Hartman CA, Hillegers MHJ, Schoevers RA, Penninx BWJH. Prevention programmes for children of parents with a mood/anxiety disorder: Systematic review of existing programmes and meta-analysis of their efficacy. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:212-251. [PMID: 33410149 PMCID: PMC8248072 DOI: 10.1111/bjc.12277] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Objectives To systematically describe the characteristics and techniques of prevention programmes for children of parents with mood/anxiety disorders. In addition, recruitment approaches and difficulties were identified and a meta‐analysis was conducted to examine the efficacy of these prevention programmes. Methods Randomized controlled trials assessing the efficacy of a prevention programme for children (6–25 years) of parents with mood and/or anxiety disorders were included. A systematic literature search was conducted in PubMed, PsychINFO, and CENTRAL from the earliest record to March 2019. In addition, programme manuals of identified prevention programmes were requested for a content analysis. Results Twenty‐two articles containing eight unique prevention programmes involving 1,325 subjects were identified. Programmes varied in the number and types of techniques, but all provided psychoeducation. Results suggested that recruitment via clinicians was more successful than recruitment via health maintenance organization databases. In a meta‐analysis, a significant risk difference was found in favour of prevention programmes on the risk of developing a depressive/anxiety disorder in offspring at short‐term (9–18 months follow‐up; RR = 0.37, 95% CI [0.21; 0.66]) and long‐term follow‐up (24 months or longer follow‐up; RR = 0.71, 95% CI [0.57; 0.87] and on symptom levels in offspring at post‐intervention (SMD = −0.19, 95% CI [−0.36; −0.02]) and at 12‐months follow‐up (SMD = −0.31, 95% CI [−0.57; −0.06]). Conclusions The prevention programmes combined psychoeducational elements with skills training and/or cognitive‐behavioural therapy elements. The recruitment process and the content of these programmes are sometimes insufficiently described. Nevertheless, they appear to be effective, indicating a need to further examine how these programmes exactly work and for whom. Practitioner points Preventive interventions for children of parents with mood/anxiety disorders appear to be effective in preventing these disorders in offspring. Available preventive intervention programmes focus mostly on psychoeducation, cognitive‐behavioural therapy, and family processes. More effort should be made into describing preventive interventions so that they can be easily implemented by practitioners. Studies should further examine why and for whom preventive interventions for children of parents with mood/anxiety disorders are effective.
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Affiliation(s)
- Petra J Havinga
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Dominique F Maciejewski
- Department of Developmental Psychopathology, Behavioural Science Institute, Nijmegen, The Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychology and Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Bauer A, Best S, Malley J, Christiansen H, Goodyear M, Zechmeister-Koss I, Paul J. Towards a Program Theory for Family-Focused Practice in Adult Mental Health Care Settings: An International Interview Study With Program Leaders. Front Psychiatry 2021; 12:741225. [PMID: 34744833 PMCID: PMC8568767 DOI: 10.3389/fpsyt.2021.741225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: In several high-income countries, family-focused practice programs have been introduced in adult mental health care settings to identify and support children whose parents live with mental health problems. Whilst their common goal is to reduce the impact of parental mental illness on children, the mechanisms by which they improve outcomes in different systems and settings are less well known. This kind of knowledge can importantly contribute to ensuring that practice programs achieve pre-defined impacts. Methods: The aim of this study was to develop knowledge about relationships between contextual factors, mechanisms and impact that could inform a program theory for developing, implementing, and evaluating family-focused practice. Principles of a realist evaluation approach and complex system thinking were used to conceptualize the design of semi-structured in-depth interviews with individuals who led the implementation of programs. Seventeen individuals from eight countries participated in the study. Results: Interviewees provided rich accounts of the components that programs should include, contextual factors in which they operated, as well as the behavior changes in practitioners that programs needed to achieve. Together with information from the literature, we developed an initial program theory, which illustrates the interconnectedness between changes that need to co-occur in practitioners, parents, and children, many of which related to a more open communication about parental mental health problems. Stigma, risk-focused and fragmented health systems, and a lack of management commitment were the root causes explaining, for example, why conversations about parents' mental illness did not take place, or not in a way that they could help children. Enabling practitioners to focus on parents' strengths was assumed to trigger changes in knowledge, emotions and behaviors in parents that would subsequently benefit children, by reducing feelings of guilt and improving self-esteem. Conclusion: To our knowledge, this is the first research, which synthesizes knowledge about how family-focused practice programs works in a way that it can inform the design, implementation, and evaluation of programs. Stakeholder, who fund, design, implement or evaluate programs should start co-developing and using program theories like the one presented in this paper to strengthen the design and delivery of family-focused practice.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NWS, Australia
| | - Juliette Malley
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps University, Marburg, Germany
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia
| | | | - Jean Paul
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
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Giannakopoulos G, Solantaus T, Tzavara C, Kolaitis G. Mental health promotion and prevention interventions in families with parental depression: A randomized controlled trial. J Affect Disord 2021; 278:114-121. [PMID: 32956960 DOI: 10.1016/j.jad.2020.09.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/14/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The transgenerational transmission of affective disorders calls for integrating promotion of child development in the services offered to families with parental depression. The main objective of the present research was to examine the effectiveness and differences in the impact of two relevant interventions in Greece. METHODS Thirty families of depressed patients were randomly assigned to the six-to-eight session Family Talk Intervention group and 32 families were included in the lower intensity parent-only two-to-three session Let's Talk about the Children group. Depressed parents and the eldest of their children were assessed prior to the interventions and 4, 10, and 18 months following baseline assessment. RESULTS In both groups there were significant improvements in parent's depression, anxiety, perceived social support, parenting and family functioning, as well as improvements in child's depression, anxiety, and child emotional/behavioral problems. Child's prosocial behavior, perceived social support, and health-related quality of life were significantly improved in both groups. All positive effects were evident four months following baseline assessment and could be still documented at 1.5-year follow-up. Mixed linear models showed that family functioning and parenting to a lesser extent were associated with the greatest changes in children's psychosocial outcomes in both interventions.. LIMITATIONS The lack of data regarding parents that refused to receive the interventions may limit generalizability of results. A further limitation is the lack of a no-intervention control group. CONCLUSIONS The study offers a preliminary evidence base for integrating preventive interventions for child mental health in routine clinical practice with adult depressed patients.
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Affiliation(s)
- George Giannakopoulos
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece.
| | - Tytti Solantaus
- MIELI Mental Health Finland, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Chara Tzavara
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Gerasimos Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
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Rapp AM, Chavira DA, Sugar CA, Asarnow JR. Incorporating family factors into treatment planning for adolescent depression: Perceived parental criticism predicts longitudinal symptom trajectory in the Youth Partners in Care trial. J Affect Disord 2021; 278:46-53. [PMID: 32949872 PMCID: PMC7704900 DOI: 10.1016/j.jad.2020.09.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to clarify the predictive significance of youth perceptions of parental criticism assessed using a brief measure designed to enhance clinical utility. We hypothesized that high perceived parental criticism would be associated with more severe depression over 18-months of follow-up. METHODS The study involved secondary analyses from the Youth Partners in Care trial, which demonstrated that a quality improvement intervention aimed at increasing access to evidence-based depression treatment in primary care led to improved depression outcomes at post-treatment compared to usual care enhanced by provider education regarding depression evaluation/management. Patients (N = 418; ages 13-21) were assessed at four time points: baseline; post-treatment (six-month follow-up); 12- and 18-month follow-ups. The primary analysis estimated the effect of perceived parental criticism on likelihood of severe depression (i.e., Center for Epidemiological Studies-Depression Scale ≥ 24) over post-intervention follow-ups using a repeated-measures logistic regression model. Secondarily, a linear mixed-effects growth model examined symptom trajectories from baseline through 18-months using the Mental Health Index-5, a measure of emotional distress available at all time-points. RESULTS High perceived parental criticism emerged as a robust predictor of clinically-elevated depression (OR=1.66, p=.02) and a more pernicious symptom trajectory over 18-months (β =-1.89, p<.0001). LIMITATIONS The association between the self-report perceived criticism and traditional expressed emotion measures derived from verbal and nonverbal parental behaviors was not evaluated. CONCLUSIONS Results support perceived parental criticism as a predictor of youth depression outcomes over 18-months. This brief measure can be feasibly integrated within clinical assessment to assist clinicians in optimizing treatment benefits.
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Affiliation(s)
- Amy M Rapp
- Department of Psychology, University of California, Los Angeles; Department of Psychiatry, Columbia University; New York State Psychiatric Institute
| | | | - Catherine A Sugar
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles; Department of Biostatistics, University of California, Los Angeles
| | - Joan R Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
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Boström PK, Strand J. Children and parents with psychosis-Balancing between relational attunement and protection from parental illness. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 34:68-76. [PMID: 33285033 PMCID: PMC7898685 DOI: 10.1111/jcap.12302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022]
Abstract
Background Few studies have explored the experiences of young children and their parents with psychosis. The aim of the present study was to explore parent and child mental health and the parent–child relationship from the perspectives of children and their parents with psychosis. Methods The present study had a multiperspectival qualitative design. Seven children (aged 8–15 years) and their six parents with psychosis were interviewed individually. Data were analyzed according to interpretative phenomenological analysis. Results Children were found to have a limited understanding of the parent's illness. While both parents and children described the illness as part of ordinary life and focused on improvements, there was incoherence both within and between interviews. Parent–child relationships appeared to be nonhierarchical and to vary in terms of attunement and distance, which in turn seemed to be associated with the child's well‐being. Conclusion The findings contribute multiperspectival insights into lived experiences of young children and parents with psychosis. Nurses are in a key position to recognize the children's needs for continuous adult support and to promote communication about the illness.
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Affiliation(s)
| | - Jennifer Strand
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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37
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Döhnert M, Wiegand-Grefe S. [Preventive and therapeutic interventions for children of mentally ill parents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 49:51-61. [PMID: 33269950 DOI: 10.1024/1422-4917/a000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Preventive and therapeutic interventions for children of mentally ill parents Abstract. The risk of developing mental disorders increases markedly in children of mentally ill parents. Several risk factors have been identified and become possible targets of preventive and therapeutic interventions. Numerous studies investigated the efficacy of these interventions, which are very heterogeneous regarding content and methodology. One part of these studies focuses on infants of depressed and substance-addicted mothers; the other part focuses on children and adolescents of parents suffering from various mental disorders. Today, we have several meta-analyses at our disposal which yielded small effect sizes concerning the development of psychological symptoms or disorders in these affected children. The current review reveals a lack of high-quality studies, and analyses on cost-effectiveness are also needed. The preventive and therapeutic interventions now available show inadequate efficacy to effectively improve the situation of these children and adolescents. Future research is needed to develop and implement cost-effective interventions as well as high-quality studies to investigate the efficacy of these interventions.
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Affiliation(s)
- Mirko Döhnert
- Universitätsklinikum Leipzig AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Leipzig
| | - Silke Wiegand-Grefe
- Universitätsklinikum Hamburg-Eppendorf (UKE), Zentrum für psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Hamburg
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Steiner V, Shlonsky A, Joubert L. Psychosocial Interventions for Parents with Incurable End‐Stage Cancer: A Rapid Evidence Assessment. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Vera Steiner
- Department of Social Work, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia,
| | - Aron Shlonsky
- Department of Social Work, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia,
| | - Lynette Joubert
- Department of Social Work, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia,
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Fong HF, Bennett CE, Mondestin V, Scribano PV, Mollen C, Wood JN. The Impact of Child Sexual Abuse Discovery on Caregivers and Families: A Qualitative Study. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:4189-4215. [PMID: 29294788 DOI: 10.1177/0886260517714437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this qualitative study with nonoffending caregivers of suspected child sexual abuse victims, we aimed to explore the perceived impact of sexual abuse discovery on caregivers and their families, and caregivers' attitudes about mental health services for themselves. We conducted semistructured, in-person interviews with 22 nonoffending caregivers of suspected sexual abuse victims <13 years old seen at a child advocacy center in Philadelphia. Interviews were audio-recorded, transcribed, coded, and analyzed using modified grounded theory. Recruitment continued until thematic saturation was reached. We found that caregivers experienced significant emotional and psychological distress, characterized by anger, depressed mood, and guilt, after learning that their child may have been sexually abused. We identified four specific sources of caregiver distress: concerns about their child, negative beliefs about their parenting abilities, family members' actions and behaviors, and memories of their own past maltreatment experiences. Some caregivers described worsening family relationships after discovery of their child's sexual abuse, while others reported increased family cohesion. Finally, we found that most caregivers in this study believed that mental health services for themselves were necessary or beneficial to help them cope with the impact of their child's sexual abuse. These results highlight the need for professionals working with families affected by sexual abuse to assess the emotional and psychological needs of nonoffending caregivers and offer mental health services. Helping caregivers link to mental health services, tailored to their unique needs after sexual abuse discovery, may be an acceptable strategy to improve caregiver and child outcomes after sexual abuse.
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Affiliation(s)
- Hiu-Fai Fong
- University of Pennsylvania, Philadelphia, PA, USA
- Harvard Medical School, Boston, MA, USA
| | - Colleen E Bennett
- University of Pennsylvania, Philadelphia, PA, USA
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Valerie Mondestin
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Riverside Regional Medical Center, Newport News, VA, USA
| | - Philip V Scribano
- University of Pennsylvania, Philadelphia, PA, USA
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cynthia Mollen
- University of Pennsylvania, Philadelphia, PA, USA
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joanne N Wood
- University of Pennsylvania, Philadelphia, PA, USA
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Van Voorhees B, Gladstone TRG, Sobowale K, Brown CH, Aaby DA, Terrizzi DA, Canel J, Ching E, Berry AD, Cantorna J, Eder M, Beardslee W, Fitzgibbon M, Marko-Holguin M, Schiffer L, Lee M, de Forest SA, Sykes EE, Suor JH, Crawford TJ, Burkhouse KL, Goodwin BC, Bell C. 24-Month Outcomes of Primary Care Web-Based Depression Prevention Intervention in Adolescents: Randomized Clinical Trial. J Med Internet Res 2020; 22:e16802. [PMID: 33112254 PMCID: PMC7657722 DOI: 10.2196/16802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/28/2020] [Accepted: 08/16/2020] [Indexed: 12/30/2022] Open
Abstract
Background Adolescent depression carries a high burden of disease worldwide, but access to care for this population is limited. Prevention is one solution to curtail the negative consequences of adolescent depression. Internet interventions to prevent adolescent depression can overcome barriers to access, but few studies examine long-term outcomes. Objective This study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education active control for depression onset at 12 and 24 months in adolescents presenting to primary care settings. Methods A 2-site randomized trial, blinded to the principal investigators and assessors, was conducted comparing Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training to health education to prevent depressive episodes in 369 adolescents (193 youths were randomly assigned to Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training and 176 to health education) with subthreshold depressive symptoms or prior depressive episodes. Participants were recruited from primary care settings in the United States. The primary outcome was the occurrence of a depressive episode, determined by the Depression Symptom Rating. The secondary outcome was functioning, measured by the Global Assessment Scale. Results In intention-to-treat analyses, the adjusted hazard ratio favoring Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training for first depressive episode was not statistically significant at 12 months (hazard ratio 0.77, 95% CI 0.42-1.40, P=.39) and 24 months (hazard ratio 0.87, 95% CI 0.52-1.47, P=.61). Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training provided preventive benefit for first depressive episode for those with mild hopelessness or at least moderate paternal monitoring at baseline. Global Assessment Scale scores improved comparably in both groups (intention-to-treat). Conclusions A technology-based intervention for adolescent depression prevention implemented in primary care did not have additional benefit at 12 or 24 months. Further research is necessary to determine whether internet interventions have long-term benefit. Trial Registration ClinicalTrials.gov NCT01893749; http://clinicaltrials.gov/ct2/show/NCT01893749.
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Affiliation(s)
- Benjamin Van Voorhees
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Tracy R G Gladstone
- The Robert S and Grace W Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College, Boston, MA, United States
| | - Kunmi Sobowale
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David A Aaby
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniela A Terrizzi
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Jason Canel
- NorthShore University Health System, Evanston, IL, United States
| | | | - Anita D Berry
- Almost Home Kids, Ann & Robert H Lurie Children's Hospital, Chicago, IL, United States
| | - James Cantorna
- Franciscan Medical Specialists, Munster, IN, United States
| | - Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - William Beardslee
- Judge Baker Center, Harvard Medical School, Roxbury Crossing, MA, United States
| | - Marian Fitzgibbon
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States.,Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States.,University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Monika Marko-Holguin
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Linda Schiffer
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Miae Lee
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Sarah A de Forest
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Emily E Sykes
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Jennifer H Suor
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | | | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Brady C Goodwin
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Carl Bell
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States.,Department of Psychiatry, Windsor University, School of Medicine, Cayon St Kitts, Saint Kitts and Nevis
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Strand J, Meyersson N. Parents with psychosis and their children: experiences of Beardslee's intervention. Int J Ment Health Nurs 2020; 29:908-920. [PMID: 32304272 DOI: 10.1111/inm.12725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 11/28/2022]
Abstract
To meet children's needs for information and support when a parent has a mental illness, Beardslee's family intervention was implemented in Swedish psychosis care. The present study aimed to gain understanding of how parents' with psychosis and their children experienced having taken part in Beardslee's family intervention. The study followed COREQ guidelines. Semi-structured interviews were conducted with 15 participants (8 parents with psychosis and 7 children) who had participated in the family intervention. Data were analysed with content analysis. Results showed that the parents perceived that the intervention had contributed to improved illness knowledge, communication, and understanding in the family. They also appreciated receiving support in finding an age-adapted way of explaining their illness, but asked for structured follow-ups in order to maintain communication. However, comparing parents' and children's interviews led to discrepancies in perceptions of the overall benefits of the intervention. In conclusion, parents with psychosis need continual support in talking to their children about their illness. Furthermore, discrepancies between parents' and children's interviews show the importance of multi-perspective data collection when studying intervention effects.
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Affiliation(s)
- Jennifer Strand
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Meyersson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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DeCandia CJ, Volk KT, Unick GJ, Donegan LRW. Developing a Screening Tool for Young Children Using an Ecological Framework. INFANTS AND YOUNG CHILDREN 2020; 33:237-258. [PMID: 34211253 PMCID: PMC8240794 DOI: 10.1097/iyc.0000000000000173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Young children from impoverished backgrounds experience high levels of family and environmental stress, adversely impacting developmental functioning. Early identification provides a pathway to solutions, but many children are never assessed. In addition, the child-serving workforce lacks resources and expertise to use traditional measures. Furthermore, existing measures do not account for the substantial influence of a child's ecology. To bridge these gaps, we developed the Neurodevelopmental Ecological Screening Tool (NEST) and conducted a pilot study (n=60) to test its feasibility for use with caregivers of children ages 3-5 in low-resource settings. We developed an item pool across three domains (child, caregiver, environment), vetted it with experts, and conducted cognitive interviewing with parents (n=15) and case managers (n-10). Simultaneously, we built an online, user-friendly delivery platform. We used a one parameter Item Response Model and a Rasch-based Rating Scale Model (RSM) and fit confirmatory factor analytic (CFA) models to test for unidimensional and construct validity. The results support the feasibility of screening children from low SES populations within low-resource settings using an ecological perspective and supports the work of child-serving paraprofessionals in identifying and addressing risks in the lives of young children.
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Affiliation(s)
| | | | - George J Unick
- University of Maryland, School of Social Work, Baltimore, MD, USA
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Chubar V, Luyten P, Goossens L, Bekaert B, Bleys D, Soenens B, Claes S. The link between parental psychological control, depressive symptoms and epigenetic changes in the glucocorticoid receptor gene (NR3C1). Physiol Behav 2020; 227:113170. [PMID: 32956684 DOI: 10.1016/j.physbeh.2020.113170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022]
Abstract
AIMS This paper examines the relationship between parental Psychological Control (PC) and depressive symptoms in adolescents and assesses whether this relationship was mediated by DNA methylation, focusing on the glucocorticoid receptor gene (NR3C1), which plays a crucial role in HPA-axis functioning and is linked to environmental stress and depression. This is among the very few studies that looked at the relation between DNA methylation, environmental stress and depression in family trios. METHODS The study cohort consisted of 250 families: father, mother and a biologically related adolescent (adolescents (48.9% boys), mean age: 15.14, SD= 1.9; mean age mothers: 45.83, SD= 4.2; mean age fathers: 47.77, SD= 4.7). Depressive symptoms and PC were measured in adolescents and in both parents. DNA methylation levels in NR3C1 were examined in all participants. RESULTS Depressive symptoms in adolescents were predicted by PC of both mothers and fathers. Moreover, maternal depressive symptoms were associated with maternal PC, and fathers' depressive symptoms and PC. In fathers, only the level of their self-reported PC was associated with their depressive symptoms. There was no relation between adolescents' DNA methylation and depressive symptoms or the level of parental PC. Yet, there was a significant association between maternal depressive symptoms and maternal epigenetic patterns in NR3C1. CONCLUSIONS These findings highlight the need for more research in order to better understand the biological and contextual mechanisms through which parenting and parental emotional well-being is related to the development of psychopathology.
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Affiliation(s)
- V Chubar
- KU Leuven, Mind-Body Research Group, Department of Neuroscience, B-3000 Leuven, Belgium.
| | - P Luyten
- KU Leuven, Faculty of Psychology and Educational Sciences, B-3000 Leuven, Belgium; University College London, Research Department of Clinical, Educational and Health Psychology, London, UK
| | - L Goossens
- KU Leuven, School Psychology and Child and Adolescent Development Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, B-3000 Leuven, Belgium
| | - B Bekaert
- KU Leuven, University Hospitals Leuven, Department of Forensic Medicine, Laboratory of Forensic Genetics and Molecular Archaeology, B-3000 Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, B-3000 Leuven, Belgium
| | - D Bleys
- KU Leuven, Faculty of Psychology and Educational Sciences, B-3000 Leuven, Belgium
| | - B Soenens
- Ghent university, Department of Developmental, Personality and Social Psychology, Ghent, Belgium
| | - S Claes
- KU Leuven, Mind-Body Research Group, Department of Neuroscience, B-3000 Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, B-3000 Leuven, Belgium
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Kemmis-Riggs J, Grove R, McAloon J, Berle D. Early Parenting Characteristics Associated with Internalizing Symptoms Across Seven Waves of the Longitudinal Study of Australian Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1603-1615. [PMID: 32918188 DOI: 10.1007/s10802-020-00700-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to identify whether parenting style during a child's toddler years predicts the course of the child's internalising symptoms throughout early to middle childhood. The current study uses data from waves 1 to 7 (acquired biennially) of the infant cohort (N = 4494) of Growing up in Australia: the Longitudinal Study of Australian Children (LSAC), a population-based longitudinal study. Latent class growth analysis identified four distinct longitudinal trajectories of internalizing symptoms: Low stable (66% of the children), High increasing (7%), Low increasing (17%) and High decreasing (10%). Multinomial logistic regression indicated that low self-efficacy and socioeconomic disadvantage during the toddler years were significant predictors of unfavourable (i.e., increasing) trajectories of internalizing symptoms across later childhood. Parenting hostility was a significant predictor of the low increasing trajectory. Additionally, male children were more likely than females to follow unfavourable trajectories. However, low parenting warmth was not predictive of increasing symptoms across time. Our findings highlight the importance of parenting factors in a child's early years, particularly the potentially detrimental outcomes associated with parental hostility and low self-efficacy.
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Affiliation(s)
- Jacqueline Kemmis-Riggs
- Graduate School of Health, University of Technology Sydney, 100 Broadway, Ultimo, NSW, 2007, Australia.
| | - Rachel Grove
- Graduate School of Health, University of Technology Sydney, 100 Broadway, Ultimo, NSW, 2007, Australia
| | - John McAloon
- Graduate School of Health, University of Technology Sydney, 100 Broadway, Ultimo, NSW, 2007, Australia
| | - David Berle
- Graduate School of Health, University of Technology Sydney, 100 Broadway, Ultimo, NSW, 2007, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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The Family Talk Intervention in palliative home care when a parent with dependent children has a life-threatening illness: A feasibility study from parents' perspectives. Palliat Support Care 2020; 19:154-160. [PMID: 32854809 DOI: 10.1017/s1478951520000735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE One of the main goals of the Family Talk Intervention (FTI) is to increase communication within families with dependent children about illness-related consequences and to support parenting. FTI is family-centered and includes six manual-based meetings led by two interventionists. This study aims to evaluate the feasibility of the FTI in terms of acceptability from the perspective of parents in families with dependent children where one parent receives specialized palliative home care. METHOD A descriptive design employing mixed methods was used to evaluate the FTI in specialized palliative home care. In total, 29 parents participated in interviews and responded to a questionnaire following FTI. Qualitative content analysis and descriptive statistics were used for analyses. RESULTS FTI responded to both the ill parent's and the healthy co-parent's expectations, and they recommended FTI to other families. Parents found the design of FTI to be well-structured and flexible according to their families' needs. Many parents reported a wish for additional meetings and would have wanted FTI to start earlier in the disease trajectory. Parents also would have wished for a more thorough briefing with the interventionists to prepare before the start. The importance of the interventionists was acknowledged by the parents; their professional competence, engagement, and support were vital for finding ways to open communication within the family. The FTI meetings provided them with a setting to share thoughts and views. Parents clearly expressed that they would never have shared thoughts and feelings in a similar way without the meetings. SIGNIFICANCE OF RESULTS According to parents, FTI was found acceptable in a palliative home care context with the potential to add valuable support for families with minor children when a parent is suffering from a life-threatening illness.
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Strand J, Rudolfsson L. Mental Health Professionals' Perceptions of Parenting by Service Users with Psychosis. Community Ment Health J 2020; 56:1014-1022. [PMID: 31925655 PMCID: PMC7289771 DOI: 10.1007/s10597-020-00548-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/02/2020] [Indexed: 12/29/2022]
Abstract
Despite extensive needs, interventions for parents with psychosis are rarely offered, poorly described, and vary between offering instrumental and emotional support. To improve the design of interventions offered to families with parental psychosis, more knowledge is needed. The aim of this study was to gain knowledge about mental health professionals' perceptions of parenting by patients with psychosis. Eleven mental health professionals educated in family interventions were interviewed using a semi-structured interview guide and the material underwent inductive thematic analysis. Results showed that the professionals described the patients parenting as characterized by difficulties in providing security and predictability, taking part in and organizing family life, and to focus on the child's needs. The difficulties were described as related to specific symptoms such as voice hearing, cognitive impairments, anxiety, and paranoia. As a vast amount of research stresses the psychosocial basis of psychosis and the interpersonal causes of its symptoms, parenting difficulties in people with psychosis could benefit from being addressed from a relational perspective. Accordingly, parents with psychosis should be offered interventions that enable them to create positive parental role models, develop reflective functioning, and identify situations in which their symptoms might hinder positive parenting. Many of these needs are unmet by interventions offered in adult psychosis services today.
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Affiliation(s)
- Jennifer Strand
- Department of Psychology, University of Gothenburg, Box 500, 405 30, Göteborg, Sweden.
| | - Lisa Rudolfsson
- Gothenburg Research Institute, University of Gothenburg, Box 603, 405 30, Göteborg, Sweden
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Eklund R, Kreicbergs U, Alvariza A, Lövgren M. Children's Views Are Not Taken Into Account in Accordance With Article 12 of the United Nations Convention on the Rights of the Child in the Family Talk Intervention When a Parent Is Cared for in Palliative Care. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:126-154. [PMID: 32659170 DOI: 10.1177/0030222820941283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Having a parent with a life-threatening illness is challenging throughout the illness trajectory, and for some also in bereavement. Article 12 of the United Nations Convention on the Rights of the Child states a child's right to express their opinion and have it respected in processes that affect them. The aims of this paper were to explore the child's active participation in a family support programme, the Family Talk Intervention, in accordance with Article 12, when having a parent cared for in palliative care. Twenty families with 50 children participated. Fieldnotes were taken during the programme and later analysed with interpretive descriptions. The study shows that all children were listened to, but only a quarter reached the minimum point required in Article 12, where their views were taken into account. The Family Talk Intervention in palliative care would benefit from implementing a child-centred approach in order for all children to be active participants.
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Affiliation(s)
- Rakel Eklund
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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48
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The Association Between Parental Depression and Child Psychosocial Intervention Outcomes: Directions for Future Research. Harv Rev Psychiatry 2020; 27:241-253. [PMID: 31219883 DOI: 10.1097/hrp.0000000000000214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent studies suggest that parental depressive symptoms may affect a child's ability to benefit from interventions for anxiety and depression. This article reviews the current literature, suggesting that, when parents experience current depressive symptoms, children are less likely to benefit from psychosocial interventions for anxiety and depression. Opportunities for future research are discussed, including moderators and mechanisms of the association between parental depressive symptoms and child intervention outcomes.
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49
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Tang X, Tang S, Ren Z, Wong DFK. Psychosocial risk factors associated with depressive symptoms among adolescents in secondary schools in mainland china: A systematic review and meta-analysis. J Affect Disord 2020; 263:155-165. [PMID: 31818773 DOI: 10.1016/j.jad.2019.11.118] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/25/2019] [Accepted: 11/28/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The objective of the study is to systematically estimate the effect size of psychosocial risk factors for depressive symptoms among adolescents in secondary schools in mainland China. METHOD A literature search was conducted in both English and Chinese databases. This meta-analysis used a random-effects model to estimate the effect size. RESULTS Fifteen psychosocial risk factors were identified in a total of 164 articles. The results revealed the absolute value of effect size ranging from 0.16 to 0.43. Among them, poor parent-child communication (r = 0.43), negative life events (r = 0.40), academic pressure (r = 0.40), abuse (r = 0.33), poor family functioning (r = 0.33), bullying (r = 0.32), and poor family cohesion (r = 0.32) were associated with depression with a medium to large effect. Moderator analysis shows that grade, study quality, mean age, and gender were significant moderators of at least one factor for depression. LIMITATIONS Limitations included the heterogeneity which is largely unexplained, and the inability to investigate the interactions of different factors and to determine the direction of causal relationships between psychosocial factors and depression in the present meta-analysis. CONCLUSIONS This study suggests that family-related factors and school-related factors may be significantly associated with depressive symptoms in Chinese secondary school students. Further research is needed to develop effective strategies to modify these factors in depression prevention programmes.
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Affiliation(s)
- Xinfeng Tang
- The Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | | | - Zhihong Ren
- School of Psychology, Central China Normal University, Wuhan, China; Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
| | - Daniel Fu Keung Wong
- The Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.
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50
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Kuo C, Mathews C, Giovenco D, Atujuna M, Beardslee W, Hoare J, Stein DJ, Brown LK. Acceptability, Feasibility, and Preliminary Efficacy of a Resilience-Oriented Family Intervention to Prevent Adolescent HIV and Depression: A Pilot Randomized Controlled Trial. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:67-81. [PMID: 32202920 PMCID: PMC7250140 DOI: 10.1521/aeap.2020.32.1.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We tested the acceptability, feasibility, and preliminary efficacy of Our Family Our Future, a resilience-oriented intervention engaging families in prevention of adolescent HIV and depression. South African adolescents, 13-15 years of age, with mild depressive symptoms, were randomized to intervention or wait-list using parallel assignment in a single-blind trial. HIV risk behavior and depression were evaluated at baseline, 1, and 3 months. We examined intervention satisfaction, fidelity, trial retention, and preliminary efficacy. One hundred-ninety-six adolescent-parent dyads completed eligibility screening and baseline, and n = 73 dyads were randomized. All families ranked intervention quality as good or excellent. Over 90% were satisfied with content. Facilitators were adherent to intervention protocol. All families were retained in post-intervention assessments. Intervention recipients reported diminished depressive symptoms, inconsistent condom use, and sexual activity, as well as increased HIV testing. Our Family Our Future is highly acceptable and feasible and should be tested in a future efficacy trial.
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Affiliation(s)
- Caroline Kuo
- Brown University School of Public Health, Providence, Rhode Island
- Providence/Boston Center for AIDS Research, and the University of Cape Town, Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Danielle Giovenco
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
| | | | - William Beardslee
- Judge Baker Children's Center, Harvard Medical School, and Boston Children's Hospital, Boston, Massachusetts
| | | | - Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, University of Cape Town
| | - Larry K Brown
- Alpert Medical School of Brown University, Providence, Rhode Island, and the Providence/Boston Center for AIDS Research
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