Delineating the impact of childhood traumatic brain injury (TBI) on long-term depressive symptom severity: Does sub-acute brain morphometry prospectively predict 2-year outcome?

Despite evidence of a link between childhood TBI and heightened risk for depressive symptoms, very few studies have examined early risk factors that predict the presence and severity of post-injury depression beyond 1-year post injury. This longitudinal prospective study examined the effect of mild-severe childhood TBI on depressive symptom severity at 2-years post-injury. It also evaluated the potential role of sub-acute brain morphometry and executive function (EF) in prospectively predicting these long-term outcomes. The study involved 81 children and adolescents with TBI, and 40 age-and-sex matched typically developing (TD) controls. Participants underwent high-resolution structural magnetic resonance imaging (MRI) sub-acutely at five weeks post-injury (M = 5.55; SD = 3.05 weeks) and EF assessments were completed at 6-months post-injury. Compared to TD controls, the TBI group had significantly higher overall internalizing symptoms and were significantly more likely to exhibit clinically significant depressive symptoms at 2-year follow-up. The TBI group also displayed significantly lower EF and altered sub-acute brain morphometry in EF-related brain networks, including the default-mode network (DMN), salience network (SN) and central executive network (CEN). Mediation analyses revealed significant indirect effects of CEN morphometry on depression symptom severity, such that lower EF mediated the prospective association between altered CEN morphometry and higher depression symptoms in the TBI group. Parallel mediation analyses including grey matter morphometry of a non-EF brain network (i.e., the mentalising network) were not statistically significant, suggesting some model specificity. The findings indicate that screening for early neurostructural and neurocognitive risk factors may help identify children at elevated risk of depressive symptoms following TBI. For instance, children at greatest risk of post-injury depression symptoms could be identified based in part on neuroimaging of networks implicated in EF and post-acute assessments of executive function, which could support more effective allocation of limited intervention resources.

Dimensions of internalizing symptoms are stable across early adolescence and predicted by executive functions: Longitudinal findings from the Adolescent Brain and Cognitive Development (ABCD) study

Early adolescence is characterized by rapid changes in executive function and increased vulnerability to internalizing difficulties. The aim of this study was to explore whether internalizing symptoms are stable across early adolescence and to identify possible links with executive function. Using data from the Adolescent Brain and Cognitive Development Study (ABCD), we identified four dimensions of internalizing symptoms from item-level ratings on the Child Behavior Checklist at ages 10 (n = 10,841) and 12 (n = 5,846), with an invariant factor structure across time. These dimensions corresponded to anxiety, depression, withdrawal, and somatic problems. We then examined associations between these dimensions and three aspects of executive function at age 10 measured by the NIH Toolbox: inhibition, shifting and working memory. Worse shifting and inhibition at age 10 was associated with elevated symptoms of anxiety and withdrawal cross-sectionally, while poor inhibition was also uniquely associated with symptoms of depression. Longitudinal associations were more limited: Worse inhibition at age 10 predicted greater symptoms of withdrawal at age 12, while worse shifting predicted fewer symptoms of anxiety 2 years later. These findings suggest that poor executive function in early adolescence is associated with greater internalizing difficulties and poor inhibition may contribute to later social withdrawal.

A Longitudinal Investigation of the Relationship Between Trauma-Related Cognitive Processes and Internalising and Externalising Psychopathology in Young People in Out-of-Home Care

Young people in out-of-home care are at increased risk of developing a range of posttrauma mental health difficulties, including PTSD, but more commonly anxiety, depression and externalising symptoms. Cognitive models of PTSD indicate that trauma-related maladaptive appraisals, coping strategies and trauma memory qualities are key processes in the development and maintenance of PTSD, yet there has been limited investigation of the potential role of these processes in broader posttrauma psychopathology, particularly in young people who have been exposed to complex, rather than acute, trauma. We recruited 120 10-18 years olds in out-of-home care, and their caregivers, who completed assessments at two time points: baseline and 12-month follow-up. Young people completed self-report measures of trauma-related maladaptive appraisals, coping strategies and trauma-memory qualities, as well as reporting on PTSD, anxiety, depression and externalising symptoms. Carers also reported on internalising and externalising symptoms. We found that all three cognitive processes were associated with baseline self-reported internalising symptoms, with maladaptive appraisals most robustly associated with both anxiety and depression. Changes in all three processes over 12-months predicted a change in self-reported internalising and externalising symptoms, with maladaptive appraisals and coping predicting anxiety symptoms, and coping uniquely predicting depression and externalising symptoms. Effects remained after controlling for co-occurring PTSD symptoms. Findings were not replicated when using carer-reported symptoms. These findings suggest that existing cognitive models of PTSD may also usefully explain broader posttrauma depression, anxiety and externalising symptoms in young people who have experienced maltreatment and live in out-of-home care. Clinical implications are discussed.

Changes in the adult consequences of adolescent mental ill-health: findings from the 1958 and 1970 British birth cohorts

BACKGROUND

Adolescent mental health difficulties are increasing over time. However, it is not known whether their adulthood health and socio-economic sequelae are changing over time.

METHODS

Participants (N = 31 349) are from two prospective national birth cohort studies: 1958 National Child Development Study (n = 16 091) and the 1970 British Cohort Study (n = 15 258). Adolescent mental health was operationalised both as traditional internalising and externalising factors and a hierarchical bi-factor. Associations between adolescent psychopathology and age 42 health and wellbeing (mental health, general health, life satisfaction), social (cohabitation, voting behaviour) and economic (education and employment) outcomes are estimated using linear and logistic multivariable regressions across cohorts, controlling for a wide range of early life potential confounding factors.

RESULTS

The prevalence of adolescent mental health difficulties increased and their associations with midlife health, wellbeing, social and economic outcomes became more severe or remained similar between those born in 1958 and 1970. For instance, a stronger association with adolescent mental health difficulties was found for those born in 1970 for midlife psychological distress [odds ratio (OR) 1970 = 1.82 (1.65-1.99), OR 1958 = 1.60 (1.43-1.79)], cohabitation [OR 1970 = 0.64 (0.59-0.70), OR 1958 = 0.79 (0.72-0.87)], and professional occupations [OR 1970 = 0.75 (0.67-0.84), OR 1958 = 1.05 (0.88-1.24)]. The associations of externalising symptoms with later outcomes were mainly explained by their shared variance with internalising symptoms.

CONCLUSION

The widening of mental health-based inequalities in midlife outcomes further supports the need to recognise that secular increases in adolescent mental health symptoms is a public health challenge with measurable negative consequences through the life-course. Increased public health efforts to minimise adverse outcomes are needed.

Risk and protective factors for children's psychopathology in the context of domestic violence - A study using nationally representative longitudinal survey data

BACKGROUND

Little is known about the causal pathways through which domestic violence affects children's internalising, externalising and prosocial behaviours over time, and the role that risk and protective factors play in mediating and moderating direct effects.

OBJECTIVE

We explored how different risk and protective factors affect children's psychopathology in the context of domestic violence. We focused on the mother and child bond and explored if this moderates or mediates the effect of domestic violence on children's internalising, externalising and prosocial behaviours.

PARTICIPANTS AND SETTING

A prospective longitudinal nationally representative study of children in Scotland aged 6 to 13 years (N:2554).

METHODS

Multivariate logit models, moderation and mediation analysis.

RESULTS

Domestic violence exposure predicted higher internalising and externalising behaviours and lower prosocial skills (e.g. OR2.17, 95%CI 1.15-4.08 for externalising symptoms). Children with a strong mother-child bond had lower odds of internalising and externalising symptoms, and were more likely to manifest prosocial skills (OR4.14, 95%CI 3.09-5.55). We found evidence that the mother-child relationship both moderated and mediated the effect that domestic violence exposure had on children's internalising, externalising and prosocial scores. The mediation effect was strongest for prosocial behaviours, and strongest in cases where the abuse was less intense.

CONCLUSIONS

We show how domestic violence directly and indirectly affects children, via the mother-child relationship. We propose a model which could explain how the mother-child bond both mediates and moderates the effect of domestic violence on children's psychopathology. Our findings suggest mothers need support to in turn support children in the context of domestic violence.

Does behavioural parent training reduce internalising symptoms (or not) among children with externalising problems? Systematic review and meta-analysis

Behaviour parent training (BPT) is known to effectively reduce child externalising problems. However, evidence for BPT to have secondary benefits for reducing internalising symptoms remains unclear. To address this, electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, and SCOPUS) were systematically searched for studies examining internalising outcomes from BPT among children aged 2-12 years with clinically elevated externalizing problems. Outcomes for internalising problems following BPT were analysed by meta-analysis. Of 9105 studies identified, 24 studies met the eligibility criteria. Results from meta-analysis demonstrated a significant small treatment effect size (g = - 0.41) for reducing internalising symptoms immediately after treatment. Studies showed moderate heterogeneity (I² = 44%). Moderation analyses indicated that the overall treatment effect was robust against variations in treatment and study design characteristics. However, a review of individual study methods indicate that these results are limited by significant heterogeneity and limitations in clinical assessment. Overall, the results suggest that BPT programmes for reducing externalising problems have the potential to improve internalising outcomes, but that there is limited information to determine the reliability of these effects, highlighting the need for further investigation.

Infant Effortful Control Mediates Relations Between Nondirective Parenting and Internalising-Related Child Behaviours in an Autism-Enriched Infant Cohort

Internalising problems are common within Autism Spectrum Disorder (ASD); early intervention to support those with emerging signs may be warranted. One promising signal lies in how individual differences in temperament are shaped by parenting. Our longitudinal study of infants with and without an older sibling with ASD investigated how parenting associates with infant behavioural inhibition (8-14 months) and later effortful control (24 months) in relation to 3-year internalising symptoms. Mediation analyses suggest nondirective parenting (8 months) was related to fewer internalising problems through an increase in effortful control. Parenting did not moderate the stable predictive relation of behavioural inhibition on later internalising. We discuss the potential for parenting to strengthen protective factors against internalising in infants from an ASD-enriched cohort.

Mediating Factors in Within-Person Developmental Cascades of Externalising, Internalising and ADHD Symptoms in Childhood

Previous studies have offered evidence for peer problems and academic achievement as mediators in developmental cascades from externalising to internalising problems, and from ADHD symptoms to both internalising and externalising problems. However, these mediators have not been found to fully account for these cascades, indicating that there may be additional mediators involved. This study investigated the role of harsh parenting and parental involvement alongside academic achievement and peer problems in mediating within-person developmental cascades from externalising to internalising problems and from ADHD symptoms to internalising and externalising problems using autoregressive latent trajectory models with structured residuals. Models were fit for parent- and teacher-reports on children’s psychosocial development as measured by the Social Behaviour Questionnaire (SBQ) collected over ages 7, 9, and 11 in an ethnically diverse Swiss longitudinal cohort study (z-proso; N = 1387, 51% male). Results indicated that, when appropriately disentangling within- from between-person effects, none of the considered factors acted as significant mediators in longitudinal within-person relations between ADHD, internalising and externalising problems; hence, mediating mechanisms in developmental cascades remain to be identified.

Patterns of Homotypic and Heterotypic Continuity Between ADHD Symptoms, Externalising and Internalising Problems from Age 7 to 15

ADHD presents a serious community-health problem through its links to a wide range of negative outcomes. These outcomes are exacerbated when ADHD symptoms co-occur with other mental health problems. Research evidence suggests high rates of co-comorbidity with a range of problems. However, there is a paucity of longitudinal research that examines the predictive links between ADHD symptoms and symptoms of other mental health problems. We examined a cross-lagged autoregressive model in order to assess homotypic and heterotypic continuity between ADHD symptoms, aggressive behavior, non-aggressive behavior problems and anxiety/depression in a community-based sample of 1571 youth (761 female, 810 male) assessed annually from age 7 to 13 and again at age 15. Consistently significant correlations between each pair of problem behaviors provided support for concurrent comorbidity. Furthermore, significant autoregressive pathways provided support for homotypic continuity. Support for heterotypic continuity was limited to ADHD symptoms predicting both aggressive behavior and non-aggressive behavior problems, but not vice versa. Our study highlights the importance of focusing on ADHD symptoms to identify children at risk not only for continued ADHD symptomatology but also a range of externalizing behavior problems including different types of aggression and non-aggressive behavior problems, such as rule-breaking. Identifying these patterns in a community-based sample provides support for the possibility of early identification of risk for a range of problem  behaviors.

Do risk factors for adolescent internalising difficulties differ depending on childhood internalising experiences?

PURPOSE

This study aimed to examine the continuity of internalising difficulties from childhood to adolescence, and determine if the influence of established risk factors on adolescent mental health differed depending on childhood internalising experiences.

METHODS

Data were used from the Kindergarten cohort of the Longitudinal Study of Australian Children (LSAC, N = 4983, est. 2004). Internalising difficulties were measured via parent report on the Strengths and Difficulties Questionnaire (SDQ) at each wave from 4-5 to 14-15 years of age, and defined as symptoms in the borderline or abnormal range (≥ 4). Logistic generalised estimating equations were used to characterise associations between childhood internalising problems (4-9 years) and previously identified risk factors with adolescent internalising difficulties at three time points (10-11, 12-13 and 14-15 years).

RESULTS

The risk of internalising problems was elevated at each adolescent age for those who previously experienced internalising symptoms in childhood compared to those who did not (10-11 years: OR 3.67, 95% CI 3.01-4.47, 12-13 years: OR 2.84, 95% CI 2.32-3.46, and 14-15 years: OR 2.33, 95% CI 1.90-2.87). Other known risk factors were found to be associated with adolescent internalising problems as expected. We found no statistical evidence that these associations differed for adolescents who previously experienced internalising symptoms in childhood.

CONCLUSION

Findings of this study confirm the continuity of childhood mental health problems and the role of individual and family characteristics in the aetiology of adolescent internalising difficulties. The same risk factors appear relevant to target for adolescents who first experienced internalising symptoms in childhood.

Reprint of: Internalising symptoms mediate the longitudinal association between childhood inflammation and psychotic-like experiences in adulthood

Psychotic-like experiences (PLEs) are part of a continuum of psychosis. Previous longitudinal studies highlighted a relationship between peripheral inflammation during childhood and onset of PLEs in adulthood. In this study, we tested if this association is mediated by internalising and externalising symptoms experienced during childhood and adolescence. To test this hypothesis, we used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). We investigated a subsample of 4525 individuals from this cohort with data on interleukin 6 (IL-6) and C-reactive protein (CRP) in childhood (age 9 years). We measured PLEs at age 18 years, and we used latent growth curve modelling to estimate longitudinal trajectories of internalising and externalising symptoms from ages 9 to 16 years. The individual predicted values of the intercept (set at baseline, 9 years) and the slope (rate of annual change) were then used in the mediation analysis. There was evidence for full mediation by the intercept of internalising symptoms. Our findings suggest that inflammation during childhood may be relevant for the future onset of PLEs via its association with a high level of internalising symptoms. These findings, although obtained from a non-clinical population, provide an additional step in advancing knowledge on the relationship between inflammation and symptoms of the psychosis continuum.

Hypertensive disorders of pregnancy and emotional and behavioural problems in children: a longitudinal population-based study

There is evidence that offspring of mothers who have hypertensive disorders of pregnancy (HDP) are at increased risk of adverse health outcomes. This study aims to examine the association between maternal HDP and emotional- and behavioural problems in offspring at age 11 years as reported by teachers and parents. The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, population-based study that has followed a cohort of offspring since their mothers were pregnant. Childhood emotional- and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ), completed by parents (n = 7196) and the child's teacher (n = 7411). Maternal preeclampsia, but not gestational hypertension, was associated with teacher-reported total behavioural difficulties (RR = 1.62; 95% CI 1.03-2.52) and internalising problems in children [peer problems (RR = 1.48; 95% CI 1.06-2.08) and emotional problems (RR = 1.68; 95% CI 1.13-2.51)]. No associations between preeclampsia and/or gestational hypertension and parent-reported emotional- and behaviour problems were observed. Our study showed that children exposed to preeclampsia had higher risk of teacher-reported total behavioural difficulties and internalising problems compared with unexposed children. The findings suggest emotional- and behavioural difficulties may not be evident in all settings, hence the importance of collecting evidence from multiple informants.

Behavioural Problems in a Nationally Representative Sample of Uruguay. Characterisation of Latent Profiles by Socioeconomic Status, Maternal Depression and Family Violence

CBCL 1½-5 is one of the most widely used behavioural problem screening instruments internationally. However, few studies have explored its psychometric properties in national representative samples. Additionally, there is limited evidence on the existence of latent profiles of behavioural problems in preschool samples. This study aimed to analyse the psychometric properties of the Spanish version of the CBCL in a representative sample of children from Uruguay (n = 4210), identify latent profiles and characterise profiles according to sociodemographic and family environment variables (maternal depression and violence practices). Our results suggest that the CBCL 1½-5 is reliable. We replicate the seven-correlated-factor solution, which is invariant by sex and age. Three large profiles of behavioural problems were identified (high, medium and low risk) where membership in groups of higher risk was explained by the socioeconomic context, child's sex, maternal depression and, to a lesser extent, violent parental practices.

Early Childhood Predictors of Anxiety in Early Adolescence

This longitudinal study examined a multitude of early childhood predictors of anxiety symptoms and disorders over an 8-year period. The purpose of the study was to identify early life predictors of anxiety across childhood and early adolescence in a sample of at-risk children. The sample included 202 preschool children initially identified as behaviorally inhibited or uninhibited between the ages of 3 years 2 months and 4 years 5 months. Temperament and familial environment variables were assessed using observation and parent report at baseline. Anxiety symptoms and disorders were assessed using questionnaires and diagnostic interviews at baseline (age 4), and at age 6, 9 and 12 years. In line with our hypotheses, the findings showed that preschool children were more likely to experience anxiety symptoms and disorders over time i) when the child was inhibited, ii) when there was a history of maternal anxiety disorders or iii) when mothers displayed high levels of overinvolvement. Further, the study identified a significant interaction effect between temperament and maternal overvinvolvement such that behaviorally inhibited preschoolers had higher anxiety symptoms at age 12, only in the presence of maternal overinvolvement at age 4. The increased risk of anxiety in inhibited children was mitigated when mothers demonstrated low levels of overinvolvement at age 4. This study provides evidence of both additive and interactive effects of temperament and family environment on the development of anxiety and provides important information for the identification of families who will most likely benefit from targeted early intervention.

Does the Incredible Years Teacher Classroom Management programme improve child-teacher relationships in childcare centres? A 1-year universal intervention in a Norwegian community sample

The Incredible Years Teacher Classroom Management (IY TCM) programme has shown promise in reducing behaviour problems among high-risk children in childcare. However, at present, we do not know whether the IY TCM successfully improves the child-teacher relationship in childcare and whether the effects manifest in both the population and in high-risk groups. Hence, we conducted a quasi-experimental pre-post study with a matched control condition to examine the changes in child-teacher relationships in a sample of 1085 children aged 3-6 years after implementing the IY TCM programme. Linear mixed models revealed favourable group-by-time differences benefitting the intervention compared to the control condition. Subgroup analyses of children scoring at or above the 90th percentile on either internalising or externalising behaviour problems showed that the preventive effects persisted in both high-risk subsamples. In sum, the findings indicate that the IY TCM programme does improve child-teacher relationships and that the effect is present for the entire study population as well as children scoring in the clinical range on behaviour problems. This suggests that the application of the IY TCM programme in childcare settings has important preventive effects. Implications and limitations are further discussed.

Internalising symptoms mediate the longitudinal association between childhood inflammation and psychotic-like experiences in adulthood

Psychotic-like experiences (PLEs) are part of a continuum of psychosis. Previous longitudinal studies highlighted a relationship between peripheral inflammation during childhood and onset of PLEs in adulthood. In this study, we tested if this association is mediated by internalising and externalising symptoms experienced during childhood and adolescence. To test this hypothesis, we used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). We investigated a subsample of 4525 individuals from this cohort with data on interleukin 6 (IL-6) and C-reactive protein (CRP) in childhood (age 9 years). We measured PLEs at age 18 years, and we used latent growth curve modelling to estimate longitudinal trajectories of internalising and externalising symptoms from ages 9 to 16 years. The individual predicted values of the intercept (set at baseline, 9 years) and the slope (rate of annual change) were then used in the mediation analysis. There was evidence for full mediation by the intercept of internalising symptoms. Our findings suggest that inflammation during childhood may be relevant for the future onset of PLEs via its association with a high level of internalising symptoms. These findings, although obtained from a non-clinical population, provide an additional step in advancing knowledge on the relationship between inflammation and symptoms of the psychosis continuum.

Stressful life events, inflammation and emotional and behavioural problems in children: A population-based study

OBJECTIVE

To test the hypothesis that higher plasma levels of inflammatory markers due to exposure to adverse life events may lead to internalising and externalising symptoms in children.

METHOD

Using data from the Avon Longitudinal Study of Parents and Children, a general population birth cohort, we explored if inflammatory markers [serum C-reactive protein (CRP) and interleukin-6 (IL-6)] at age 9 years explain the longitudinal association between adverse life events (at ages 1-9 and 9-11 years) and internalising and externalising symptoms (at ages 9 and 11 years). Data (n = 4583) were analysed using cross-lagged panel modelling to take into account reciprocal associations and reverse causality, and path analyses to test for mediation. Gender, ethnicity, body mass index, maternal education, paternal social class and maternal depression were used as potential confounders.

RESULTS

CRP was not associated with adverse life events. There was evidence for partial mediation by IL-6 such that exposure to adverse life events was associated with increased levels of IL-6 later, in turn associated with later internalising symptoms. These associations were robust to adjustment for confounders. IL-6 did not explain part of the opposite association, that of earlier internalising symptoms and later life events, nor did it explain either direction of the association between life events and externalising symptoms.

CONCLUSION

Our findings suggest a pathway that may connect early psychosocial adversity and childhood internalising symptoms via higher plasma levels of inflammatory markers, such as IL-6.

Development and evaluation of the Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS): assessment of parental concordance with guidelines for the prevention of child anxiety and depression

BACKGROUND

Involving parents in the prevention of mental health problems in children is prudent given their fundamental role in supporting their child's development. However, few measures encapsulate the range of risk and protective factors for child anxiety and depression that parents can potentially modify. The Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS) was developed as a criterion-referenced measure to assess parenting against a set of evidence-based parenting guidelines for the prevention of child anxiety and depressive disorders.

METHODS

In Study 1, 355 parents of children 8-11 years old across Australia completed the PaRCADS and measures of parenting, general family functioning, child anxiety and depressive symptoms, and parent and child health-related quality of life. Their children completed measures of parenting, anxiety and depressive symptoms, and health-related quality of life. In Study 2, six subject-experts independently evaluated the PaRCADS items for item-objective congruence and item-relevance. Item analysis was conducted by examining item-total point-biserial correlation, difficulty index, B-index, and expert-rated content validity indices. Reliability (or dependability) was assessed by agreement coefficients for single administration. Construct validity was examined by correlational analyses with other measures.

RESULTS

Four items were removed to yield a 79-item, 10-subscale PaRCADS. Reliability estimates for the subscale and total score range from .74 to .94. Convergent validity was indicated by moderate to strong correlations with other parenting and family functioning measures, and discriminant validity was supported by small to moderate correlations with a measure of parents' health-related quality of life. Higher scores on the PaRCADS were associated with fewer anxiety and depressive symptoms and better health-related quality of life in the child. PaRCADS total score was associated with parental age, parent reported child's history of mental health diagnosis and child's current mental health problem.

DISCUSSION

Results showed that the PaRCADS demonstrates adequate psychometric properties that provide initial support for its use as a measure of parenting risk and protective factors for child anxiety and depression. The scale may be used for intervention and evaluative purposes in preventive programs and research.

Profiles of childhood trauma and psychopathology: US National Epidemiologic Survey

PURPOSE

Childhood trauma may increase vulnerability to numerous specific psychiatric disorders, or a generalised liability to experience dimensions of internalising or externalising psychopathology. We use a nationally representative sample (N = 34,653) to examine the long-term consequences of childhood trauma and their combined effect as predictors of subsequent psychopathology.

METHODS

Data from the US National Epidemiologic Survey on Alcohol and Related Conditions were used. Latent class analysis was used to identify childhood trauma profiles and multinomial logistic regression to validate and explore these profiles with a range of associated demographic and household characteristics. We used Structural Equation Modelling to substantiate initial latent class analysis findings by investigating a range of mental health diagnoses. Internalising and externalising domains of psychopathology were regressed on trauma profiles and associated demographic and household characteristics. We used Differential Item Functioning to examine associations between the trauma groups and a number of psychiatric disorders within internalising and externalising dimensions of mental health.

RESULTS

We found a 3-class model of childhood trauma in which 85% of participants were allocated to a low trauma class; 6% to a multi-type victimization class (reporting exposures for all the child maltreatment criteria); and 9% to a situational trauma class (exposed to a range of traumas). Confirmatory Factor Analysis revealed an internalising-externalising spectrum was used to represent lifetime reporting patterns of mental health disorders. Both trauma groups showed specific gender and race/ethnicity differences, related family discord and increased psychopathology. Additionally, we found significant associations between the trauma groups and specific diagnoses within the internalising-externalising spectrum of mental health.

CONCLUSIONS

The underlying patterns in the exposure to types of interpersonal and non-interpersonal traumas and associated mental health highlight the need to screen for particular types of childhood traumas when individuals present with symptoms of psychiatric disorders.

The impact of parental mental illness across the full diagnostic spectrum on externalising and internalising vulnerabilities in young offspring

BACKGROUND

The intergenerational risk for mental illness is well established within diagnostic categories, but the risk is unlikely to respect diagnostic boundaries and may be reflected more broadly in early life vulnerabilities. We aimed to establish patterns of association between externalising and internalising vulnerabilities in early childhood and parental mental disorder across the full spectrum of diagnoses.

METHODS

A cohort of Australian children (n = 69 116) entering the first year of school in 2009 were assessed using the Australian Early Development Census, providing measures of externalising and internalising vulnerability. Parental psychiatric diagnostic status was determined utilising record-linkage to administrative health datasets.

RESULTS

Parental mental illness, across diagnostic categories, was associated with all child externalising and internalising domains of vulnerability. There was little evidence to support interaction by parental or offspring sex.

CONCLUSIONS

These findings have important implications for informing early identification and intervention strategies in high-risk offspring and for research into the causes of mental illness. There may be benefits to focusing less on diagnostic categories in both cases.

The association between poor reading and internalising problems: A systematic review and meta-analysis

Numerous studies have demonstrated an association between learning disabilities and internalising problems such as anxiety and depression. However, our understanding of this association for people with specific types of learning disability - such as poor reading - is poorly understood. Here, we present the first systematic review and meta-analysis of studies that have examined associations between poor reading and internalising problems - including anxiety and depression - in children, adolescents, and adults. Our systematic search identified 34 studies comprising 16,275 participants (N = 2491 poor readers). Our meta-analysis revealed statistically significant differences between poor readers and typical readers on general measures of internalising problems (d = 0.41), as well as specific measures of anxiety (d = 0.41) and depression (d = 0.23). These outcomes suggest that poor readers are at moderate risk for experiencing internalising problems compared to typical readers, which appears to stem from a greater risk for anxiety than depression.

Parenting Resilient Kids (PaRK), an online parenting program to prevent anxiety and depression problems in primary school-aged children: Study protocol for a randomised controlled trial

Background

Preventive efforts targeting childhood anxiety and depression symptoms have the potential to alter the developmental trajectory of depression and anxiety disorders across the lifespan. Substantial previous research suggests that modifiable parenting factors such as parental aversiveness and over-involvement are associated with childhood anxiety, depressive and internalising symptoms, indicating that parents can play a critical role in prevention. The Parenting Resilient Kids study is a new evidence-based online parenting program designed to prevent anxiety and depression problems in primary school-aged children by reducing family-based risk factors and enhancing protective factors through increased positive interactions between parent and child.

Methods/design

The current study is a parallel group superiority randomised controlled trial with parent-child dyads randomised to the intervention or active-control group in a 1:1 ratio. The intervention group will receive the Parenting Resilient Kids program consisting of a feedback report on parenting behaviours and up to 12 interactive online modules personalised based on responses to the parent survey. The active-control group will receive a standardised package of online educational materials about child development and wellbeing. The trial website is programmed to run a stratified random allocation sequence (based on parent gender) to determine group membership. We aim to recruit 340 parent-child dyads (170 dyads per group). We hypothesise that the intervention group will show greater improvement in parenting risk and protective factors from baseline to 3-month follow-up (primary outcome), which will in turn mediate changes in child depressive and anxiety symptoms from baseline to 12 and 24 months (co-primary outcomes). We also hypothesise that the intervention group will show greater benefits from baseline to 3-, 12- and 24-month follow-up, with regard to: child depressive and anxiety symptoms (co-primary outcomes); and child and parent health-related quality of life, and overall family functioning (secondary outcomes).

Discussion

This randomised controlled trial will examine the efficacy of the Parenting Resilient Kids program as a preventive intervention for anxiety and depression symptoms in primary school-aged children, as well as changes in child and parent health-related quality of life. Findings from this study will examine design features that render web-based prevention programs effective and the extent to which parents can be engaged and motivated to change through a minimally guided parenting program.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR): Trial ID ACTRN12616000621415 Registered on 13 May 2016. Updated on 3 March 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2605-8) contains supplementary material, which is available to authorized users.

Does parent-child agreement vary based on presenting problems? Results from a UK clinical sample

BACKGROUND

Discrepancies are often found between child and parent reports of child psychopathology, nevertheless the role of the child's presenting difficulties in relation to these is underexplored. This study investigates whether parent-child agreement on the conduct and emotional scales of the Strengths and Difficulties Questionnaire (SDQ) varied as a result of certain child characteristics, including the child's presenting problems to clinical services, age and gender.

METHODS

The UK-based sample consisted of 16,754 clinical records of children aged 11-17, the majority of which were female (57%) and White (76%). The dataset was provided by the Child Outcomes Research Consortium , which collects outcome measures from child services across the UK. Clinicians reported the child's presenting difficulties, and parents and children completed the SDQ.

RESULTS

Using correlation analysis, the main findings indicated that agreement varied as a result of the child's difficulties for reports of conduct problems, and this seemed to be related to the presence or absence of externalising difficulties in the child's presentation. This was not the case for reports of emotional difficulties. In addition, agreement was higher when reporting problems not consistent with the child's presentation; for instance, agreement on conduct problems was greater for children presenting with internalising problems. Lastly, the children's age and gender did not seem to have an impact on agreement.

CONCLUSIONS

These findings demonstrate that certain child presenting difficulties, and in particular conduct problems, may be related to informant agreement and need to be considered in clinical practice and research. Trial Registration This study was observational and as such did not require trial registration.

Early Childhood Precursors and School age Correlates of Different Internalising Problem Trajectories Among Young Children

It is unclear why trajectories of internalising problems vary between groups of young children. This is the first attempt in the United Kingdom to identify and explain different trajectories of internalising problems from 46 to 94 months. Using both mother- and child-reported data from the large Growing Up in Scotland (GUS) birth cohort (N = 2901; male N = 1497, female N = 1404), we applied growth mixture modelling and multivariable multinomial regression models. Three trajectories were identified: low-stable, high-decreasing and medium-increasing. There were no gender differences in trajectory shape, membership, or importance of covariates. Children from both elevated trajectories shared several early risk factors (low income, poor maternal mental health, poor partner relationship, pre-school behaviour problems) and school-age covariates (low mother-child warmth and initial school maladjustment) and reported fewer supportive friendships at 94 months. However, there were also differences in covariates between the two elevated trajectories. Minority ethnic status and pre-school conduct problems were more strongly associated with the high-decreasing trajectory; and covariates measured after school entry (behaviour problems, mother-child conflict and school maladjustment) with the medium-increasing trajectory. This suggests a greater burden of early risk for the high-decreasing trajectory, and that children with moderate early problem levels were more vulnerable to influences after school transition. Our findings largely support the sparse existing international evidence and are strengthened by the use of child-reported data. They highlight the need to identify protective factors for children with moderate, as well as high, levels of internalising problems at pre-school age, but suggest different approaches may be required.

Situating violent ideations within the landscape of mental health: Associations between violent ideations and dimensions of mental health

Violent ideations occur more frequently in individuals with mental health problems. They may be of interest in clinical contexts as possible indicators of dangerousness, as corollaries of mental health problems, as candidate treatment targets and as potentially playing a role in perpetuation or onset of symptoms. In spite of their relevance to mental health, some fundamental questions about their place within the broader landscape of mental health problems remain unanswered. To provide a basic characterisation of the relations between violent ideations and dimensions of mental health and provide a foundation for future research in this area we factor analysed a measure of violent ideations and an omnibus measure of mental health dimensions in a normative sample of 1306 youth (at age 17). Results supported a separate dimension of violent ideations with a small to moderate correlation with five other dimensions of mental health: internalising, prosociality, ADHD, indirect/proactive aggression, and physical/reactive aggression. Controlling for comorbidity among mental health dimensions, all but ADHD had unique relations with violent ideations. This suggests that violent ideations are potentially of broad relevance to mental health and related behaviours and there should be a greater research effort aimed at understanding their possible role in mental health.

Anxiety, depression and risk of cannabis use: Examining the internalising pathway to use among Chilean adolescents

BACKGROUND

Adolescents who experience internalising symptoms may be susceptible to the use of alcohol and other substances in an attempt to alleviate or cope with these symptoms. We examined the hypothesised internalising pathway from symptoms of depression, generalised anxiety, social anxiety and panic, to incidence and frequency of cannabis use 18 months later.

METHOD

Longitudinal cohort study of participants (n=2508; 45% female; mean age 14.5 years) recruited from the 9th grade at 22 low-income secondary schools in Santiago, Chile. Baseline internalising symptoms were assessed using the Beck Depression Inventory and the Revised Child Anxiety and Depression Scale. Frequency of cannabis was assessed at baseline, 6 month and 18 month follow-up.

RESULTS

High rates of use were observed in this sample, with 40.3% reporting cannabis use at least once over the study period. Adjusted for baseline cannabis use, symptoms of depression, panic and generalised anxiety were associated with greater cannabis use frequency 18 months later. When all predictors were considered simultaneously, only generalised anxiety symptoms showed an independent association with subsequent cannabis use frequency (OR: 1.23, 95% CI: 1.08-1.41). Generalised anxiety symptoms were also associated with a 25% increased risk of transitioning from non-user to use of cannabis during the study (OR: 1.25, 95% CI: 1.09-1.44).

CONCLUSIONS

Internalising symptoms, and in particular symptoms of generalised anxiety, increase risk of cannabis use during adolescence. Targeted interventions that promote adaptive anxiety management among high-risk adolescents may represent a promising strategy to prevent uptake of cannabis use during adolescence.

Severity of mental illness as a result of multiple childhood adversities: US National Epidemiologic Survey

PURPOSE

To examine patterns of childhood adversity, their long-term consequences and the combined effect of different childhood adversity patterns as predictors of subsequent psychopathology.

METHODS

Secondary analysis of data from the US National Epidemiologic Survey on alcohol and related conditions. Using latent class analysis to identify childhood adversity profiles; and using multinomial logistic regression to validate and further explore these profiles with a range of associated demographic and household characteristics. Finally, confirmatory factor analysis substantiated initial latent class analysis findings by investigating a range of mental health diagnoses.

RESULTS

Latent class analysis generated a three-class model of childhood adversity in which 60 % of participants were allocated to a low adversity class; 14 % to a global adversities class (reporting exposures for all the derived latent classes); and 26 % to a domestic emotional and physical abuse class (exposed to a range of childhood adversities). Confirmatory Factor analysis defined an internalising-externalising spectrum to represent lifetime reporting patterns of mental health disorders. Using logistic regression, both adversity groups showed specific gender and race/ethnicity differences, related family discord and increased psychopathology.

CONCLUSIONS

We identified underlying patterns in the exposure to childhood adversity and associated mental health. These findings are informative in their description of the configuration of adversities, rather than focusing solely on the cumulative aspect of experience. Amelioration of longer-term negative consequences requires early identification of psychopathology risk factors that can inform protective and preventive interventions. This study highlights the utility of screening for childhood adversities when individuals present with symptoms of psychiatric disorders.

Internalising symptoms and body dissatisfaction: untangling temporal precedence using cross-lagged models in two cohorts

BACKGROUND

Cross-sectional studies demonstrate that body dissatisfaction and internalising symptoms are correlated and are both overrepresented in girls compared to boys. However, it is not clear whether body dissatisfaction typically precedes internalising symptoms or vice versa. Existing literature provides theoretical and empirical support for both possibilities, but is limited in two ways: (a) no study has simultaneously tested the two temporal hypotheses within the same model, and (b) the studies focus almost exclusively on early adolescents resulting in little being known about development from preadolescence and across puberty.

METHODS

This study used data from 5485 primary school students (49.1% girls, aged 8-9 years at baseline) and 5981 secondary school students (53.9% girls, aged 11-12 years at baseline). Self-reports of internalising symptoms and body dissatisfaction were collected over three consecutive years at 1-year intervals. Cross-lagged models were estimated in the two cohorts, for boys and girls separately, to examine the temporal associations between these two domains across the three measurement points.

RESULTS

In the younger cohort, internalising symptoms predicted body dissatisfaction 1-year later for both boys and girls, whereas there was no evidence for the reverse being true. In the older cohort, internalising symptoms predicted later body dissatisfaction for boys. However, in girls, body dissatisfaction predicted later internalising symptoms.

CONCLUSIONS

In preadolescents, internalising symptoms drive later body dissatisfaction regardless of gender, suggesting body dissatisfaction is a specific manifestation of a tendency towards negative affect. From age 11, girls develop a distinct risk profile whereby body dissatisfaction drives later internalising symptoms. Preventative interventions in this field would benefit from adopting a developmentally sensitive approach that takes into account gender differences in risk pathways.

Investigating age-related differences in responses to screening items for internalising disorders in three national surveys

BACKGROUND

Epidemiological studies typically report lower prevalence of mental disorders among older adults relative to middle-aged and young adults. A possible explanation is that age-related bias in the screening items of diagnostic instruments leads to older adults being differentially screened out of the full assessment. This study investigated potential age-related bias in screening items for internalising disorders in three epidemiological surveys.

METHOD

Measurement invariance was estimated for the internalising disorder screening items in the 2007 and 1997 Australian National Survey of Mental Health and Wellbeing, and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. These surveys assessed mental disorders using the Composite International Diagnostic Interview (CIDI) and the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). A series of multi-group confirmatory factor analyses (CFA) were performed for each survey across older (65-85 years), middle (35-64 years) and young (16-34 years) adults.

RESULTS

Differences between successive CFA models for each survey were negligible, indicating measurement invariance across age groups for the CIDI and AUDADIS-IV screening items.

LIMITATIONS

The number of items and symptoms representing internalising pathology differed between surveys. The samples excluded people in aged-care institutions.

CONCLUSIONS

While findings do not rule out that other measurement errors may be present (e.g., age-related bias in the remaining items), these results support the validity of the screening items in the CIDI and AUDADIS-IV. Low prevalence estimates of internalising disorders in older adults are unlikely attributable to differences in response patterns to screening items.