Long-Term Effects of Maternal and Paternal Emotional Distress, Eating, and Body Image on Children’s Weight: The Mediating Role of Child Social Functioning

Longitudinal studies including parental distress when examining adverse health outcomes in adolescents with type 1 diabetes are lacking. This study examined whether parental depression and anxiety predict adolescent emotional distress and glycated hemoglobin A1c (HbA1c) 1 year later and whether a relation between parental distress and HbA1c is mediated by the level of parental involvement in diabetes care and by treatment behaviors. Longitudinal path modeling was applied to data from 154 adolescents and parents from diabetes centers participating in the Longitudinal study of Emotional problems in Adolescents with type 1 diabetes and their Parents/caregivers (Diabetes LEAP). At baseline and 1-year follow-up, participants completed measures of depression and anxiety. HbA1c was extracted from medical charts. Responsibility and treatment behavior questionnaires were completed by adolescents at baseline. Baseline parental depressive and anxiety symptoms were not associated with 1-year adolescent depressive symptoms, anxiety symptoms, and HbA1c. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA1c. Parental depressive and anxiety symptoms did not predict adolescent health outcomes 1 year later. Future studies may determine whether the link is present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress. Adolescents with T1D are a vulnerable group in terms of psychological and health outcomes. Whether parental emotional distress (i.e., depressive and anxiety symptoms) is prospectively associated with adolescent emotional distress and/or HbA1c has been understudied. Our results show that parental distress was not related to adolescent distress or HbA1c 1 year later. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA1c. Future studies could determine whether these links are present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress.

While there have been studies exploring the relationships between parental representations of their child’s illness, parental emotional distress and coping, there is lack of research on parents of children with intellectual disability (ID). The present study explores relationships between parental illness representations of their child’s ID, parental emotional distress and coping. Ninety-one parents of children with ID completed measures of the Illness Perception Questionnaire-Revised (IPQ-R), the Brief COPE scale and the Depression, Anxiety and Stress Scale (DASS-21). Correlation, regression and mediation analyses were conducted for all variables. Emotional distress correlated negatively with ‘identity’ (r = − .23) and positively with self-blame and substance abuse (r = .51), ‘consequences’ (r = .34), perception of child’s symptoms as ‘cyclical’ appearing and disappearing (r = .29) and maladaptive coping such as behavioural disengagement (r = .27). Negative illness representations such as consequences and perception of symptoms as ‘cyclical’ uniquely predicted about 9% of parental emotional distress after accounting for self-blame and substance abuse and behavioural disengagement together explaining nearly 30% of the outcome. Lastly, self-blame and substance abuse mediated the relationship between ‘illness coherence’ and ‘emotional distress’ as well as the relationship between ‘consequences’ and ‘emotional distress’. The study has identified that certain parental coping methods and illness representations that parents have of their child’s ID are associated with parental emotional distress.

The current study investigated the occurrence of emotional distress in parents of long-term survivors of childhood acute lymphoblastic leukemia (ALL) and identified factors associated with parent emotional distress symptoms. Parents of 127 long-term survivors of childhood ALL treated on a chemotherapy-only protocol at St. Jude Children's Research Hospital participated in the study. Parents completed standard ratings of emotional distress, caregiver strain, and child physical, emotional, and psychosocial functioning. Multivariable hierarchical linear regression analyses were used to examine associations between symptoms of caregiver strain, survivor functioning, and parent emotional distress. Covariates included parent education, survivor age, survivor sex, and time since childhood cancer diagnosis. On average, few parents reported significant symptoms of emotional distress. Clinically significant levels of anxiety and depression were reported by 7.1% and 3.1% of parents, respectively. Only 3.9% of parents endorsed significant symptoms of posttraumatic stress. Perceived caregiver strain was significantly associated with symptoms of parent anxiety, depression, and posttraumatic stress. Parent-report of child emotional functioning was significantly associated with symptoms of parent anxiety. Most parents of long-term survivors of ALL exhibit low levels of emotional distress in the context of rates observed in the general population. Perceived caregiver strain was significantly associated with parent emotional distress. Further research is required to examine specific sources of caregiver strain, as well as other risk and protective factors associated with parent emotional distress symptoms.

Background:Parental psychological and behavioral factors may influence outcomes in youths with functional abdominal pain disorders (FAPDs), yet limited research has explored these associations in families referred for hospital-based psychological treatment.Objectives:To describe parental emotional and behavioral factors in families referred to internet-based cognitive behavioral therapy (ICBT) for FAPDs, and examine their associations with youth-reported outcomes.Design:Cross-sectional exploratory study.Methods:Eighty-seven parent-youth dyads (youth aged 8–17 years) enrolled in an ICBT intervention study at a Danish hospital participated. Parental factors included emotional distress (SCL-8), health anxiety by proxy (HAPYs), and behavioral responses (Adult Responses to Child Symptoms Monitor and Protect subscales). Youth-reported outcomes included gastrointestinal symptoms (Pediatric Quality of Life Gastrointestinal Symptom Scale (PedsQL-Gastro)), pain intensity (Faces Pain Rating Scale-Revised), quality of life (PedsQL), gastrointestinal-anxiety (Visceral Sensitivity Index-Child adapted short scale), and avoidance/control behaviors (BRQ-C). Associations were examined using Spearman’s correlations and hierarchical linear regression models, adjusting for all parental factors and youth sex.Results:Most parents were mothers, highly educated, employed, cohabiting, with a middle to high household income. They generally reported low emotional distress, moderate health anxiety by proxy (HAPY) and monitoring behavior, and low protective behavior. Parental emotional distress and HAPY were significantly correlated with lower youth-reported quality of life and higher gastrointestinal-specific anxiety, particularly among adolescents. Monitoring behavior correlated with greater pain intensity, especially in children. In adjusted analyses, higher emotional distress remained significantly associated with lower youth-reported quality of life (β = –0.95, p = 0.02) and higher gastrointestinal-specific anxiety (β = 0.63, p = 0.008). Monitoring behavior remained significantly associated with greater youth-reported pain intensity (β = 0.22, p = 0.01). HAPY and protective behavior showed no significant independent associations with adverse youth outcomes. However, in age-stratified analyses, protective behavior was associated with fewer gastrointestinal symptoms in adolescents (β = 2.84, p = 0.02). No notable significant sex differences were observed.Conclusion:Parental emotional distress and monitoring behavior were the most consistent parental factors associated with adverse youth outcomes and may represent key targets in intervention for pediatric FAPDs. The potential protective role of certain parental behaviors in adolescents warrants further exploration. Findings should be replicated in larger, more diverse samples.

ObjectiveThis study examines whether parental emotional distress during the first pandemic-related school shutdown in 2020 in Germany affected the development of primary school students’ mathematical skills and investigates changes in parents’ working conditions as triggers of cascading stress processes. BackgroundThe Family Stress Model (FSM) explains the mechanisms that mediate between families’ structural conditions and children's developmental outcomes. Foundational works for this approach focus on historic events that instigate rapid structural changes which, in turn, undermine families' economic situation. The economic losses trigger stress processes. Research on the COVID-19 pandemic reports heightened levels of parental stress and negative impacts on children's cognitive and socioemotional development. This study examines the role of parental emotional distress during the COVID-19 shutdown on children's cognitive development. Expanding on the classical FSM, we hypothesize that changes in parents' working situation, rather than economic changes, may have triggered family stress processes during the shutdown, as federal support largely cushioned economic cutbacks in Germany. MethodFor the German National Educational Panel Study (NEPS), interviews were conducted with parents, and primary school students in Starting Cohort 1 were tested after the first shutdown in 2020. The database provides rich information from survey waves prior to the COVID-19 pandemic, allowing a longitudinal analysis of a sample of 1512 primary school students with ordinary least squares regression. ResultsParents’ emotional distress during the pandemic had a robust negative effect on students’ mathematical skills, even when controlling for prior parenting stress. Changes in parents’ working conditions also had an effect on children’s test scores, and the negative effect of working from home on the test scores was mediated by parents’ emotional distress. ConclusionThe COVID-19 pandemic was a historic event which, at least in Germany, challenged the mental health of many parents and, in turn, impaired the skill development of primary school students. We introduce the role of changes in working conditions as triggers of such processes.

The current study evaluated risk factors in adolescence on problem drinking and emotional distress in late adolescence and emerging adulthood, and meeting criteria for diagnosed disorders in adulthood. The study included 501 parents and their adolescent who participated from middle adolescence to adulthood. Risk factors in middle adolescence (age 18) included parent alcohol use, adolescent alcohol use, and parent and adolescent emotional distress. In late adolescence (age 18), binge drinking and emotional distress were assessed, and in emerging adulthood (age 25), alcohol problems and emotional distress were examined. Meeting criteria for substance use, behavioral, affective, or anxiety disorders were examined between the ages of 26 and 31. Results showed parent alcohol use predicted substance use disorder through late adolescent binge drinking and emerging adulthood alcohol problems. Behavioral disorders were indirectly predicted by adolescent and emerging adult emotional distress. Affective disorders were indirectly predicted by parent emotional distress through adolescent emotional distress. Finally, anxiety disorders were predicted by parent alcohol use via adolescent drinking; parent emotional distress via adolescent emotional distress, and through adolescent alcohol use and emotional distress. Results provided support for the intergenerational transmission of problem drinking and emotional distress on meeting criteria for diagnosed psychiatric disorders in adulthood.

Health disparities among children living in poverty underscore the importance of identifying risk and protective factors for childhood obesity. By applying a family stress framework with an equity lens, this study aimed to test the differential associations between maternal distress and child body mass index (BMI) in preschool‐age children living in low‐income families. Pre‐intervention data from an obesity prevention randomized controlled trial were used to assess mother‐reported parental distress and anthropometry collected from children and mothers in a diverse sample of 450 families enrolled in Head Start. Analyses examined associations between maternal distress and child BMI z‐score (BMIz) and moderation by child sex. The sample of children was 49% female, 42% White, 25% Black, 11% Hispanic and 33% had overweight status or obesity. Results indicated higher BMIz for girls compared to boys (β = 0.10, p = 0.03). Child sex modified the association between maternal distress and child BMIz (β = 0.12, p = 0.01). Greater maternal distress was associated with higher BMIz among girls but not boys. Among preschoolers, the maternal distress–BMIz association differed by child sex. Understanding individual differences in how maternal distress relates to childhood obesity may have important implications for obesity prevention efforts.

I. The Problem: Childhood Obesity—A Burgeoning Epidemic e490II. Childhood Obesity Research Summit.........e490III. Pathophysiology and Morbidity ofChildhood Obesity e490A. Pathophysiology of Obesity e490B. Medical Consequences of Childhood Obesity. . .e490C. Psychosocial and Societal Consequences ofChildhood Obesity e490IV. Current Healthcare Practices in ChildhoodObesity Prevention and Treatment e492A. Lifestyle Assessment: Diet and Physical Activity . . . .e492B. Clinical Assessment e493C. Psychosocial/Behavioral Assessment .......e493D. Implementing Effective Prevention andTreatment Options: Diet e494E. Implementing Effective Prevention and TreatmentOptions: Exercise and Sedentary Behaviors . . . .e495F. Implementing Effective Prevention TreatmentOptions: Family and Behavioral Approaches . . .e496G. Behavioral Management e497H. Medical and Pharmacological Management. . . .e497I. Surgical Management e498V. Barriers to Optimum Care e498A. Healthcare System Factors e4981. Preparedness of Providers e4982. Models of Coverage and Care e4993. Uninsurance and Underinsurance AmongChildren and Families e5004. Healthcare Providers and Settings asRole Models e500B. The Challenge of Behavior Change ........e5011. Motivational Interviewing for Pediatric Obesity. .e5012. Psychosocial Factors InfluencingBehavior Change e5023. Environmental Factors InfluencingBehavioral Change e503VI. Practice-Based Resources for Preventionand Management e503A. Models From Other Disciplines e5031. Adult Chronic Care Model e5032. Treatment of Heart Failure e5043. Treatment of Type 2 Diabetes Mellitus .....e5044. Treatment of Childhood Asthma.........e505B. Public Health Measures forChildhood Obesity e5061. Tobacco Control: Implications forChildhood Obesity e506C. Specific Research Issues e5061. Specifying Priorities in the Context of aComplex, Multifactorial Problem ........e5062. Taking a Developmental Approach .......e5073. Engaging Stakeholders e5074. Targeting the Appropriate Outcome .......e508VII. Research Challenges e509A. Research in the Busy Practice e509B. Bring Research Into Practices: Web-BasedAssessment for the PediatricObesity Clinic e509C. Research Agenda: NHLBI and thePediatric Heart Network e510D. Research Agenda: The Children’sOncology Group e510E. Research Agenda: CDC e511F. Research Agenda: Foundations e511VIII. Research and Policy: KnowledgeTranslation e512A. From Practice to Policy to Practice ........e512IX. Concluding Remarks e512Appendix A: Planning Committee e513Appendix B: Presenters e513

This study examined the combined effects of traumatic brain injury (TBI) history and posttraumatic stress disorder (PTSD) symptoms on social functioning in treatment-seeking active duty service members. We sought to determine whether objective cognitive performance, self-reported neurobehavioral symptoms, and emotional distress would be associated with more social functioning difficulties. Additionally, we hypothesized self-reported neurobehavioral symptoms would mediate both the relationships between emotional distress and social functioning, and between cognitive performance and social functioning. The study was part of a larger clinical project conducted at two military hospitals. We analyzed smaller datasets of baseline data from two groups: service members with history of TBI and/or PTSD (n = 71) and those with responses considered “valid” (n = 39). A significant predictive relationship among cognitive performance, neurobehavioral symptoms, and emotional distress on social functioning was found in the full sample. Further, neurobehavioral symptoms completely mediated the relationship between emotional distress and social functioning, but not between cognitive performance and social functioning. In the subsample, the overall regression was significant, but individual independent predictors were not. Findings suggest emotional distress and self-reported neurobehavioral symptoms are key considerations in treatment as a means of improving functioning in social domains and prioritizing treatment goals.

This study examined a structural equation model of the associations among food insecurity, parental emotional distress, quality of parenting, and adolescents’ adjustment problems, controlling for socioeconomic status (SES), sex, and race/ethnicity. Additionally, we examined the relative effects of food insecurity, SES, parental emotional distress, and quality of parenting on adjustment problems. A sample of 11,139 12–17-year-olds selected from the 2002 National Survey of American Families data set were used. The results revealed the following: first, the model exhibited a reasonable fit to the data. Second, heightened food insecurity was associated with increased parental emotional distress, poor quality of parenting, and increased adjustment problems. Third, increased parental emotional distress was associated with poor quality of parenting and with higher levels of adjustment problems; and better quality of parenting was associated with lower levels of adjustment problems. Fourth, food insecurity had an indirect effect on adjustment problems through its effect on parental emotional distress and quality of parenting. Finally, parental emotional distress and quality of parenting had stronger total effects on adjustment problems than did food insecurity. The implications of these findings for policy are also discussed.

To analyse, in a population-based study, the association between parental fear of hypoglycaemia and (i) the prevalence of hypoglycaemia and diabetes treatment factors in children with Type 1 diabetes and (ii) emotional distress in mothers and fathers. Mothers (n = 103) and fathers (n = 97) of 115 children with Type 1 diabetes (1-15 years old) participated in the study. In addition to demographic and disease-specific data, the participants completed the Hypoglycaemia Fear Survey-Parent version (HFS-P) (worry and behaviour subscales) and the Hopkins Symptom Checklist-25 items (HSCL-25) to measure emotional distress. A higher HFS-P worry score was associated with higher glycated haemoglobin (HbA(1c)), a higher frequency (>or= 7) of what parents experienced as problematic hypoglycaemic events during the past year and co-morbid disease in the child. A higher HFS-P behaviour score was associated with children receiving insulin injections compared with using an insulin pump and a higher frequency (>or= 7 per day) of blood glucose measurements. The mothers had higher scores than the fathers in both the worry and behaviour subscales. The mothers' and the fathers' HFS-P worry scores correlated significantly with their HSCL-25 scores. The association between a higher level of hypoglycaemic-related fear and parental emotional distress and poorer glycaemic control in the child emphasizes the need for programmes to support and guide parents. The results suggest that future interventions should target both the parents' fear and appropriate ways to prevent hypoglycaemia in children with Type 1 diabetes.

Fear of hypoglycaemia in mothers and fathers of children with type 1 diabetes is associated with poor glycaemic control and parental emotional distress: a population-based study

Health-related quality of life in disease-free survivors of breast cancer with the general population

This study evaluated which factors most influenced the impact of childhood asthma on the child's family. Seventy children/families seen at a tertiary-care hospital for asthma were evaluated. Stepwise multiple regression examined the effects of illness severity; family socioeconomic status (SES); family structure; social support; child's emotional characteristics; parent's health; family functioning; and maternal psychological distress on the Family Impact of Illness Scale. Analysis indicated that only the parent's Psychiatric Symptom Index significantly predicted impact scores. The most important predictors of how much impact a child's asthma has on the family are parental emotional distress and amount of social support.

To assess the level of agreement between body size self-perception and actual body size determined by body mass index (BMI) z-score and body fatness measured by the deuterium dilution method (DDM) in South African children aged 6–8 years. A cross-sectional sample of 202 children (83 boys and 119 girls) aged 6–8 years from the Body Composition–Isotope Technique study (BC–IT) was taken. Subjective measures of body image (silhouettes) were compared with the objective measures of BMI z-score and body fatness measured by the DDM. The World Health Organization BMI z-scores were used to classify the children as underweight, normal, overweight, or obese. DDM-measured fatness was classified based on the McCarthy centile curves set at 2nd, 85th and 95th in conjunction with fatness cut-off points of 25% in boys and 30% in girls. Data were analyzed using SPSS v26. Of 202 children, 32.2%, 55.1%, 8.8%, and 2.4% perceived their body size as underweight, normal, overweight, and obese, respectively. Based on BMI z-score, 18.8%, 72.8%, 6.9%, and 1.5% were classified as underweight, normal, overweight, and obese, respectively. Body fatness measurement showed that 2.5%, 48.0%, 21.8%, and 29.7% were underweight, normal weight, overweight, and obese, respectively. The application of silhouettes and BMI z-scores resulted in either overestimation or underestimation of own body size. Overall, the levels of agreements (kappa, κ) between body size perception, body fatness, and BMI for age respectively, were small (κ = 0.083, p = 0.053 and κ = 0.154, p<0.001). Level of agreement between body size perception, body fatness, and BMI z-score was poor. The use of silhouettes made children either overestimate their own body size while being underweight or underestimate their own body size while being overweight or obese. Given the potential health implications associated with misclassification of body size during childhood, correct self-assessment of body size is important, and may be key to the adoption of weight control strategies directed at curbing the escalating obesity epidemic in the country. Scalable measures to allow for more accurate self-assessment are urgently needed–one approach is behavior change communication at all levels.