Violence Against Women, Mother–Infant Bond and Child Behaviour: An Exploratory Path Analysis at IVAPSA Cohort

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

BackgroundThere is increasing recognition that the early-years of a child’s life are critical periods in which social inequalities in mental health can develop. A systematic review has shown that a...

Child mental health services in England: a continuing crisis

This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

To prevent an intergenerational cycle of malfunction, it is crucial to understand how mothers' exposure to traumatic war experiences contributes to their children's vulnerability to mental health problems. This study examined the role of maternal psychopathology and mother-child emotional availability (EA) in the association between mothers' trauma exposure and children's mental health problems in a sample of 222 Burundian mother-child dyads living in refugee camps in Tanzania. Maternal and child EA were assessed through recorded observations of mother-child interactions. In structured clinical interviews, mothers reported on their lifetime exposure to traumatic events and their psychopathology and both mothers and fathers reported on children's emotional and behavioral problems. Structural equation modeling showed that mothers' higher trauma exposure was indirectly associated with higher levels of children's mental health problems through higher levels of maternal psychopathology. Mothers' higher trauma exposure was also directly associated with lower maternal EA in mother-child interactions, which was in turn related to higher levels of children's mental health problems. The findings suggest that trauma exposure independently affects mothers' mental health and their EA, which can contribute to children's mental health problems. Interventions aiming to reduce mothers' psychopathology and strengthen their EA may be beneficial for children's well-being.

Childhood is a crucial period for the formation of an individual's attachment type. Previous studies focused more on how to directly intervene in children's mental health problems such as depression, and less on how to improve children's mental health from the perspective of attachment relationship. Secure base, as one of the core concepts of attachment theory, plays an important role in the whole process of children's psychological development. In this article, we review the concept of the secure base, describe current clinical practice and suggest future directions. A literature search was performed within electronic databases such as Web of Science, PubMed, and CNKI. Chinese and English articles focusing on the secure base and attachment relationship among children were retrieved. Their publication dates were set from the inception of the database to August 6, 2024. While the secure base significantly impacts early childhood, a safe base may also be established through group and teacher-student relationships to activate individual secure attachment schemas. Most prior studies concentrated on the mother-child bond, with limited exploration of the father's role in the family dynamic. Furthermore, children's secure attachment development is not only influenced by parents' secure base script knowledge (SBSK) but also by intergenerational transmission. The underlying structure of secure base scripting knowledge plays a distinct role in middle childhood mental health. The mechanism by which family structure, the functional division of family roles, and the potential structure of safe-base script knowledge influence children's secure attachment development at various stages warrants further elucidation, including investigating cross-gender and cross-cultural stability. To facilitate the development of children's secure attachment pathways, it is essential to consider different attachment styles within parents and diverse family structures (including those in lesbian, gay, bisexual). From a clinical psychotherapy perspective, this review offered novel insights and practical guidance on how the secure base mechanism impacts children's mental health, with the overarching goal of mitigating the risk of mental health problems.

Objective: Several studies have explored the correlation between postpartum depression and a weak mother-infant bond; however, fewer studies have analyzed how other postpartum mental health conditions, such as childbirth-related post-traumatic stress disorder (PTSD), or important personal characteristics, including adult attachment styles, affect the quality of the mother-infant bond. This study aims to examine the association between attachment styles and postpartum bonding in mothers, considering the mediating influence of postpartum depression and childbirth-related PTSD. Methods: A total of 150 mothers, 4 to 12 weeks postpartum, completed a demographic questionnaire, the Edinburgh postpartum depression questionnaire, the posttraumatic stress questionnaire related to the birth of a child, the mother-child bonding questionnaire, and the attachment style questionnaire. The posttraumatic stress related to the birth of a child questionnaire was translated into Persian for the first time and was used after confirming its validity and reliability. The proposed model was examined by the structural equation modeling method. Results: The conceptual model’s results showed that the direct and standardized effect of anxious attachment style (β=0.49, P=0.001) and avoidant attachment style (β=0.47, P=0.001) on postpartum depression were significant. Also, the direct effect of anxious attachment style (β=0.59, P=0.001) on postpartum PTSD was significant. However, the coefficient of avoidant attachment style (β=-0.04, P=0.581) was not significant for postpartum PTSD. Also, the coefficients were investigated from the direct effect of postpartum depression, postpartum PTSD, anxious attachment style, and avoidant attachment style. The obtained results showed that postpartum depression (β=0.27, P=0.001), postpartum PTSD (β=0.43, P=0.001), and anxious attachment style (β=0.39, P=0.001) could predict the mother-child bond. However, the avoidant attachment style (β=0.00, P=0.946) could not predict the mother-child bond. Conclusion: The findings of the study revealed that insecure attachment styles were linked to challenges in forming a strong mother-infant bond. Anxious attachment was also associated with bonding difficulties, which were influenced by symptoms of postpartum depression and childbirth-related PTSD. In contrast, a higher degree of avoidant attachment style was associated with more significant difficulties in bonding, which were mediated by symptoms of depression. Accordingly, if interventions aim to enhance the mother-infant bond, treatment should focus on addressing childbirth-related PTSD, PPD symptoms, and insecure attachment styles.

Evidence suggests that participation in physical activity may support young people's current and future mental health. Although previous reviews have examined the relationship between physical activity and a range of mental health outcomes in children and adolescents, due to the large increase in published studies there is a need for an update and quantitative synthesis of effects. The objectives of this study were to determine the effect of physical activity interventions on mental health outcomes by conducting a systematic review and meta-analysis, and to systematically synthesize the observational evidence (both longitudinal and cross-sectional studies) regarding the associations between physical activity and sedentary behavior and mental health in preschoolers (2-5years of age), children (6-11years of age) and adolescents (12-18years of age). A systematic search of the PubMed and Web of Science electronic databases was performed from January 2013 to April 2018, by two independent researchers. Meta-analyses were performed to examine the effect of physical activity on mental health outcomes in randomized controlled trials (RCTs) and non-RCTs (i.e. quasi-experimental studies). A narrative synthesis of observational studies was conducted. Studies were included if they included physical activity or sedentary behavior data and at least one psychological ill-being (i.e. depression, anxiety, stress or negative affect) or psychological well-being (i.e. self-esteem, self-concept, self-efficacy, self-image, positive affect, optimism, happiness and satisfaction with life) outcome in preschoolers, children or adolescents. A total of 114 original articles met all the eligibility criteria and were included in the review (4 RCTs, 14 non-RCTs, 28 prospective longitudinal studies and 68 cross-sectional studies). Of the 18 intervention studies, 12 (3 RCTs and 9 non-RCTs) were included in the meta-analysis. There was a small but significant overall effect of physical activity on mental health in children and adolescents aged 6-18years (effect size 0.173, 95% confidence interval 0.106-0.239, p < 0.001, percentage of total variability attributed to between-study heterogeneity [I2] = 11.3%). When the analyses were performed separately for children and adolescents, the results were significant for adolescents but not for children. Longitudinal and cross-sectional studies demonstrated significant associations between physical activity and lower levels of psychological ill-being (i.e. depression, stress, negative affect, and total psychological distress) and greater psychological well-being (i.e. self-image, satisfaction with life and happiness, and psychological well-being). Furthermore, significant associations were found between greater amounts of sedentary behavior and both increased psychological ill-being (i.e. depression) and lower psychological well-being (i.e. satisfaction with life and happiness) in children and adolescents. Evidence on preschoolers was nearly non-existent. Findings from the meta-analysis suggest that physical activity interventions can improve adolescents' mental health, but additional studies are needed to confirm the effects of physical activity on children's mental health. Findings from observational studies suggest that promoting physical activity and decreasing sedentary behavior might protect mental health in children and adolescents. PROSPERO Registration Number: CRD42017060373.

Responding to the Child Mental Health Emergency: Future Pediatricians to the Rescue?

Objective: To assess healthcare resource utilization (HRU) and costs in children of mothers with and without postpartum depression (PPD).Methods: Administrative claims data from the IBM Watson Health MarketScan Databases (2010–2016) were used. Women with live births (index date = delivery date) were identified and linked to their newborns. The mother–child pairs were divided into PPD and non-PPD exposure cohorts based on claims for depression, mood or adjustment disorders, or anxiety identified in the mother between 15 and 365 days after delivery. Mother–child pairs with PPD exposure were propensity score matched 1:3 to mother–child pairs without PPD exposure. Children were required to have 24 months of continuous health plan enrolment following delivery. Additional comparisons were performed between mother–child pairs with and without preterm delivery.Results: Overall, 33,314 mother–child pairs with PPD exposure were propensity score matched to 102,364 mother–child pairs without PPD exposure. During the 24-month follow-up period, HRU across most service categories was significantly higher among children in the PPD exposure cohort than non-PPD exposure cohort. Among outpatient services, the percentages of children with a physician specialist service (68% versus 64%), early-intervention screening (40% versus 37%), and an emergency room visit (48% versus 42%) were greater in children of mothers with PPD (all p < .001). Furthermore, children of mothers with PPD incurred 12% higher total healthcare costs in the first 24 months of life compared to children of mothers without PPD ($24,572 versus $21,946; p < .001). After excluding mothers with preterm delivery, the proportion of children with ER visits, physician specialist services, and outpatient pharmacy claims was significantly higher in the PPD exposure cohort than non-PPD exposure cohort (all p < .001).Conclusion: The results of this analysis suggest that HRU and costs over the first 24 months of life in children of mothers with PPD exceeded that of children of mothers without evidence of PPD.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

This study aims to understand the temporal and spatial characteristics of public concern for "children's mental health" in China in the context of the COVID-19 epidemic. Baidu Index is a research tool to collect and analyze massive data on Chinese netizens' behaviors. Using Baidu Index as the research tool, this paper analyzes the trend and distribution of Chinese netizens' attention to "children's mental health" from December 1st, 2019 to March 20th, 2022 from three aspects of trend research, demand map, and crowd portrait. The study found that since the outbreak of COVID- 19, the search trend of "children's mental health" has shown a cyclical change, peaking in May and valley around the Spring Festival and National Day, and stable in other periods. "Mental health", "handwritten newspaper on mental health" and "youth mental health" are the most popular buzzwords among the public. The groups concerned with "children's mental health" is mainly distributed in Guangdong, Jiangsu, Beijing, and the majority are women between 30 and 39 years old. Meanwhile, search trends for "mental health" are like that for "children's mental health." The factors influencing the search volume change of "children's mental health" include Chinese traditional holidays, Spring Festival, National Day, Chinese Mental Health Day, and policies and instructions on children's mental health issued by the PRC Ministry of Education. The public would like to know about "mental health", "handwritten newspaper on mental health" and "adolescent mental health".

Child and adolescent psychiatry research during the COVID-19 pandemic

A systematic review was undertaken of scientifically rigorous studies of family-based services in children's health and mental health. From a pool of over 4000 articles since 1980 in health and mental health that examined either specific family-based interventions for families of children or the processes of involvement, 41 studies were identified that met the methodological criteria for inclusion. These 41 studies encompassed 3 distinct categories: families as recipients of interventions (e.g., family education, support, engagement, empowerment); (b) families as co-therapists; and (c) studies of the processes of involvement (e.g., therapeutic alliance, engagement, empowerment, expectancies, and choice). Too few experimental studies exist to conclude decisively that family-based services improve youth clinical outcomes. However, those studies that have been rigorously examined demonstrate unequivocal improvements in other types of outcomes, such as retention in services, knowledge about mental health issues, self-efficacy, and improved family interactions - all outcomes that are essential ingredients of quality care. Four implications are drawn from this review. (1) Effective family education and support interventions from studies of adults with mental illnesses and from studies of families of high-risk infants exist and can be imported into the field of children's mental health. (2) The range of outcomes that are typically assessed in clinical treatment studies is too narrow to afford an adequate view of the impact of family-based interventions. A broader view of outcomes is needed. (3) The absence of a robust literature on process variables other than therapeutic alliance limits conclusions about how and why interventions are effective. Attention to the processes by which families become involved in services will require a more robust and nuanced range of studies that attend simultaneously to processes of change and to outcome improvement. (4) Linkage of effective family-based interventions to delivery of evidence-based services is likely to amplify the impact of those services and improve outcomes for youth and families.