Childhood Emotional Disorders Research Articles

Is the Unified Protocol for Children Effective for the Transdiagnostic Treatment of Children’s Emotional Disorders? A Randomized Controlled Trial

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) aims to reduce internalizing symptoms in children by addressing fundamental mechanisms that underlie emotional disorders through a combination of cognitive, emotional, and behavioral strategies. This study, the largest randomized controlled trial (RCT) to date of UP-C efficacy and the first one conducted outside the U.S., assesses the efficacy of UP-C compared to an active control group. A total of 153 children (6–13 years old; 58.8% girls) with at least one emotional disorder as a primary diagnosis and their parents (88.2% mothers) were randomly assigned to either the UP-C condition (n = 77) or an active control condition (n = 76; receiving a psychoeducational intervention, the ABC of Emotions). Participants completed self-report questionnaires at pretreatment, midtreatment, posttreatment, and at the 3-month follow-up, assessing children’s internalizing symptoms and their interference with the child and family functioning. Clinicians assessed the severity of the child’s symptoms and monitored clinical improvement throughout the study. Descriptive statistics, comparative tests and Linear Mixed Models were used. Results showed greater satisfaction, lower dropout rates, and better adherence in the UP-C condition, with a reduced need for additional interventions posttreatment compared to the control group. The UP-C demonstrated significantly greater efficacy in reducing internalizing symptoms, with a large effect size, including anxiety and depression, as well as in reducing the interference and severity of child symptoms and in improving clinical gains compared to the control group. These findings provide strong support for UP-C as a feasible, acceptable, and effective treatment for childhood emotional disorders, reinforcing its status as an evidence-based treatment.

Implications of a De Novo Variant in the SOX12 Gene in a Patient with Generalized Epilepsy, Intellectual Disability, and Childhood Emotional Behavioral Disorders.

SRY-box transcription factor (SOX) genes, a recently discovered gene family, play crucial roles in the regulation of neuronal stem cell proliferation and glial differentiation during nervous system development and neurogenesis. Whole exome sequencing (WES) in patients presenting with generalized epilepsy, intellectual disability, and childhood emotional behavioral disorder, uncovered a de novo variation within SOX12 gene. Notably, this gene has never been associated with neurodevelopmental disorders. No variants in known genes linked with the patient's symptoms have been detected by the WES Trio analysis. To date, any MIM phenotype number associated with intellectual developmental disorder has not been assigned for SOX12. In contrast, both SOX4 and SOX11 genes within the same C group (SoxC) of the Sox gene family have been associated with neurodevelopmental disorders. The variant identified in the patient here described was situated within the critical high-mobility group (HMG) functional site of the SOX12 protein. This domain, in the Sox protein family, is essential for DNA binding and bending, as well as being responsible for transcriptional activation or repression during the early stages of gene expression. Sequence alignment within SoxC (SOX12, SOX4 and SOX11) revealed a high conservation rate of the HMG region. The in silico predictive analysis described this novel variant as likely pathogenic. Furthermore, the mutated protein structure predictions unveiled notable changes with potential deleterious effects on the protein structure. The aim of this study is to establish a correlation between the SOX12 gene and the symptoms diagnosed in the patient.

The Association Between Early Family Social Stressors and Emotional Well-Being Among Infants and Toddlers

ObjectiveEarly childhood behavioral and emotional disorders are linked to diagnosable mental health problems both later in childhood and into adulthood. However, little work has examined the association between family social stressors and emotional well-being among children under two years of age, including whether differences exist between infancy and toddlerhood. MethodsData come from the nationally representative 2019–2022 National Health Interview Survey, an annual, cross-sectional survey conducted by the National Center for Health Statistics. Separate multivariate logistic regression models estimated associations between family social stressors (stressful life events, family food insecurity, family difficulty paying medical bills) and having a Baby Pediatric Symptom Checklist (BPSC) subscale score of 3 or more (“above the BPSC cutoff”) for poorer emotional well-being among children 2–23 months. Models were additionally stratified by age group (infants, 2–11 months; toddlers, 12–23 months), and adjusted for child and family sociodemographic and geographical characteristics. ResultsChildren who had experienced a stressful life event (AOR=3.83, 95% CI: 2.48–5.92), family food insecurity (AOR=1.69, 95% CI: 1.13–2.51), or family difficulty paying medical bills (AOR=2.10, 95% CI: 1.54–2.87) had higher odds of being above the BPSC cutoff, adjusted for all relevant covariates. Toddlers who experienced a stressful life event (66.5% vs 41.0%) or family difficulty paying medical bills (53.1% vs 29.8%) had higher odds of being above the BPSC cutoff compared with infants. ConclusionsFamily social stressors were linked to poorer emotional well-being among young children. Future research may benefit from the exploration of additional predictors of emotional well-being among this age group.

Cumulative comorbidity between neurodevelopmental, internalising, and externalising disorders in childhood: a network approach

Cumulative comorbidity of mental disorders is common, but the extent and patterns of comorbid psychopathology in childhood are not well established. The current study aimed to elucidate the emergent patterns of cumulative mental disorder comorbidity in children using network analysis of diagnoses recorded between birth and age 12 years. Participants were 90,269 children (mean age 12.7 years; 51.8% male) within the New South Wales Child Development Study (NSW-CDS)—a longitudinal record-linkage cohort study of Australian children born in NSW between 2002 and 2005. Binary indicators for eight types of mental disorder were derived from administrative health records. Patterns of conditional association between mental disorders were assessed utilising network analysis. Of 90,269 children, 2268 (2.5%) had at least one mental disorder by age 12 years; of the 2268 children who had at least one mental disorder by age 12 years, 461 (20.3%) were diagnosed with two or more different disorders out of the eight disorder types included in analyses. All disorders were either directly or indirectly interconnected, with childhood affective and emotional disorders and developmental disorders being most central to the network overall. Mental disorder nodes aggregated weakly (modularity = 0.185) into two communities, representative of internalising and externalising disorders, and neurodevelopmental and sleep disorders. Considerable sex differences in the structure of the mental disorder comorbidity networks were also observed. Developmental and childhood affective and emotional disorders appear to be key to mental disorder comorbidity in childhood, potentially reflecting that these disorders share symptoms in common with many other disorders.

Stratifying early-onset emotional disorders: using genetics to assess persistence in young people of European and South Asian ancestry.

Depression and anxiety are the most common mental health problems in young people. Currently, clinicians are advised to wait before initiating treatment for young people with these disorders as many spontaneously remit. However, others develop recurrent disorder but this subgroup cannot be identified at the outset. We examined whether psychiatric polygenic scores (PGS) could help inform stratification efforts to predict those at higher risk of recurrence. Probable emotional disorder was examined in two UK population cohorts using the emotional symptoms subscale of the Strengths and Difficulties Questionnaire (SDQ). Those with emotional disorder at two or more time points between ages 5 and 25 years were classed as 'recurrent emotional disorder' (n = 1,643) and those with emotional disorder at one time point as having 'single episode emotional disorder' (n = 1,435, controls n = 8,715). We first examined the relationship between psychiatric PGS and emotional disorders in childhood and adolescence. Second, we tested whether psychiatric PGS added to predictor variables of known association with emotional disorder (neurodevelopmental comorbidity, special educational needs, family history of depression and socioeconomic status) when discriminating between single-episode and recurrent emotional disorder. Analyses were conducted separately in individuals of European and South Asian ancestry. Probable emotional disorder was associated with higher PGS for major depressive disorder (MDD), anxiety, broad depression, ADHD and autism spectrum disorder (ASD) in those of European ancestry. Higher MDD and broad depression PGS were associated with emotional disorder in people of South Asian ancestry. Recurrent, compared to single-episode, emotional disorder was associated with ASD and parental psychiatric history. PGS were not associated with episode recurrence, and PGS did not improve discrimination of recurrence when combined with clinical predictors. Our findings do not support the use of PGS as a tool to assess the likelihood of recurrence in young people experiencing their first episode of emotional disorder.

Pessimistic cognitive biases mediate socioeconomic status and children’s mental health problems

Low socioeconomic status (SES) is associated with higher rates of emotional disorders in childhood and beyond. Here we assessed one possible contributor to this disparity, a cognitive bias in the interpretation of negative events, in a group of 341 9-year-olds (49% female, 94% White) ranging widely in SES. This cognitive bias, known as pessimism in the attributional style literature, is the tendency to interpret negative events as persistent (Stable) and pervasive (Global). It was found to be more common among lower SES children (effect sizes = 0.18–0.24 depending on SES measures: income to needs ratio, proportion of poverty from birth to age 9, and parental educational attainment). Moreover, persistent, pervasive adversity in children’s lives predicted this bias and mediated the SES—pessimism link. Pessimistic attributional style, in turn, was related to childhood emotional problems and mediated the relation between SES and these problems. Finally, evidence for serial mediation of the SES-mental health problems relationship was found via persistent, pervasive adversity and pessimism, respectively.

Changes in major psychiatric disorders in children and adolescents from 2001 to 2020: A retrospective single-center study.

This study aimed to determine the hospitalization rates, length of stay, age at the time of admission, and sex distribution for major psychiatric disorders in children and adolescents and provide a reference for early intervention for these diseases and distribution of medical resources in hospitals. We screened 4,423 patients in the child and adolescent wards of the Anhui Provincial Mental Health Center from 2001 to 2020, and examined the top four (81.1%) mental health disorders that accounted for the overall proportion of patients admitted, namely schizophrenia (SCZ) (45.7%), depressive disorder (DD) (14.5%), bipolar disorder (BD) (9.3%), and childhood emotional disorder (CED) (11.6%), and for each disorder, the percentage of hospitalization, length of stay, age at admission, and sex distribution were analyzed. From 2001 to 2020, there was a significantly decreasing trend in the proportion of hospitalizations for SCZ (p < 0.001) and an increasing trend for depression and CED (p < 0.001). In terms of length of stay, SCZ was significantly longer than the other three disorders (p < 0.001), whereas there was no significant difference between DD, BD, and CED, and there was no significant trend in length of stay for any of the four disorders. The age at admission for CED was significantly lower than that for the other three disorders (p < 0.001). There was a decreasing trend in the age at admission for DD (p = 0.011) and an increasing trend for BD (p = 0.001). A significant increase in the number of female patients admitted for SCZ, DD, and CED was observed, while there was no significant change in the sex ratio for BD. Although there is a significant downward trend in the percentage of hospitalizations for SCZ, it is still the most common psychiatric disorder in children and adolescents. We observed a significant increase in the percentage of hospitalizations for DD and CED. In addition, the proportion of female patients being hospitalized is on the rise, and this aspect requires continuous attention.

A study on psychiatric conditions in children with school refusal- A clinic based study.

School refusal is a broad term that encompasses a child-motivated refusal to attend or remain at school, or a clear and apparent difficulty in doing so. Different factors that may influence the development of school refusal include a genetic predisposition, the home and family environment, the school environment, and social pressures. the present study aimed at examining, the psychiatric diagnostic status of children and adolescents who presented with school refusal. 92 consecutive subjects who attended the Child guidance clinic at Tata Main Hospital Jamshedpur were taken up for this study. The Clinical Diagnosis was based on the classificatory system of the International classification of diseases-10(ICD-10) through interviews. findings show that the mean age of the patient was 9.6 years. The prominent psychiatric co-morbidity present was Childhood emotional disorder unspecified, separation anxiety, conversion disorder, over-anxiety disorder, and somatoform disorder. Among children who refuse school, emotional reasons and anxiety disorders are most prevalent. This calls for early recognition and appropriate culturally relevant intervention to ensure early return to school.

MENTAL DISORDERS OF CHILDREN HOSPITALIZED IN A PEDIATRIC WARD. A STATISTICAL AND PSYCHOTHERAPEUTIC PERSPECTIVE

Introduction:The global prevalence (pooled-prevalence) of mental illnesses in children and adolescents is 13.4%, the prevalence of anxiety disorders is 6.5%, of depressive disorders 2.6%, and of activity and attention disorders 3.4 %. Materials and Methods: This research represents a 4-year retrospective study, including cases of continuous hospitalization, conducted in the Bistrita Emergency County Hospital, pediatrics department. The cases with the main discharge diagnostic code F were selected. The aim of the study was to analyze the diagnoses from a statistical and psychotherapeutic point of view. Results: In the case of patients with the main diagnosis coded with the letter F, the relative value (RV) of the case is higher than the pacient complexity index (PCI) of the section in most cases, in other words the complexity of these cases is higher than the average complexity of the section’s cases. The length of stay index (LOS) for psychiatric patients is most often a lower value than the average length of hospitalization (ALOS), or the length of hospitalization of psychiatric cases is shorter than the average length of hospitalization of the entire department. The most frequent group F diagnoses found are: F98.9 - Unspecified behavioral and emotional disorders with onset usually in childhood and adolescence, F98.8 - Other specified disorders of behavioral and emotional disorders with onset usually in childhood and adolescence, F90 .1 - Attention-deficit hyperactivity disorder, predominantly hyperactive type , F90.0 - Attention-deficit hyperactivity disorder, predominantly inattentive type, F92.0 - Depressive conduct disorder, F41.0 - Panic disorder (paroxysmal episodic anxiety) without agoraphobia, F71.0 - Moderate mental retardation with declaration of a minimal or no behavioral impairments, F90.0 - Disturbance of activity and attention, F93.8 - Other emotional disorders of childhood, F98.0 - Nonorganic enuresis. Conclusions: Diagnoses labeled F98 (Other behavioral and emotional disorders with usual onset in childhood and adolescence) were the most common. The complexity and non-specificity of pathologies can justify the importance of some psychotherapeutic interventions among diagnosed patients both during the respective episode of hospitalization and especially after discharge, for the good recovery and psycho-emotional development of children.

Selective mutism and the risk of mental and neurodevelopmental disorders among siblings.

The siblings of children with mental disorders are more likely to experience mental health issues themselves, but there has been a lack of sibling studies on selective mutism (SM). The aim of this population-based study was to use national registers to examine associations between children with SM and diagnoses of various mental disorder in their siblings. All singleton children born in Finland from 1987 to 2009, and diagnosed with SM from 1998 to 2012, were identified from national health registers and matched with four controls by age and sex. Their biological siblings and parents were identified using national registries and the diagnostic information on the siblings of the subjects and controls was obtained. The final analyses comprised 658 children with SM and their 1661 siblings and 2092 controls with 4120 siblings. The analyses were conducted using generalized estimating equations. Mental disorders were more common among the siblings of the children with SM than among the siblings of the controls. The strongest associations were observed for childhood emotional disorders and autism spectrum disorders after the data were adjusted for covariates and comorbid diagnoses among SM subjects. The final model showed associations between SM and a wide range of disorders in siblings, with strongest associations with disorders that usually have their onset during childhood. Our finding showed that SM clustered with other mental disorders in siblings and this requires further research, especially the association between SM and autism spectrum disorders. Strong associations with childhood onset disorders may indicate shared etiologies.

Social Networks of Children with Mental Disorders

Social Networks of Children with Mental Disorders Abstract. The study compares the social networks of children with mental disorders with a matched control group (n = 75/75, male 69 %/69 %, age: 9.4/9.0 years). In addition, we examined the quantity and structure of social networks as well as the stresses and resources in the respective patient group in general and regarding specific disorders (hyperkinetic disorder, HKS, and childhood emotional disorder). We assessed their use of social networks with a revision of the Social Relationship Test for Children (SoBeKi-R) and their mental disorders via clinical diagnoses, CBCL, and SDQ. The patients reported significantly smaller networks overall and fewer social resources, particularly in the nonfamily domains. While children with emotional disorders were found to have fewer social strains than the comparison group, children with ADHD tended to have higher strain scores per network person, and externalizing symptoms were significantly associated with higher network strains. The results, which vary by disorder, suggest complex disorder-specific associations between the syndromes and the reported social network resources and strains.

Crippled By Fear: Anxiety Disorders Among Adolescents In Nigeria

More than half of all lifetime psychiatric disorders begin by the early adolescent period, with anxiety and depressive disorders responsible for a significant part of this disease burden [1]. Collectively referred to as childhood emotional disorders, juvenile-onset anxiety and depressive syndromes are widely recognized to be the most prevalent group of mental disorders in this population, as they are in adults [2-6]. The prevalence of anxiety disorders in adolescent populations is estimated to range between 8.3% to 27.0% [7]. The National Comorbidity Replication Survey - Adolescent Supplement (NCS-A) in the United States found a lifetime rate of 31.9% for any anxiety disorder [8]. In comparison, a study in rural Uganda demonstrated a 26.6% prevalence rate of anxiety disorders amongst children and adolescents [9]. In a local study conducted among adolescents aged 13–18 years in a semi-urban Nigerian town, anxiety disorders’ estimated 12-month prevalence rate was 15% [10].

Exploring sex differences in fetal programming for childhood emotional disorders

In examining maternal depression, placental 11β-HSD2 mRNA expression and offspring cortisol regulation as a potential fetal programming pathway in relation to later child emotional disorders, it has become clear that sex differences may be important to consider. This study reports on data obtained from 209 participants in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) recruited before 20 weeks of pregnancy. Maternal depressive disorders were diagnosed using the SCID-IV and maternal childhood trauma using the Childhood Trauma Questionnaire. Placental 11β-HSD2 mRNA was measured using qRT-PCR. For assessment of stress-induced cortisol reactivity, salivary cortisol samples were taken at 12 months of age. At 4 years of age, measurement of Childhood Emotional Disorders (depression and anxiety) was based on maternal report using the Preschool Age Psychiatric Assessment (PAPA) and internalizing symptoms using the Child Behavior Checklist (CBCL). Maternal depression in pregnancy and postpartum, and infant cortisol reactivity, was associated with internalizing symptoms for females only. For female offspring only, increased 12-month cortisol reactivity was also associated with increased emotional disorders at 4 years of age; however, there was no association with placental 11β-HSD2 mRNA expression. In females only, the combination of lower placental 11β-HSD2 mRNA expression and higher cortisol reactivity at 12 months of age predicted increased internalising problems. These findings suggest there may be sex differences in prenatal predictors and pathways for early childhood depression and anxiety symptoms and disorder.

How childhood trauma and emotions influence essential tremor and its severity in Sakarya Province.

Essential tremor (ET) is among the most common central nervous system disorders. It is characterised by symmetrical and bilateral postural tremor, usually affecting the hands. Alongside such motor symptoms, psychiatric symptoms, such as anxiety and depression, often occur. This study aimed to investigate how anxiety, depression and childhood trauma influence ET patients' tremor frequency and severity. The participants comprised 85 patients and 70 control volunteers. Participating patients have been admitted to our clinic for hand tremor complaints and diagnosed with ET, according to the Washington Heights Inwood Genetic Study of Essential Tremor (WHIGET) diagnosis criteria, and they returned for follow-up for at least one year after their initial treatment. Patients with thyroid dysfunction, Parkinson's disease, central nervous system pathology, a history of smoking or alcohol use or a history of drug use that may cause tremor were excluded from the study. Patients' demographic data, such as their age and gender, age at disease onset, disease duration, family history and tremor severity were recorded. The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Childhood Trauma Questionnaire (CTQ) were applied to all patients. Statistically significant differences were found in BDI score averages and BAI score averages between the patient and control groups (p = 0.002; p = 0.001) and physical abuse, emotional neglect and sexual abuse scores on the CTQ scale (p = 0.001, p = 0.007 and p = 0.001, respectively). Childhood mental trauma and emotional mood disorders are more common among ET patients. However, these disorders do not appear to affect ET severity.

Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians.

There is a complex relationship between sleep disorders and childhood neurodevelopmental, emotional, behavioral and intellectual disorders (NDEBID). NDEBID include several conditions such as attention deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, epilepsy and learning (intellectual) disorders. Up to 75% of children and young people (CYP) with NDEBID are known to experience different types of insomnia, compared to 3% to 36% in normally developing population. Sleep disorders affect 15% to 19% of adolescents with no disability, in comparison with 26% to 36% among CYP with moderate learning disability (LD) and 44% among those with severe LD. Chronic sleep deprivation is associated with significant risks of behavioural problems, impaired cognitive development and learning abilities, poor memory, mood disorders and school problems. It also increases the risk of other health outcomes, such as obesity and metabolic consequences, significantly impacting on the wellbeing of other family members. This narrative review of the extant literature provides a brief overview of sleep physiology, aetiology, classification and prevalence of sleep disorders among CYP with NDEBIDs. It outlines various strategies for the management, including parenting training/psychoeducation, use of cognitive-behavioral strategies and pharmacotherapy. Practical management including assessment, investigations, care plan formulation and follow-up are outlined in a flow chart.

Trends in mental health presentations in a south Australian tertiary emergency department.

Limited recent interstate evidence suggests an increase in paediatric mental health presentations to emergency departments in Australia. We set out to confirm this and whether any specific diagnosis was responsible for this increase. We identified all patients with mental health presentations aged 6-18 years who attended our tertiary emergency department from January 2006 to June 2019 using our emergency department patient record system. Patients were determined to have a mental health presentation if they had a discharge diagnosis or presenting complaint code that corresponded to a mental health disorder or were referred to the mental health team. For analysis, we divided the 13.5-year duration of our study into three periods of 4.5 years. Comparing the first and last time periods, there was a 156% increase in mental health presentations over 9 years. This was out of proportion to the increase in combined general and mental health presentations of 11.9%. There was an increase in the proportion of patients who were diagnosed with an adjustment disorder (14-26.6%) or a childhood emotional disorder (8.5-20.8%). Additionally, there was an increase in median wait time and a reduction in the proportion of patients seen within their recommended triage time. There is a large increase in the number of paediatric mental health presentations to our emergency department. Further resources may need to be allocated to mental health services in the community and in the emergency department.

Young people who engage in child to parent violence: an integrative review of correlates and developmental pathways

ABSTRACT Objective Review and synthesise Australian and New Zealand research on correlates and predictors of child to parent violence. Method Ten electronic databases were searched for relevant empirical studies. An integrative review methodology was adopted, with the Mixed Methods Appraisal Tool used to assess methodological quality. Results Twenty-one relevant studies met the inclusion criteria. Assessment of methodological quality revealed a moderate level of bias resulting from small sample sizes and a lack of representative sampling, missing outcome data, definitional variations, and inconsistencies in categorising variables across studies. The primary factors identified as correlates were prolonged or early childhood exposure to adult intimate partner violence and adversity, a childhood behavioural pattern of aggressive behaviour, mental health or emotional or behavioural disorders, other criminality and negative peer associations. Conclusion Extracting and understanding developmental pathways in the Australian and New Zealand context that contribute towards child to parent violence was limited by the amount and quality of research. Thus, highlighting the need for further research in this field. KEY POINTS What is already known about this topic: A small amount of research has been conducted in Australia and New Zealand relating to child to parent violence. The factors contributing to a young person engaging in child to parent violence are complex and interrelated. Exposure to adult intimate partner violence in childhood is a known correlate of child to parent violence. What this topic adds: This is the first integrative review of Australian and New Zealand evidence on child to parent violence. While childhood behavioural and emotional disorders were identified as correlates for young people engaging in violence towards parents, this research evidence is not strong. This review reveals a need to examine further the developmental pathways towards child to parent violence, identifying points of intervention best suited to service engagement.

Impulsive Behavior as a Mediator Between Childhood Maltreatment and Emotional Disorders

Background: Impulsive behavior plays an important role in mediating the relationship between childhood maltreatment and emotional disorders. Objectives: This study aimed to determine the relationship between childhood maltreatment and emotional disorders, considering the mediating role of impulsive behavior. Methods: This descriptive cross-sectional study was conducted on a statistical population, including all students of Azarbaijan Shahid Madani University, Tabriz, Iran. A total of 316 students were selected randomly and completed the Inventory of depression and anxiety symptoms (IDAS), Impulsive Behavior Scale (UPPS-P), and Childhood Trauma Questionnaire (CTQ). The collected data were analyzed in SPSS version 22 and LISREL. Results: The correlation coefficient showed a significant relationship between childhood maltreatment and emotional disorders, and the structural equation model exhibited a good fit to the data (GFI = 0.9, AGFI = 0.86, CFI = 0.99, and RMSEA = 0.07). Conclusions: The results showed that impulsive behavior played an important role in mediating the relationship between childhood maltreatment and emotional disorders.

Maternal perinatal depression, circulating oxytocin levels and childhood emotional disorders at 4 years of age: The importance of psychosocial context

Oxytocin has been a hormone of interest in understanding both depression and parenting. Here, the role of oxytocin has been explored in understanding the interaction between perinatal depression, history of trauma and subsequent longer-term child socio-emotional outcomes. Data were obtained from 203 pregnant women from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a pregnancy cohort study with data collected across pregnancy, postpartum and until 4 years for mother and child. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) together with the Childhood Trauma Questionnaire to measure maternal trauma history. Maternal oxytocin levels were measured by enzyme immunoassay following extraction at four time points across pregnancy and the postpartum. The offspring consisted of 203 children followed up from birth until 4 years of age when they were assessed for DSM 5 depression and anxiety disorders (emotional disorders) using the Preschool Age Psychiatric Assessment. Maternal oxytocin levels increased over pregnancy and the postpartum in both control and depressed women with no difference between groups. Maternal childhood trauma and antenatal antidepressant use was also not associated with maternal oxytocin levels. Lower gestational age, maternal depression and early childhood trauma, and late pregnancy oxytocin concentrations were associated with later childhood emotional disorders; together they predicted 10% of variance for emotional disorders. Oxytocin is a hormone whose role in understanding intergenerational risk from pregnancy to child emotional disorders is dependent on relational context. Future research can expand on understanding these important early predictors of childhood mental health.

Birth with Synthetic Oxytocin and Risk of Childhood Emotional Disorders: A Danish Population-based Study

Background: Concerns have been raised that synthetic oxytocin, a widely used obstetric tool for labor induction and augmentation, may have deleterious effects on the neuropsychological development of children. Few studies have examined the relationship between oxytocin-stimulated labor and emotional disorders.Methods: We conducted a nationwide register-based cohort study including 677,629 singletons born in Denmark in the years 2000 to 2012 and followed through 2016 (median age = 10.6 years). Data on oxytocin-stimulation were obtained from the Danish Medical Birth Register. Cases of emotional disorders - anxiety, obsessive-compulsive disorder, mood or traumatic stress disorders or a redeemed prescription for a selective serotonin reuptake inhibitor - were identified using Danish patient and prescription registries.Results: Oxytocin was used to stimulate 31% of births, and oxytocin-stimulated labor was not associated with childhood emotional disorders (HR = 1.05, 95% CI 0.99, 1.11) after adjustment for maternal history of psychopathology, antidepressants during pregnancy, cohabitation status, highest educational attainment, smoking status during pregnancy, birth year, and indications for labor stimulation. The crude cox model was also small and close to unity (HR = 1.09, 95% CI 1.03, 1.15).Limitations: About 50% of our population had reached the age of 10 years, but the outcome included disorders with later average debut ages. Oxytocin dosage levels are not recorded in the registers.Conclusions: Our small effect size estimates suggest that perinatal synthetic oxytocin does not contribute to the development of emotional disorders. Current evidence does not warrant revision of guidelines for the use of oxytocin in obstetrics.