Adult Mental Health Problems Research Articles

Contribution of birth weight to mental health, cognitive and socioeconomic outcomes: two-sample Mendelian randomisation.

Low birth weight is associated with adult mental health, cognitive and socioeconomic problems. However, the causal nature of these associations remains difficult to establish owing to confounding. To estimate the contribution of birth weight to adult mental health, cognitive and socioeconomic outcomes using two-sample Mendelian randomisation, an instrumental variable approach strengthening causal inference. We used 48 independent single-nucleotide polymorphisms as genetic instruments for birth weight (genome-wide association studies' total sample: n = 264 498) and considered mental health (attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), schizophrenia, suicide attempt), cognitive (intelligence) and socioeconomic (educational attainment, income, social deprivation) outcomes. We found evidence for a contribution of birth weight to ADHD (OR for 1 s.d. unit decrease (~464 g) in birth weight, 1.29; 95% CI 1.03-1.62), PTSD (OR = 1.69; 95% CI 1.06-2.71) and suicide attempt (OR = 1.39; 95% CI 1.05-1.84), as well as for intelligence (β = -0.07; 95% CI -0.13 to -0.02) and socioeconomic outcomes, i.e. educational attainment (β = -0.05; 95% CI -0.09 to -0.01), income (β = -0.08; 95% CI -0.15 to -0.02) and social deprivation (β = 0.08; 95% CI 0.03-0.13). However, no evidence was found for a contribution of birth weight to the other examined mental health outcomes. Results were consistent across a wide range of sensitivity analyses. These findings support the hypothesis that birth weight could be an important element on the causal pathway to mental health, cognitive and socioeconomic outcomes.

Cool, Calm, and Collected: The Associations Between Self-Leadership and Adult Mental and Relational Health Outcomes

Internal Family Systems (IFS) is an effective model of psychotherapy. The central concept of IFS is the Self, characterized by compassion, calm, and courage. The Self is theorized to reduce adult mental health problems and strengthen intimate relationships. The current study examined the associations between Self-Leadership and adult symptoms of anxiety, depression, sleep disturbances, and dissociation as well as relational outcomes including positive relationship quality, negative relationship quality, and attributions. Results indicate that Self-Leadership was uniquely associated with of all mental and relational health outcomes. Helping clients increase Self-Leadership can reduce mental health symptoms and strengthen adult intimate relationships.

A latent profile analysis of adverse childhood experiences and adult health in a community sample

BackgroundChildhood adversity is generally associated with adult mental health problems, but most studies have an insufficient sample size to examine relationships among various aspects of childhood adversity and adult mental health outcomes. Further, past research has predominantly been restricted to a single or limited types of adverse events, which ignores the inherent interdependence among childhood adversity indicators. ObjectiveThe current study explored various configurations of adverse childhood experiences (ACEs) and then examined the relationships among these configurations and various mental health constructs with a person-centered analytic framework. Participants and settingA sample of 3, 932 adult outpatients was recruited in primary care settings, during regular physician visits. MethodsParticipants provided informed consent, demographic information, and then completed validated measure of ACEs (emotional abuse, physical abuse, sexual abuse, physical neglect, emotional neglect, family dysfunction), and a series of validated mental health measures. ResultsLatent profile analyses revealed four configurations (or profiles) of ACEs, which were analysed for their relationships with mental health outcomes. The profile with a dominance of physical neglect was associated with the highest levels of anxiety and depression. The profiles with high levels of sexual abuse, either alone or combined with general adversity, had more emotional problems than the profile with low levels of adversity. The profiles characterizing mistreatment did not consistently differ from each other on the mental health outcomes. ConclusionsIt is critical to consider ACEs in their complex relationship with each other. Different patterns of ACEs are associated with differential health outcomes in adults.

Association Between Serum Lipid Levels, Resilience, and Self-Esteem in Japanese Adolescents: Results From A-CHILD Study.

Previous studies have found that serum lipid levels independently associate with mental health problems in adulthood. However, little is known about the association between serum lipid levels and positive aspects of mental health such as resilience and self-esteem, which develop in adolescence. The aim of this study is to examine the association between serum lipid levels and resilience and self-esteem in Japanese adolescents. Data were pooled data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in 2016 and 2018, a school-based, cross-sectional study in Adachi City, Tokyo, Japan (N = 1,056, aged 13–14 years). Resilience of the child was assessed by caregivers, and self-esteem was self-identified via questionnaires. Serum lipid levels [total cholesterol, low-density lipoproteins (LDL), and high-density lipoproteins (HDL)] were assessed in school health checkup, in addition to height and weight measurements. Multiple linear regression was applied to investigate the association between standardized serum lipid levels and resilience and self-esteem. LDL showed inverse association with resilience [β = −1.26, 95% confidence interval (CI) = −2.39 to −0.14] after adjusting for child’s BMI, month of birth, sex, absence of parent, household income, caregiver’s mental health, and lifestyle (e.g., habits of eating, physical activity, and sleep). We also found an inverse association of total cholesterol and higher LDL cholesterol with self-esteem (β = −0.58, 95% CI = −0.99 to −0.18; β = −0.42, 95% CI = −0.83 to −0.01, respectively). HDL cholesterol was not associated with resilience and self-esteem. Among Japanese adolescent, total and LDL cholesterol may be biomarkers of resilience and self-esteem.

Cohort Profile: Quebec Longitudinal Study of Child Development (QLSCD).

The Quebec Longitudinal Study of Child Development (QLSCD) was designed to examine the long-term associations of preschool physical, cognitive, social, and emotional development with biopsychosocial development across childhood, adolescence, and young adulthood. QLSCD is an ongoing prospective cohort including 2120 singletons born in 1997/1998 in the Canadian province of Quebec. So far, data have been collected annually or every 2years from child ages 5months to 21years. The cohort currently includes 1245 participants. Data available include a range of environmental (e.g., family characteristics, child behaviour, educational attainment, mental health), biological (e.g., hair cortisol, genetic, epigenetic), and administrative data. QLSCD has contributed to the understanding of children's psychosocial development, including the development of physical aggression and anxiety. QLSCD articles have advanced scientific knowledge on the influence of early childhood factors on childhood, adolescent, and young adult mental health, including the effect of participation in early childcare on cognitive and behavioural development, the developmental origins of adolescent and young adult mental health problems and suicide risk, and the development of interpersonal difficulties (e.g., peer victimisation) from preschool years to adolescence. QLSCD has given major contributions to our understanding of the link between different aspects of child development and biopsychosocial development during the first two decades of life. Unique features include the presence of environmental, biological, and administrative data, long-term follow-up with frequent data collections, and use of data from multiple informants, including teachers, mothers, fathers, and the children themselves.

Mental Health During COVID-19 Lockdown in the United Kingdom.

The coronavirus disease (COVID-19) pandemic and related lockdown measures have raised important questions about the impact on mental health. This study evaluated several mental health and well-being indicators in a large sample from the United Kingdom (UK) during the COVID-19 lockdown where the death rate is currently among the highest in Europe. A cross-sectional online survey with a study sample that mirrors general population norms according to sex, age, education, and region was launched 4 weeks after lockdown measures were implemented in the UK. Measures included mental health-related quality of life (World Health Organization Quality-of-Life Brief Version psychological domain), well-being (World Health Organization Well-Being Index), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), perceived stress (Perceived Stress Scale-10), and insomnia (Insomnia Severity Index). Analyses of variances, Bonferroni-corrected post hoc tests, and t tests were applied to examine mental health indicators across different sociodemographic groups (age, sex, employment, income, physical activity, relationship status). The sample comprised n = 1006 respondents (54% women) from all regions of the UK. Approximately 52% of respondents screened positive for a common mental disorder, and 28% screened positive for clinical insomnia. Mean scores and standard deviations were as follows: Patient Health Questionnaire-9, mean = 9.0 ± 7.7; Generalized Anxiety Disorder-7, mean = 8.0 ± 6.5; Insomnia Severity Index, mean = 10.4 ± 7.0; Perceived Stress Scale-10, mean = 17.7 ± 7.9; World Health Organization Quality-of-Life Brief Version, mean = 58.6 ± 21.4; and World Health Organization Well-Being Index score, mean = 13.0 ± 6.0. Statistical analyses consistently indicated more severe mental health problems in adults younger than 35 years, women, people with no work, and people with low income (all p values < .05). Mental health indices also varied across UK regions. The prevalence of depressive, anxiety, and insomnia symptoms is significantly higher in the UK relative to prepandemic epidemiological data. Further studies are needed to clarify the causes for these high rates of mental health symptoms.

Bullies Get Away With It, But Not Everywhere: Mental Health Sequelae of Bullying in Chinese and German Students

Bullying victimization is associated with adverse mental health consequences, while bullies suffer few or no adverse consequences in Western societies. Yet the universality of these consequences across western and eastern cultures is unknown. The current study investigated retrospective bullying experience in primary and secondary schools and its effects on adult mental health (depression, anxiety, stress, lifetime suicidal behavior, positive mental health, life satisfaction, social support, self-efficacy, and sense of control) in 5,012 Chinese and 1,935 German university students. School bullying victimization was far less frequently recalled by the Chinese sample (6.2%–12.6%) than the German sample (29.3%–37.0%), but victims had similar adverse mental health in both countries. In Germany, bullies and not-involved had equally good mental health, whereas bullies in China had poor mental health comparable to victims. Bullying victimization has similar adverse effects on mental health across countries. However, compared to the German students, the prevalence of school bullying is significantly lower, and bullies are also more likely to suffer mental health problems in adulthood in Chinese students. The differences of reasons for and consequences of being bullies are discussed and may have important implications for evolutionary theories and interventions of bullying.

The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria

BackgroundThe impact of Coronavirus disease (COVID-19) and the governmental restrictions on mental health have been reported for different countries. This study evaluated mental health during COVID-19 lockdown in Austria and the effect of age, gender, income, work, and physical activity. MethodsAn online survey was performed through Qualtrics® after four weeks of lockdown in Austria to recruit a representative sample regarding gender, age, education, and region. Indicators of mental health were quality of life (WHO-QOL BREF), well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), stress (PSS-10), and sleep quality (ISI). ResultsIn total, N = 1005 individuals were included (53% women). 21% scored above the cut off ≥10 points (PHQ-9) for moderate depressive symptoms, 119% scored above the cut-off ≥10 points (GAD-7) for moderate anxiety symptoms, and 16% above the cut-off ≥15 points (ISI) for clinical insomnia. ANOVAs, Bonferroni-corrected post-hoc tests, and t-tests showed highest mental health problems in adults under 35 years, women, people with no work, and low income (all p-values <.05). Comparisons with a large Austrian sample recruited within the ATHIS 2014 study showed increases of depression and decreases of quality of life in times of COVID-19 as compared to before COVID-19. ConclusionsDepressive symptoms (21%) and anxiety symptoms (19%) are higher during COVID-19 compared to previous epidemiological data. 16% rated over the cut-off for moderate or severe clinical insomnia. The COVID-19 pandemic and lockdown seems particularly stressful for younger adults (<35 years), women, people without work, and low income.

A qualitative study of experiences during placement and long-term impact of institutional care: Data from an adult Greek sample

BackgroundThere is growing interest in the long-term impact of institutional care during childhood and/or adolescence. Studies indicate that residential care is associated with poor adult outcomes, including health and mental health problems, lower educational attainment and serious emotional and behavioral difficulties. This is, to our knowledge, the first qualitative study οn a Greek sample. AimsThe aim of the present study was to provide understanding into the past and present experiences of individuals who had resided in a child-care institution during their childhood and/or adolescence and to contribute to the study of the long-term impact of institutional care on adult life. MethodIn depth interviews were conducted with 15 individuals (men and women) who had lived in a child-care institution during their childhood and/or adolescence, followed by qualitative thematic analysis. ResultsAnalysis revealed three distinct cohorts of participants, based on their current age and the time period during which they were placed at the institution. Systematic comparison of the three cohorts revealed that independent living was strenuous and challenging and that, although institutional practices ameliorate, the social and emotional needs of the looked after children and their families become increasingly complex. ConclusionContinuous training and support of the personnel of the institutions, a well-planned transitional period with the active involvement of the individuals, as well as systematic follow-ups, seem necessary in order to ensure better adult outcomes.

Adolescent and young adult mental health problems and infant offspring behavior: Findings from a prospective intergenerational cohort study

BackgroundParental depression and anxiety have been consistently linked to offspring behavior problems across childhood. However, many of the risks for these common mental health problems are established well before pregnancy. This study takes advantage of rare, prospective data to examine relations between parental mental health histories (from adolescence onwards) and next generation offspring behavior problems. MethodsData were drawn from a multi-generational cohort study that has followed Australians from infancy to adulthood since 1983, and 1171 of their offspring assessed prospectively from pregnancy. Generalized estimating equation models were used to estimate associations between parents’ depression/anxiety symptoms in adolescence and young adulthood and offspring behavior problems at 1 year. ResultsIn analyses of 648 mother-infant and 423 father-infant dyads, after adjustment for confounders and concurrent mental health problems, mean behavior problem scores in infants of mothers with a history of mental health problems in both adolescence and young adulthood were over half a standard deviation higher than those of mothers without problems during these periods, B = 2.19, 95% CI 1.21 – 3.17, β = 0.52. No association was observed for fathers. LimitationsWe only included infants born to participants aged 29–35 years and we assessed behavior problems via parent-report. ConclusionsA mother's history of persistent depression and anxiety from adolescence to young adulthood can predict higher levels of behavior problems in her infant. Findings support calls for greater policy and prevention focus on preconception and postnatal mental health, particularly a mother's early emotional health history, prior to parenthood.

A systematic review of mental health measurement scales for evaluating the effects of mental health prevention interventions.

Consistent and appropriate measurement is needed in order to improve understanding and evaluation of preventative interventions. This review aims to identify individual-level measurement tools used to evaluate mental health prevention interventions to inform harmonization of outcome measurement in this area. Searches were conducted in PubMed, PsychInfo, CINAHL, Cochrane and OpenGrey for studies published between 2008 and 2018 that aimed to evaluate prevention interventions for common mental health problems in adults and used at least one measurement scale (PROSPERO CRD42018095519). For each study, mental health measurement tools were identified and reviewed for reliability, validity, ease-of-use and cultural sensitivity. A total of 127 studies were identified that used 65 mental health measurement tools. Most were used by a single study (57%, N = 37) and measured depression (N = 20) or overall mental health (N = 18). The most commonly used questionnaire (15%) was the Centre for Epidemiological Studies Depression Scale. A further 125 tools were identified which measured non-mental health-specific outcomes. There was little agreement in measurement tools used across mental health prevention studies, which may hinder comparison across studies. Future research on measurement properties and acceptability of measurements in applied and scientific settings could be explored. Further work on supporting researchers to decide on appropriate outcome measurement for prevention would be beneficial for the field.

Is person‐centred counselling effective when assisting young people who have experienced bullying in schools?

AbstractBackgroundThe effects of bullying on children have profoundly been researched; however, there is a gap in research on how therapy can assist children who are bullied. The aim of this research was to understand how person‐centred therapy may assist individuals who are being bullied within the school environment.MethodologyPerson‐centred therapy was chosen as it is the author's profession. When pursuing his master's degree and the allied research programme, the author conducted the therapy. This research was performed using interpretative phenomenological analysis. The researcher worked with four research participants, and the contributors were individuals who had left school due to childhood bullying. The participants also underwent person‐centred therapy to work through the issues that bullying had caused them. A series of interviews were conducted with the participants using pre‐decided questions. These interviews were then transcribed, and key themes were found within the text.The themes, and the subordinate themes, include the following:Childhood bullying in the context of the experience of support, and the absence of support leading to trauma.Bullying as a multifaceted experience, and bullying as an emotional communication.Childhood bullying and its association to adult mental health and adult experiences of anxiety.How person‐centred counselling helped participants, and gaining support in schools.ConclusionsThe article found that in the school environment a lack of emotional support added to the trauma that the victims experienced from bullying. Bullying was experienced individually, but each participant reported it being an emotional way of communicating. The bullying the participants experienced during school lead to mental health problems in adulthood, the most reported mental health condition was anxiety. Finally, the article explored how the person‐centred approach assisted participants, whilst most participants found the approach to be very useful. A few participants believed that the limitations of the person‐centred approach lead to less exploration, many wished for techniques to help them cope with their bullying experiences something that CBT might be more adequate for.

The mediating role of KITLG DNA methylation in the association between childhood adversity and cortisol stress reactivity does not replicate in monocytes

Adverse childhood experiences such as maltreatment or neglect are associated with mental health problems in adulthood. Changes in the regulation of the psychological and physiological stress reaction, mediated via epigenetic modifications, are discussed as potential mechanisms. This study aimed to replicate the role of DNA methylation of the KITLG gene in mediating the association between childhood adversity and stress-induced cortisol reactivity in a sample of adults reporting childhood adversity and a matched control group (N = 60). DNA was extracted from purified CD14+ monocytes and genome-wide DNA methylation was assessed with the 450k BeadChip for targeted replication and exploratory analyses. As previously reported, childhood adversity was associated with significantly lower cortisol reactivity to stress. We could neither replicate the association between KITLG DNA methylation and cortisol stress reactivity nor the association with childhood adversity. Moreover, DNA methylation of the target CpG (cg27512205) was not associated with KITLG mRNA expression in monocytes. Exploratory analyses of array-wide DNA methylation patterns showed no significant results for individual sites after correction for multiple testing – neither in association with childhood trauma nor with adult cortisol stress reactivity. The analysis of differentially methylated regions (DMRs) revealed two significant regions which both mapped to non-coding genes in the association with cortisol stress reactivity.The mediating role of DNA methylation of the KITLG locus in the association between childhood adversity and cortisol stress reactivity could not be replicated in monocytes. In addition to differences in investigated tissue, reasons for non-replication might include differences between samples in age, ethnicity, trauma severity, and cortisol reactivity.

Urbanicity, biological stress system functioning and mental health in adolescents.

Growing up in an urban area has been associated with an increased chance of mental health problems in adults, but less is known about this association in adolescents. We examined whether current urbanicity was associated with mental health problems directly and indirectly via biological stress system functioning. Participants (n = 323) were adolescents from the Dutch general population. Measures included home and laboratory assessments of autonomic nervous system and hypothalamic-pituitary-adrenal axis functioning, neighborhood-level urbanicity and socioeconomic status, and mother- and adolescent self-reported mental health problems. Structural equation models showed that urbanicity was not associated with mental health problems directly. Urbanicity was associated with acute autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity such that adolescents who lived in more urban areas showed blunted biological stress reactivity. Furthermore, there was some evidence for an indirect effect of urbanicity on mother-reported behavioral problems via acute autonomic nervous system reactivity. Urbanicity was not associated with overall autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity or basal hypothalamic-pituitary-adrenal axis functioning. Although we observed some evidence for associations between urbanicity, biological stress reactivity and mental health problems, most of the tested associations were not statistically significant. Measures of long-term biological stress system functioning may be more relevant to the study of broader environmental factors such as urbanicity.

Childhood Domestic Violence as an Ancestor for Adulthood Mental Health Problems: Experiences of Jordanian Women

This study was conducted to explore the relationship between women’s history of experiencing different types of abuse during childhood and development of mental health problems in adulthood. A convenience sample of 409 women recruited from health care centers in Jordan provided data for the study. One-way between-groups multivariate analysis of variance was implemented. Results indicated absence of statistically significant differences in mental health problems between physically abused and sexually abused women compared to their counterparts. Further, a statistically significant difference in mental health was found between women who experienced emotional abuse and childhood neglect compared to their counterparts (Wilks’ lambda for emotional abuse = .914, p &lt; .0001; Wilks’ lambda for childhood neglect = .83, p &lt; .0001). Between-groups comparisons using Bonferroni adjustment indicated that all dependent variables (depression, anxiety, stress, and self-esteem) differed significantly between emotionally and nonemotionally abused women and between neglected and nonneglected women. It was concluded that not all childhood abuse experiences lead to long-term impacts on women’s mental health. However, mental health consequences of childhood abuse may alter women’s obligations toward family, children, and home. Therefore, efforts directed toward assessing women’s history of childhood abuse are very important especially for those who are starting a marital relationship.

Unpacking childhood experiences of abuse: Can clinicians identify their patients’ History of Abuse?

ABSTRACT Emotional, physical and sexual abuse, have been consistently linked to mental health problems in adults. Previous research found that mental health providers rarely ask their patients about their childhood experiences of abuse. No study to date has examined the convergence of clinicians’ and patients’ reports of childhood abuse. The current study applied a multi-method, multi-informant approach to explore the concordance between patients’ reports of childhood experiences of abuse and clinicians’ identification of their patients’ history of abuse. Assessment of an independent interviewer was included. A convenience sample of clinicians (N = 80) and their patients (N = 170) in mental health clinics in care-as-usual settings participated in the study. To assess the history of abuse clinicians and patients completed the Clinical Data Form, patients additionally completed the Childhood Trauma Questionnaire. Independent interviewer completed the Familial Experiences Interview. Findings show that across all informants, exposure to emotional abuse was most prevalent, followed by physical abuse and least prevalent was sexual abuse. Additionally, clinicians reported lower prevalence of physical and sexual abuse among their patients as compared with the patient and independent interviewer’s reports. Moderate to strong correlations were observed between clinicians, patients and independent interviewer reports of emotional, physical and sexual childhood abuse. Moreover, the severity of the patient’s history of abuse was related to greater accuracy in clinicians’ reports. Clinicians are advised to collect explicit information regarding childhood abuse through interviews or valid measures. Clinicians should pay special attention when assessing patients with moderate severity of childhood abuse since they are frequently under-identified.

Unhappy us, unhappy me, unhappy life: The role of self-esteem in the relation between adult attachment styles and mental health

With increasing recognition of and concern about mental health problems in Chinese young adults, the factors that contribute to mental health in Chinese young adults are receiving growing attention. Prior research has documented that adult attachment styles may be a risk factor for depression and anxiety in Western societies. However, little is known about the relation between adult attachment and mental health problems in China. In addition, research on the underlying mechanism between adult attachment and mental health problems is limited. The present study aimed to examine (1) the relation between adult attachment and young adults’ mental health problems in China and (2) the mediating effect of self-esteem in the relation between adult attachment and young adults’ mental health problems in China. The study was based on a sample of 305 urban Chinese students who completed a questionnaire about their attachment styles, self-esteem, and general mental health. Structural equation modeling was used to test our hypotheses. The results showed that (1) Both anxious and avoidant attachment linked to mental health problems in China through the partial mediating effect of self-esteem; (2) Anxious adult attachment also directly and positively associated with mental health problems, and (3) Avoidant adult attachment directly and negatively associated with mental health problems. The findings are interpreted on the basis of Chinese cultural features.

Intergenerational patterns of mental health problems: the role of childhood peer status position

BackgroundPast research has established the intergenerational patterning of mental health: children whose parents have mental health problems are more likely to present with similar problems themselves. However, there is limited knowledge about the extent to which factors related to the child’s own social context, such as peer relationships, matter for this patterning. The aim of the current study was to examine the role of childhood peer status positions for the association in mental health across two generations.MethodsThe data were drawn from a prospective cohort study of 14,608 children born in 1953, followed up until 2016, and their parents. Gender-specific logistic regression analysis was applied. Firstly, we examined the associations between parental mental health problems and childhood peer status, respectively, and the children’s mental health problems in adulthood. Secondly, the variation in the intergenerational patterning of mental health according to peer status position was investigated.ResultsThe results showed that children whose parents had mental health problems were around twice as likely to present with mental health problems in adulthood. Moreover, lower peer status position in childhood was associated with increased odds of mental health problems. Higher peer status appeared to mitigate the intergenerational association in mental health problems among men. For women, a u-shaped was found, indicating that the association was stronger in both the lower and upper ends of the peer status hierarchy.ConclusionsThis study has shown that there is a clear patterning in mental health problems across generations, and that the child generation’s peer status positions matter for this patterning. The findings also point to the importance of addressing gender differences in these associations.

Collaborative care for child and youth mental health problems in a middle-income country: study protocol for a randomized controlled trial training general practitioners

BackgroundChild and youth mental health problems are leading causes of disability and particular problems in low- and middle-income countries where populations are young and child mental health services are in short supply. Collaborative care models that support primary care providers’ efforts to detect and treat child mental health problems offer one way to address this need. However, collaborative care for child mental health can be more complex than collaboration for adults for a number of reasons, including two-generational aspects of care, high degrees of co-morbidity, and variations in presentation across developmental stages.MethodsThe study takes advantage of an existing collaborative care network in Tehran, Iran, in which general practitioners are supported by community mental health centers to care for adult mental health problems. At present, those practitioners are asked to refer children with mental health problems to the collaborating centers rather than treating them themselves. We are conducting a cluster randomized trial in which practitioners in the network will be randomized to receive training in child/youth mental health treatment or a booster training on recognition and referral. Children/youth aged 5–15 years making visits to the practitioners will be screened using the Strengths and Difficulties Questionnaire; those found positive will be followed for six months to compare outcomes between those treated by trained or control practitioners.DiscussionIf the trial demonstrates superior outcomes among children treated by trained practitioners, it will support the feasibility of expanding collaborative care networks to include children.Trial registrationClinicalTrials.gov, NCT03144739. Registered on 8 May 2017.

Adjustment Problems in Early Adulthood Among Victims of Childhood Physical Abuse: A Focus on Adolescent Risk and Protective Factors

Physical abuse in childhood places individuals at risk for many behavioral and mental health problems in adulthood. Nevertheless, not all abused children will ultimately experience these negative outcomes. Using a subsample of physically abused youth from the National Longitudinal Study of Adolescent to Adult Health, we examined whether protective and risk factors in adolescence (intelligence, family attachments, and neighborhood disadvantage) explained why some victims fared better in early adulthood. Outcomes of violent offending, depressive symptoms, and low self-esteem were examined. Family attachments were found to be protective against depressive symptoms and low self-esteem, while the effects of intelligence were more limited. These findings emphasize that there is marked variability in how physically abused children fare in early adulthood.