Parental Mental Health Problems Research Articles

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.

Associations between parenting stress, parent mental health and child sleep problems for children with ADHD and ASD: Systematic review

BackgroundChildren with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) experience high rates of sleep problems. Their parents experience higher parenting stress and more mental health difficulties than parents of typically developing children. AimTo examine the association between child sleep problems, parenting stress and parent mental health for children with ADHD or ASD. MethodsMEDLINE Complete, EMBASE, PsycINFO and CINAHL Complete databases were searched. Studies needed to include: children aged 5–18 with ADHD or ASD, a child sleep measure, and a parenting stress or adult mental health measure. ResultsEleven studies were identified (four ADHD, seven ASD). Six studies examined parenting stress (five cross-sectional, one longitudinal) and five found associations, of varying strengths, with child sleep problems. Six studies examined parent mental health (four cross-sectional, two longitudinal) and five found associations, of differing magnitudes, with child sleep problems. ConclusionsThese studies demonstrate child sleep problems are associated with poorer parent mental health and higher parenting stress. ImplicationsFuture longitudinal research including multiple measurements of child sleep problems and family functioning is required to clarify the directionality of associations. Such knowledge is key in adapting sleep interventions to better meet the needs of children with ADHD or ASD and their families.

Adverse childhood experiences and adult inflammation: Single adversity, cumulative risk and latent class approaches

Abstract Background Adverse childhood experiences (ACEs) have long been known to be related to poorer health across the life course. Previous studies typically relied on cumulative risk scores or individual adversities measured through retrospective self-reports. However, these approaches have important limitations. Cumulative risk scores assume equal weighting of adversities and the single adversity approach ignores the high probability that adversities co-occur. In contrast, latent class analysis (LCA) offers an alternative approach to operationalise ACEs that respects the clustering of adversities and may identify specific patterns of ACEs important for health outcomes. Furthermore, prospective and retrospective reports of ACEs show poor agreement. Therefore, it is important to compare findings based on prospective and retrospective measures in the same individuals. Despite an increasing number of studies applying LCA to ACEs data, no studies have yet simultaneously investigated LCA to cumulative risk and single adversity approaches in their relationships with adult inflammation. Identifying the specific ACEs or combinations of ACEs which are strongly related to inflammation is important for investigating the mechanisms involved and the planning of effective interventions. Methods Using data on 8810 members of the 1958 British birth cohort we investigated 12 ACEs – physical, psychological and sexual abuse, physical and emotional neglect, parental mental health problems, witnessing abuse, parental conflict, parental divorce, parental offending, parental substance misuse and parental death. LCA was applied to explore the clustering of prospectively and retrospectively reported ACEs separately. Associations between latent classes, cumulative risk scores and individual adversities with three inflammatory markers (C-Reactive Protein, fibrinogen and von Willebrand Factor) were tested using linear regression. Results There was co-occurrence between adversities, and particularly for retrospectively reported adversities. Three latent classes were identified in the prospective data – ‘Low ACEs’ (95.7%), ‘Household dysfunction’ (2.8%) and ‘Parental loss’ (1.5%) which were related to increased inflammation in mid-life, as were high ACE scores and individual measures of offending, death, divorce, physical neglect and family conflict. Four latent classes were identified in the retrospective data – ‘Low ACEs’, ‘Parental mental health and substance misuse’, ‘Maltreatment and conflict’ and ‘Polyadversity.’ The latter two (5.2%) were related to raised inflammation in mid-life, as was a retrospective ACE score of 4+ (8.3%) and individual measures of family conflict, psychological and physical abuse, emotional neglect and witnessing abuse. Conclusions Specific ACEs or ACE combinations might be important for chronic inflammation. LCA is an alternative approach to operationalising ACEs data but further research is needed.

プライマリ・ケアにおける小児科と心療内科の協働 ―親子の心の問題への早期対応―

プライマリ・ケアにおける小児科と心療内科の協働 ―親子の心の問題への早期対応―

Maternal alcohol use and children's emotional and cognitive outcomes in rural South Africa.

Alcohol use in South Africa (SA) is increasing. The World Health Organization (WHO) states that SA is the third-largest drinking population in Africa, with the highest rate of fetal alcohol syndrome in the world. Internationally, parental drinking during childhood is a risk factor for poor child mental health, behavioural problems and weaker educational outcomes in middle childhood. However, parental alcohol use in Africa is under-researched, and much of the literature on maternal alcohol consumption is restricted to clinical and pregnancy samples. To investigate alcohol use and hazardous drinking (HD) among mothers/primary caregivers of children aged 7 - 11 years in a rural SA cohort. We explored risk factors for drinking and the association between HD and child behaviour/cognition. The primary outcome measure was the WHO Alcohol Use Disorder Identification Test (AUDIT) using the standardised cut-off for HD (≥8). Secondary measures were the Patient Health Questionnaire Depression Scale (PHQ-9), Patient Health Questionnaire General Anxiety Disorder Scale (GAD-7), Parenting Stress Index, short form (PSI-36), Child Behaviour Checklist (CBCL, parent reported), Kaufman Developmental Assessment Battery (KABC-II) for child cognition, and Neuropsychological Assessment Battery, 2nd edition, subtests (NEPSY-II) for executive function. We compared characteristics of those drinking/not drinking, using χ2 tests, and modelled outcomes on parenting stress, cognitive outcomes and CBCL scores for children using logistic regression analysis. We grouped mothers/caregivers engaged in HD to examine its effect on parent/child outcomes using t-tests to test for significant differences. Of 1 505 women (1 266 mothers and 239 caregivers) with 1 536 children, 12% reported consuming alcohol and 3% reported HD. Higher maternal/caregiver age (31 - 40 years, adjusted odds ratio (aOR) 0.57 (95% confidence interval (CI) 0.4 - 0.9); >41 years, aOR 0.30 (95% CI 0.2 - 0.5)), education (matriculation, aOR 0.49 (95% CI 0.3 - 0.9); post matriculation, aOR 0.30 (95% CI 0.1 - 0.6)), and a stable relationship with the father (aOR 0.6 (95% CI 0.4 - 1.0)) were associated with no alcohol use. Food insecurity increased the odds of alcohol use (aOR 1.52 (95% CI 1.1 - 2.1)), while parental mental health (parenting stress, anxiety) and child mental health problems were associated with approximately double the odds of consuming alcohol in univariate analysis. Children of HD mothers/caregivers had higher mean scores for psychological problems (CBCL total score: no HD (mean 45.0) v. HD (mean 48.9); p=0.029) and lower cognitive scores (KABC Learning Scale: no HD (mean 14.3) v. HD (mean 12.8); p=0.017). While HD rates were low, maternal/caregiver alcohol use negatively impacted on parenting and children's behavioural/cognitive outcomes. International evidence suggests that integrated approaches engaging parents and families may be more effective for parent-child outcomes than individual psychiatric or medical care for the parent on their own.

Meta-Analysis: Association of Parent and Child Mental Health with Pediatric Health Care Utilization

To examine the association of psychological factors and pediatric health care utilization. Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria. There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38). Child and parent MH problems are significantly associated with increased HCU.

Parent mental health problems and motivation as predictors of their engagement in community-based child mental health services

Parent or caregiver engagement in child mental health treatment is an important element of treatment effectiveness, particularly for children with disruptive behavior problems. Parent or caregiver characteristics, such as their mental health and/or motivation to participate in treatment, may impact engagement and subsequent treatment outcomes. However, a lack of empirical research exists examining these potential links, particularly in community-based treatment settings. The current pilot study: 1) examines whether parent mental health problems and/or early parent motivation to participate in treatment predict three indicators of parent engagement in child treatment, controlling for the other predictor; and 2) examines and compares the differential influence of parent mental health and parent motivation on each parent engagement indicator. Participants in this study include 19 dyads from 18 therapists who were recruited from community mental health clinics. Results indicated a significant association between parent mental health and session attendance, and a marginally significant association between parent mental health and therapist-rated parent engagement. Parent mental health predicted outcomes above and beyond parent motivation. These findings preliminarily suggest that parent mental health problems early in child mental health treatment may be important to consider as an impactful target to promote parent treatment engagement, in addition to focusing on parent motivation to participate in treatment.

Family History: An Opportunity to Disrupt Transmission of Behavioral Health Problems.

Family history is a traditional clinical approach to identify potential genetic-related disorders within families. Research on brain development and life course health has raised awareness of the impact of childhood social experiences related to parenting behavior leading to subsequent health and mental health problems of children.1 The high and rising rates of mental health disorders, half of which have an onset by age 14 years,2 are now known to be due to genetic and social factors. Family history provides a special opportunity to identify risk and develop strategies to mitigate adverse social factors and experiences associated with parental mental health problems and promote resilience in children. Because some adverse parenting behaviors are related to adverse childhood experience, family history can be a clinical approach to identify such experiences because screening for them lacks reliability and validity.3 The family history is conventionally used to identify risk for genetically loaded physical conditions, such as cardiovascular disease. Yet, too often, behavioral and mental health problems that frequently run in families4–6 are not given comparable attention. Beyond genetic vulnerabilities for mental health problems, parents and grandparents convey multigenerational risk through role modeling and dysfunctional parenting behaviors, including harsh discipline, stress, abuse, and … Address correspondence to Barry Zuckerman, MD, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, 72 E Concord St, Room 324L, Boston, MA 02118. E-mail: barry.zuckerman{at}bmc.org

Reduced psychiatric symptoms at 6 and 12 months' follow-up of psychotherapeutic and psychoeducative group interventions for children exposed to intimate partner violence.

Long-term follow-up studies of interventions for children exposed to intimate partner violence are few, and the sustainability of their outcomes often remains unexplored and uncertain. Current research including follow-up assessment suggests that treatment gains may be maintained or continue post termination. In addition some children may show increased levels of symptoms. The present effectiveness study investigated the long-term outcomes of two established group interventions for children exposed to intimate partner violence and their non-offending parent. The study included 50 children, 24 girls and 26 boys, aged 4 to 13 years attending a psychotherapeutic child and adolescent mental health service intervention and a psychoeducative community-based intervention. Background information, child and parental mental health problems, trauma symptoms, and exposure to violence were assessed pre- and post treatment and at 6 and 12 months' follow-up. Sustained treatment gains and late improvements in children's internalizing and externalizing symptoms and in symptoms of traumatic stress were recorded from post treatment to the follow-up assessments (p = .004- .044; d = 0.29-0.67). No significant increase in symptoms was reported. Additionally, very little continued or renewed child exposure to violence was reported. The results of the study indicate that the children did benefit from the two interventions studied and that the outcomes of reduced child symptoms and protection from exposure to violence were sustainable. Children with severe trauma symptoms benefited the most, though maternal psychological problems may for some have hindered recovery. Clinical implications are discussed.

The influence of early familial adversity on adolescent risk behaviors and mental health: Stability and transition in family adversity profiles in a cohort sample.

Although familial adversity is associated with poorer outcomes in childhood and adulthood, little research has looked at the influence of stability or transition between distinct familial adversity subgroups or the impact in adolescence. Using data from the 9-month, 3-, 5-, and 14-year time waves of the Millennium Cohort Study (n > 18,000), we used latent class analysis to identify distinct classes of early familial adversity (marital instability/conflict, "suboptimal" parenting, economic disadvantage, and parental mental health problems) and the impact of these adversity classes on adolescent (a) mental health (including self-harm), (b) risk taking, (c) criminality, and (d) victimization. Four profiles were identified largely differing on economic hardship, family composition, and parental conflict. Across the first three time points, 72% of the sample remained stable, with the remainder transitioning between classes. Adolescents in the higher risk groups (particularly categorized by economic hardship or high parental conflict) had poorer outcomes in adolescence. Transitioning to a higher adversity group at any time in the first 5 years was associated with poorer outcomes but was particularly pronounced when the transition occurred when the child was under 3 years. These findings demonstrate the broad consequences of early familial adversity and the need for targeted early support for at-risk families.

Family Empowerment (FAME): study protocol for a pilot implementation and evaluation of a preventive multi-family programme for asylum-seeker families

BackgroundFamilies applying for asylum have often experienced multiple potentially traumatic events and continue to face stressors during their resettlement. Studies have indicated that traumatic events can negatively impact parenting behaviour and child development. A secondary preventive multi-family intervention programme, called Family Empowerment, was developed. Family Empowerment aims to strengthen parenting skills and prevent exacerbation of emotional problems in asylum-seeker families. This study protocol aims to evaluate the feasibility, acceptability, and potential effectiveness of Family Empowerment to reduce parental mental health problems and improve family functioning.MethodsAn uncontrolled pre-test-post-test design will be conducted, using a mixed-methods approach. Approximately 60 families living at asylum centres and family locations with children aged 0–18 will be included. All participants will be invited to take part in seven sessions of Family Empowerment. Measurements take place at baseline, during implementation of Family Empowerment and 1 week post-Family Empowerment. Demographic data, the quality of the parent-child interaction, family functioning, parental symptoms of depression and anxiety, and participants’ feedback on progress and the therapeutic alliance will be assessed. A programme integrity list will be filled out during each session. Semi-structured interviews at baseline and post-Family Empowerment will be used to evaluate Family Empowerment.DiscussionThis is the first study to provide a pilot implementation and evaluation of Family Empowerment. The current study will inform us on how to improve programme elements and the implementation of Family Empowerment. Limitations are discussed.Trial registrationDutch Trial Register, TC = NTR6934. Registered on January 8 2018.

Parents' Spontaneous Attributions about their Problem Child: Associations with Parental Mental Health and Child Conduct Problems.

Parents' attributions about their child's personality and behaviour are known to predict the quality of parent-child interactions and outcomes for the child, including those from parenting interventions. Nothing is known, however, about the quantity and quality of attributions parents use during free speech about their children referred for treatment of behavioural and emotional problems. We tested hypotheses about the types of attributions and associations among parental attributions, parental psychopathology and child conduct problems, using 504 five-minute speech samples (FMSS) coded using the Parent Attribution Speech Sample (PASS) coding system. Both mothers and fathers talked about their thoughts and feelings regarding their children with disruptive behaviour problems (N = 295; 74% male; 3-8years old). The assessment of spontaneous parental attributions via the PASS coding system was shown to be valid and reliable. Mothers made more negative, dispositional attributions than fathers, however, parents of either gender made, on average, more positive than negative attributions about their children. Parents' natural attributions about these children with emotional and behavioural problems were rather independent from parents' own mental health, but were consistently related to child factors. Specifically, across parent gender and across all attribution dimensions, levels of callous-unemotional traits were associated with spontaneous parental attributions above and beyond other child and parent factors. Overall, the results show that parents' spontaneous speech about referred children contains important information about their causal attributions, and that these are associated with child temperament rather than specific referral symptoms.

Risk and protective factors for the development of ADHD symptoms in children and adolescents: Results of the longitudinal BELLA study.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood worldwide, and causes significant impairments in overall functioning. In order to develop effective prevention and intervention programs, knowledge of the determinants that have an impact on the onset and development of ADHD symptoms is essential. So far, little is known about factors affecting ADHD symptoms in children and adolescents over time. Therefore, this study investigates potential psychosocial risk and protective factors for ADHD symptoms based on cross-sectional and longitudinal data of a German population-based study.MethodsData on children and adolescents (n = 1,384 aged 11 to 17 years) were collected at three measurement points (baseline, 1-year and 2-year follow-ups) covering a period of two years. We used latent growth modelling to investigate effects of parental mental health problems (risk factor) and self-efficacy, family climate and social support (protective factors) on symptoms of ADHD based on cross-sectional as well as longitudinal data. Sociodemographic factors, pre- and postnatal factors, and comorbid symptoms of internalizing and externalizing mental health problems were considered as covariates.ResultsAt baseline, male gender, younger age, stronger aggressive behavior, and stronger parental mental health problems were related to more ADHD symptoms. Longitudinal analyses showed that female gender, migration status, increasing symptoms of generalized anxiety, increasing aggressive behavior and increasing parental mental health problems were associated with stronger increase of ADHD symptoms over time. However, improving family climate was related to decreasing ADHD symptoms over time. We further found moderator effects for social support.ConclusionThe findings of the study provide important information concerning risk and protective factors in the context of ADHD. Hence, the results may be integrated into the planning and implementation of future prevention and early intervention strategies that target affected children and adolescents.

Childhood hearing loss: Impact on parents and family life

BackgroundStudies investigating the impact of having a child with hearing loss on the lives of parents and families have shown divergent results. Where some studies have reported that childhood hearing loss is associated with parental mental health problems, such as depression and stress, other studies report no impact on parental mental health and/or wellbeing. ObjectiveThe aim of this study was to examine the association between child-related variables—degree of hearing loss, additional disabilities, sign language abilities, cochlear implants (CI), externalizing and internalizing emotional and behavioral difficulties measured by the Strength and Difficulties Questionnaire (SDQ)—and parent-related variables—parents living together, parents' mental health, spouse activities without children, and parents’ experience of the child as being a burden for the family. MethodData of 257 parents of children with hearing loss from a national survey were included. ResultsOnly 18% of the children with hearing loss did not live with both parents, a figure significantly lower than that of the general population. The child variables of degree of hearing loss, having a CI or not, and sign language ability were not significantly associated with any of the parent variables investigated. The child having a disability in addition to hearing loss was found to be significantly associated with the frequency of spouses engaging in activities without children and reports that the child was a burden for the family. Both higher externalizing and internalizing scores on the SDQ were significantly associated with parental mental health problems, frequency of spouse activities without children, and the degree to which the child's difficulties were experienced as a burden for the family. ConclusionChildren's hearing loss, per se, was found not to be significantly related to several key parent and family variables. However, children having additional disabilities and behavioral and emotional difficulties were significant with parent and family variables. This study thus underlines the need for further studies concerning relationships among factors related to childhood hearing loss and various family factors in order to better understand their impact on child development and family life.

Childhood adversity and depressive symptoms among middle-aged and older Chinese: results from China health and retirement longitudinal study

Objectives: A number of studies have established the link between childhood adversity (CA) and depression across the life span. This association can be culturally specific, and it remains unclear whether and how different aspects of CA affect depressive symptoms in later life in non-Western societies.Method: Data were from the China Health and Retirement Longitudinal Study in 2011, 2013, 2014 (Life Event History survey) and 2015 (N = 13,710). Depressive symptoms were measured repeatedly in 2011, 2013, and 2015 using the ten-item Centre for Epidemiologic Studies Depression Scale (CES-D-10). CA was assessed in 2014 by parental physical abuse, maternal emotional neglect, early parental death, parental mental health problems, poor quality of parental relationship, and childhood socioeconomic disadvantage. Multilevel linear models were used to analyse the data.Results: Parental physical abuse was associated with 0.51 (95% confidence interval [CI]: 0.28, 0.74) and 0.59 (95% CI: 0.31, 0.88) higher CES-D-10 scores compared to those without such abuse experience for men and women, respectively. Emotional neglect predicted 0.30 (95% CI: 0.07, 0.51) and 0.33 (95% CI: 0.08, 0.58) higher CES-D-10 scores for men and women. Elevated CES-D-10 scores were also found among men and women whose parents had poor mental health and poor relationship, and those who experienced food inadequacy (men: 0.78, 95% CI: 0.54, 1.01; women: 1.15, 95% CI: 0.90, 1.41). Early parental death nevertheless was not associated with CES-D-10 scores.Conclusion: CA exerts long-term detrimental effects on mental health in mid- and late-life among Chinese adults. The findings are consistent with those from Western societies, except for early parental death.

Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?

BackgroundAdolescent health problems are more prevalent in families with low socioeconomic position, but few studies have assessed the role of parental health in this association. This study examines the extent...

Parent-child-relationship quality predicts offspring dispositional compassion in adulthood: A prospective follow-up study over three decades.

Compassion is known to predict prosocial behavior and moral judgments related to harm. Despite the centrality of compassion to social life, factors predicting adulthood compassion are largely unknown. We examined whether qualities of parent-child-relationship, namely, emotional warmth and acceptance, predict offspring compassion decades later in adulthood. We used data from the prospective population-based Young Finns Study. Our sample included 2,761 participants (55.5% women). Parent-child-relationship qualities were reported by each participant's parents at baseline in 1980 (T0) when participants were between 3 and 18 years old. Compassion was self-reported 3 times: in 1997 (T1), 2001 (T2), and 2012 (T3) with the Temperament and Character Inventory (Cloninger, Przybeck, Svrakic, & Wetzel, 1994). By using age at the assessment as a time-variant variable, we applied multilevel modeling for repeated measurements to examine developmental trajectories of compassion from the ages of 20 (the age of the youngest cohort at T1) to 50 (the age of the oldest cohort at T3). On average, compassion increased in a curvilinear pattern with age. Higher acceptance (p = .013) and higher emotional warmth (p < .001) were related to higher compassion in adulthood. After adjusting for childhood confounds (i.e., participant gender, birth cohort, externalizing behavior, parental socioeconomic status, and parental mental health problems), only emotional warmth (p < .001) remained a significant predictor of compassion. Quality of the parent-child-relationship has long-term effects on offspring compassion. An emotionally warm and close relationship, in particular, may contribute to higher offspring compassion in adulthood. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Health-related quality of life in children and adolescent with ASD: the role of mothers' emotional symptoms

Objective: Health-related quality of life (HRQOL) in children with autism spectrum disorder (ASD) has been the subjects of many studies. However, there is limited literature about the effects of parental mental health problems on the HRQOL of children with ASD. This study aims to compare HRQOL of ASD children and their mothers’ emoti-onal problems with healthy controls and to investigate the associations between ASD children’s HRQOL and mater-nal psychiatric symptoms. Methods: The sample consisted of 81 ASD patients and 79 healthy controls, with an age range of 2-18 years, and an equal number of mothers. Childhood Autism Rating Scale was used to check severity of autistic symptoms, Kinder Lebensqualitatsfragebogen: Children’s Quality of Life Questionnaire-revised (KINDL-R) was used to examine child HRQOL, Beck Depression Inventory (BDI) was used to evaluate maternal depressive symptoms, and State-Trait Anxiety Inventory (S-STAI, T-STAI) was used to assess maternal anxiety symptoms. Results: BDI and T-STAI total scores were significantly higher, KINDL-R total score, physical well-being, family, social, and school subscores were significantly lower in children with ASD than the control group. BDI total score was significantly higher, self-esteem and social subscores of KINDL-R were significantly lower in the severe ASD group. Self-esteem and school subscores of KINDL-R were significantly lower in ASD children with clinically anxious mothers. Among ASD children, family and school subscores of KINDL-R were negatively corre-lated with BDI total score. Conclusions: ASD patients have lower HRQOL than typically developing peers. Mothers of ASD children experience greater anxiety and depressive symptoms. Self-esteem and school performance in ASD children appear to be linked with maternal anxiety symptoms. Family and school problems in ASD children may be associated with maternal depressive symptoms.

Factor analysis and predictive validity of the Early Risks of Physical Abuse and Neglect Scale (ERPANS): A prospective study in Dutch public youth healthcare.

Early detection of child abuse risk factors in families of new-born babies is an important task of the public youth health care system in the Netherlands. The Early Risks of Physical Abuse and Neglect Scale (ERPANS) was originally developed in Belgium as an observation scale for public child healthcare nurses. The present longitudinal study is an independent prospective validation of the ERPANS in a Dutch community sample (N = 1257) of families with a new-born. Results showed a commonality of underlying subsets of items belonging to the 'Disturbed parent-child relationship' and 'Psychological problems' factors, but the factor 'Communication problems' of the original ERPANS could not be replicated. We found that parental psychological problems were a significant predictor of family problems, including involvement of child protection authorities, at an average follow-up of 22 months. Parents who reported feeling unloved by their own parents were at higher risk of reports of serious concern to child protection authorities at 22 months after birth. These findings support the utility of at least a subset of the ERPANS items as a screening tool for child abuse risk in preventive public youth health care for new-born babies. Our research adds to a growing body of evidence which points to the importance of parental mental health problems and adverse childhood experiences as precursors to child abuse risk.

Childhood adversities and mid-late depressive symptoms over the life course: evidence from a retrospective cohort study in China

BackgroundThe cumulative effect of childhood adversities on depressive symptoms in later life is well documented in many countries. However, there is a dearth of accurate information about this effect in the Chinese population. We aimed to examine the cumulative effect of childhood adversities on depressive symptoms in mid-to-late life, using data from the Chinese population. MethodsWe retrieved data from the third and fourth wave of the China Health and Retirement Longitudinal Study (CHARLS), which was carried out in 2014 and 2015. We included anonymised data from 17 425 respondents aged 45 years and older, and retrospectively collected information about childhood history, including socioeconomic status, health status, child neglect and abuse, friendship, and parental mental health. The information about socioeconomic status and health status in mid-to-late life was also included. The depressive symptoms were assessed using a ten-item Center for Epidemiologic Studies Depression Scale (CES-D). We used a structural equation model and depicted the direct or indirect pathways from five aspects of childhood adversities to depressive symptoms in mid-to-late life. Socioeconomic status and health status in mid-to-late life acted as a mediated factor in this model. FindingsThe structural equation model had a good satisfactory fit (comparative fit index 0·927; Tucker–Lewis index 0·922; root mean square error of approximation 0·020). Parental mental health problems had a significant direct effect on depressive symptoms in mid-to-late life (β=0·180, p<0·001). Having no friends also showed a direct effect (β= 0·118, p<0·001) and there was an indirect effect of low socioeconomic status and poor health status in mid-to-late life (β=0·054, p<0·001). Poor health status, child neglect and abuse, and low socioeconomic status in childhood had an indirect effect on depressive symptoms in mid-to-late life (poor health status β=0·128, p<0·001; child neglect and abuse β=0·040, p<0·001; low socioeconomic status β=0·098, p<0·001). InterpretationChildhood adversities were directly or indirectly associated with depressive symptoms in mid-to-late life, and the cumulative effects were mediated by poor health status and low socioeconomic status in mid-to-late life. These findings are crucial for the development of integrated practices and deployment of available resources to prevent childhood adversities, subsequently reducing the prevalence of depression. Moreover, the indirect pathways from childhood adversities to depressive symptoms in mid-to-late life indicate that early inequality may develop along multiple axes and shape life outcomes in later life, such as socioeconomic status. The findings suggested the interruptive potential of early resource mobilisation and human agency to curb the cumulative effects of adversity. FundingChina Medical Board (14-198)