Family Difficulties Research Articles

Retrospective Chart Review of Patients with Self-Harm Seen as Liaison Psychiatry in Pakistan

IntroductionSelf‑harm is an ‘act of self‑poisoning or self‑injury carried out by a person, irrespective of their motivation’. A history of self-harm is linked with suicide risk. A study in Pakistan found self-harm to be more common in young people with unemployment and interpersonal difficulties as common triggers. Expanding liaison psychiatry services leads to an earlier assessment of patients with self-harm.ObjectivesTo study the demographic and clinical variables of patients along with methods and precipitating factors of self-harm.MethodsA retrospective chart review of patients presenting with self-harm seen as a part of liaison psychiatry from October 2018 to June 2021.ResultsA total of 168 cases were seen of which 10 were excluded due to incomplete data. Of 158 cases gender split was roughly in the middle, with 49.4% males (n=78) and 50.6% females (n=80). The mean age of patients was 27.59 with a range of 12-70, 40.5% belonged to the age group of 20-29 (n=64) (Figure 1).77.8% (n=123) had a past psychiatric history. The most common being depressive disorder 31.6% (n=50) and borderline personality disorder 30.4% (n=48). 35.4% of patients reportedly had previous attempts of self-harm. The most common methods being the use of sharp objects, rat-pill poisoning, and corrosive intake (Figure 2).Conflicts with family and relationship difficulties were reported to be the most common precipitating factors.ConclusionsSelf-harm is a challenging and frequent presentation. Patients may present with diverse characteristics and varying needs. Hence physicians must be prepared for timely liaison and prompt management.DisclosureNo significant relationships.

Neuropsychological profile of Turner Syndrome in relation to deficits in academic and psychosocial areas. A case report

Introduction Previous reviews reported an association between Turner Syndrome (TS) and a profile of deficits in some neurocognitive domains (visual-spatial domains, mathematics, and executive functions: cognitive flexibility, working memory, cognitive inhibition, and problem solving), although pointing out individual variability.ObjectivesTo describe the neuropsychological profile of a patient with diagnosis of TS and psychosocial difficulties attended at the Service of Psychiatry, Clinical Psychology and Mental Health at La Paz University Hospital (Madrid).MethodsA descriptive study is conducted on a single case of a 11-year-old woman with diagnosis of TS attended by a clinical psychologist at a child-adolescent Mental health center for social, family and academic difficulties. Neuropsychological assessment was completed in October, 2021. The Wechsler Intelligence Scale for Children-Five Edition (WISC-V) and Neuropsychological Assessment of Executive Functions in Children (ENFEN) batteries were administered.ResultsThe full-scale intelligence quotient was observed in the normal range, with lower scores in non-verbal tasks. Deficits (range from z = -2.00 to -1.75) were observed in tests of working memory, processing speed and complex problem-solving tasks. The results showed great variability in other executive functioning tasks (selective attention tasks: from z = -1.75 to -0.75; and cognitive flexibility tasks: from z = -2.25 to 0.25).ConclusionsThe neurocognitive profile described in the literature was partially consistent with the results obtained in this study. The neuropsychological assessment can support the elucidation of clinical diagnostic and therapeutic factors in TS patients with relevant psychosocial or cognitive difficulties.DisclosureNo significant relationships.

Text mining for identifying the nature of online questions about non-suicidal self-injury

ObjectiveThe internet provides convenient access to information about non-suicidal self-injury (NSSI) owing to its accessibility and anonymity. This study aimed to explore the distribution of topics regarding NSSI posted on the internet and yearly trends in the derived topics using text mining.MethodsWe searched for the keyword “non-suicidal self-injury” (Ja-Hae in Korean) in the Naver Q&A using the statistical package R. We analyzed 7893 NSSI-related questions posted between 2009 and 2018. Text mining was performed using latent Dirichlet allocation (LDA) on the dataset to determine associations between phrases and thus identify common themes in posts about NSSI.ResultsIn the LDA, we selected the following 10 most common topics: anger, family troubles, collecting information on NSSI, stress, concerns regarding NSSI scarring, ways to help a non-suicidal self-injurious friend, depression, medical advice, ways to perform or stop NSSI, and prejudices and thoughts regarding non-suicidal self-injurious people.ConclusionsThis study provides valuable information on the nature of NSSI questions posted online. In future research, developing websites that provide NSSI information and support or guidance on effectively communicating with NSSI is necessary.

Diagnostic and Therapeutic Complexity of Gender Dysphoria: About A Clinical Case

Gender dysphoria is a medical term used in the American Psychiatric Association (APA) textbook to describe the distress of the transgender person in the face of a sense of inadequacy between their assigned sex and their gender identity. The work we present is based on a clinical case in which we have retained the diagnosis of gender dysphoria comorbid with other psychiatric disorders after several close consultation appointments, and through which we will address the socio-cultural aspect of this disorder within our society Adults with gender dysphoria can benefit from psychological, medical and surgical treatment in France. However, this dysphoria rarely appears in adulthood, often being present since childhood and adolescence and generating difficulties in family, social and school life, particularly at the time of puberty. It is necessary to take adequate care of patients with gender dysphoria, often generating psychological suffering responsible for numerous comorbidities.

The effect of child benefits on financial difficulties and spending habits: evidence from Poland’s Family 500 + program

In response to the low fertility rate and high child poverty in Poland, the government implemented the Family 500 + program which provides cash transfers to families with two or more children, and low-income, one-child families. Using a difference-in-differences approach, we explore the causal effect of this policy on expenditure and financial difficulties of beneficiaries relative to non-eligible families. The findings suggest that after the introduction of the program, expenditures on food and cultural activities increased, and the likelihood of experiencing a hardship paying for utilities and medical care declined for the treatment relative to the control group. These results imply a beneficial effect of child benefits on tackling financial difficulties of families with children. From a policy perspective, the findings indicate that cash transfers can alleviate child poverty concerns and financial constraints to having children.

The role of grandparents in the family's penitentiary crisis: biographical research

This paper focuses on the role and importance of grandparents in the situation of the family's penitentiary crisis. In the light of biographical research carried out with two research groups: (1) adults who experienced a parent's incarceration in childhood and (2) parents of prisoners – the activities and key strategies of grandparents involved in supporting their grandchildren were analysed. The potential of Fritz Schütze's biographical sociology was used to carry out the study, based on the reconstruction of the life history of the respondents. On the basis of the narrative interviews, I described the specificity of two key contexts: (1) the (negative) experience of parentification in the situation of complete takeover of the care of grandchildren, and (2) (positive and negative) aspects of grandparents' occasional participation in family life. The obtained results allow to improve the knowledge about the experiences (needs and difficulties) of prisoners' families, especially focusing on intergenerational relations.

Birth, Postpartum, and Home Experiences of Individuals With Lower Extremity Nerve Injury

ObjectiveTo explore birth and at-home postpartum experiences of individuals with lower extremity nerve injury (LENI) related to childbirth. DesignMixed-methods, descriptive, cross-sectional survey with open-ended questions. SettingClosed Facebook support group. ParticipantsTwo hundred-thirty individuals who experienced LENI during childbirth. MeasurementsTwo research team members developed the online LENI survey that incorporated suggestions from LENI support group leaders. We used descriptive statistics, linear regression, and Kaplan–Meier survival curves to summarize the quantitative data and used content analysis for open-ended items. ResultsWe described labor, birth, and postpartum characteristics in our sample, including immediate and long-term LENI symptoms. Falls resulting from LENI were common in the hospital (55.6%) and at home (75.6%). At discharge home, respondents reported low confidence in their ability to care for themselves and their infants as well as high levels of dependence on others. There was an 89.6% prevalence of depression in the first month at home. Approximately 80% of participants rated their degree of healing at 5 years as 80% to 100% healed. Content analysis yielded six themes: (a) Grieving Loss of Current and Future Life; (b) Caregiver Responses That Helped or Hindered; (c) Being in Danger; (d) Experiencing Emotional Turmoil; (e) Dealing With Family, Marital, and Financial Difficulties; and (f) Finding Strength, Overcoming Obstacles, and Experiencing Personal Growth. ConclusionParticipants in our sample reported a very high rate of falls, anxiety, and depression at home. Nurses should recognize LENI symptoms, take action to prevent falls, and offer accurate information and referrals.

Inequalities in the distribution of COVID-19-related financial difficulties for Australian families with young children.

BackgroundWe examine (1) the frequency of financial difficulties in Australian families with young children (0–8 years) in the early and later phases of the pandemic; (2) the extent to which parents' pre‐pandemic socio‐economic disadvantage (SED) predicted financial difficulties; and (3) whether grandparent intergenerational SED further amplified this risk.Method Data: Australian Temperament Project (ATP; established 1983, N = 2443) and ATP Generation 3 study (ATPG3; established 2012; N = 702), of which 74% (N = 553) completed a COVID‐specific module in the early (May–September 2020) and/or later (October–December 2021) phases of the pandemic. Outcomes: Parent‐reported loss of employment/reduced income, difficulty paying for essentials, and financial strain. Exposures: Pre‐pandemic parent and grandparent education and occupation. Analysis: Logistic regressions, estimated via generalized estimating equations, were used to examine associations between the pre‐pandemic SED of parents and grandparents and their interaction with financial difficulties, adjusting for potential confounders.ResultsAt both pandemic time points, a third of parents reported adverse financial impacts (early: 34%, 95% confidence interval [CI] = 30–38; later: 32%, 95% CI = 28–36). Each standard deviation increase in the parents' pre‐pandemic SED was associated with a 36% increase in the odds of reporting multiple financial difficulties (odds ratio [OR] = 1.36, 95% CI = 1.04–1.78). There was little evidence of an interaction between the SED of parents and grandparents.ConclusionsFinancial impacts related to the COVID‐19 pandemic were common and, irrespective of grandparent SED, disproportionately borne by parents with higher pre‐pandemic SED. Given the well‐established relationship between disadvantage and child health and development, sustained and well‐targeted government supports will be critical to minimizing adverse impacts in years to come.

Children’s well-being and intra-household family relationships during the first COVID-19 lockdown in France

Objective: This article explores the consequences of the first COVID-19 lockdown in the spring of 2020 in France on intra-family relationships and 9-year-old children's socio-emotional well-being.
 Background: On 17th March 2020, France began a strict lockdown to contain the COVID-19 pandemic, with school closures and limited outings permitted until early June. All family routines and work-life arrangements were impacted. A major concern relates to how these measures impacted family and child well-being.
 Method: We use data from the Elfe Sapris survey, administered during the first lockdown to about 5,000 families participating to the Etude longitudinale française depuis l'enfance (Elfe), a nationally representative birth cohort of children born in 2011. We analysed correlations between parents' socioeconomic and living conditions on four relational indicators: the experience of lockdown, the quality of relationships between parents and children, and between siblings, and an indicator of children’s socio-emotional well-being, the Strengths and Difficulties Questionnaire (SDQ).
 Results: The impact of the lockdown on family well-being was conditional on socio-economic factors and their changes over the period. Deterioration of households' financial situation and having to work outside the home during lockdown was negatively correlated with family relationships and children’s socio-emotional well-being.
 Conclusion: Overall, our results suggest that while France's first lockdown was a relatively positive period for many households with a primary-school-aged child, we highlight that restrictions exacerbated existing difficulties for disadvantaged families.

Reducing the incidence of domestic violence: An observational study of an equine-assisted intervention.

This paper is presenting results from an observational study which has measured the impact of an equine‐assisted education (EAE) intervention on the future occurrence of domestic violence within the family over 1 year following completion of the intervention as part of the troubled families program. The data analyzed were collected by the local authority troubled family's team from the different agencies involved including crime, health, and social care data. The data were analyzed and compared across four groups, those families on the troubled families program who had a key worker with a member or members who had attended and completed the equine‐assisted intervention (n = 268); those families who were on the troubled families program but no support had been offered (n = 10,569), those families who were on the program and were being supported by a key worker only (n = 2119), and those families on the program who were being supported by a key worker and had received further support, not from the equine‐assisted intervention (N = 1119). Significant reductions in domestic violence and child in need status were found for those families who had a member or members attend and complete the equine‐assisted intervention under study. Those families referred to the equine‐assisted intervention also had significantly more complex needs than those in the other groups. Referrals to this intervention are normally for those families for whom talk‐based interventions such as parenting, or education‐based interventions are not working.

The role of harsh parenting practices in early- to middle-childhood socioemotional development: An examination in the Millennium Cohort Study.

Patterson's coercion model describes a gradual escalation in maladaptive parent–child transactions whereby externalizing behaviors lead to increases in maladaptive parenting and vice versa. The current study investigates the role of (predominantly mother‐reported) harsh parenting practices in the within‐person development of conduct problems, hyperactive/inattentive behaviors, and emotional problems. A random‐intercept cross‐lagged panel model was fit across ages 3, 5, and 7 (N = 14,037, 49% female, 84% White) using the UK population‐representative Millennium Cohort Study. Findings support Patterson's coercion model, providing evidence for reciprocal within‐family relations between parenting practices and child behaviors. They suggest the importance of addressing parenting difficulties in families where children present with socioemotional difficulties in order to help prevent the accumulation of additional issues.

Monthly Trends in the Life Events Reported in the Prior Year and First Year of the COVID-19 Pandemic in New Zealand.

The current study examines changes in the economic, social, and well-being life events that women and men reported during the first 7 months of the COVID-19 pandemic. Analyses compared monthly averages in cross-sectional national probability data from two annual waves of the New Zealand Attitudes and Values Study collected between October 2018–September 2019 (N = 17,924), and October 2019–September 2020 (N = 41,653), which included the first 7 months of the pandemic (Mar–Sep 2020). Results indicated that people (particularly women) reported increased job loss in the months following an initial COVID-19 lockdown relative to the same months the year earlier. Women also experienced an increase in family troubles when restrictions eased and reported increased negative lifestyle changes that persisted throughout the first 7 months of the pandemic. The proportion of people experiencing many other life events (e.g., mental health, financial concerns) in New Zealand did not differ reliably from the pre-pandemic monthly baseline. These results highlight resilience to many potential negative life events within the first 7 months of the COVID-19 pandemic. However, the pandemic did not affect everyone equally, and the burden of increased negative events appears more heavily borne by women. As the pandemic continues more than 18 months from initial community transmission of COVID-19, our findings provide important insight into the impact of the pandemic on potential negative life events, especially among women, that may have critical consequences for mental health, gender equality, and social well-being over time.

Role of Ayurveda in the Prevention and Management of Nephrotoxicity

Nephrotoxicity, the prevalence and incidence of which is increasing day by day, is affecting very badly the quality of life of the sufferers in addition to the impalement of physical, mental, social and economical damages. The fact that the mortality rate of hospitalized patients with acute kidney injury over the last 40–50 years is almost constant and is not improving itself iterates its graveness. Treatment/management of acute kidney injury is primarily supportive, with the goals of preventing further damage and promoting recovery of renal function. It may include discontinuation, dose adjustment or monitoring of the medications prescribed. There are only few drugs like melatonin and lithium which are supposed to be having the potential of mitigation of drug-induced nephrotoxicity. If metabolic derangements from acute kidney injury do not respond to conservative treatment, either dialysis or renal replacement therapy is the only option to ensure the maintenance of homeostasis. But neither hemodialysis nor renal transplantation, which themselves bring about a lot of personal and familial difficulties, is free from side/adverse effects. Ayurveda, the ancient healing science, describes a lot of measures for the prevention and management of diseases in a great detail. Although nephrotoxicity seems to be a new entity, it can be very well prevented and managed with the adoption of Ayurveda in a cost effective and safe way. This article presents the nehroprotective effect of Ayurvedic advocacy and that of Ayurvedic plants evident by experiments in animal model.

University students coping with COVID-19 challenges: Do they need help?

Objective: This study examined students’ perceived levels of coping and need for help, and the relationship with their risks and protective factors during the early stages of the COVID-19 pandemic in Israel. Participants: A sample of 4,710 university students responded anonymously to an online questionnaire. Methods: The risk and protective factors assessed were: specific COVID-related functional difficulties, levels of social support, and trust in the university authorities and the government in handling the crisis. Results: The most frequent COVID-19 related difficulties were: worry for the health of family members (64.4%) and difficulties with online learning (63.2%). Almost half of the students (47.3%) reported that they needed at least a little help. Hierarchical regression analyses for coping and need for help showed that COVID-related difficulties predicted lower levels of perceived coping and a higher need for help. Conclusions: Universities need to build specific services for students to provide concrete support throughout this continuous health crisis.

Financial insecurity among children with atopic dermatitis in the United States

Financial insecurity among children with atopic dermatitis in the United States

Recursos sociales y familiares según la experiencia con la migración en jóvenes universitarios mexicanos

The objective was to analyze the family and social resources of Mexican university students according to the type of experience with migration, be it their own and / or that of a family member to support the design of interventions. It is a quantitative study of correlational type of comparison of groups. 4,284 students from 15 schools of Mexican Higher Education institutions participated, who answered different scales to evaluate their social and family resources. Significant differences were found in three subdimensions of social resources: initiative F (2,923) p (.003), support network F (2,170) p (.027) and total social resources F (1,437) p (.175). And in two subdimensions of family resources: family expression F (1.259) p (.260) and family difficulties F (3.70) p (.001), the differences are discussed emphasizing their usefulness for the design of specific interventions that take into account the type of experience with migration that has been lived.

Factors that carry way the appearance of anxiety during the COVID-19 pandemic

Anxiety is a central phenomenon that is most often characterized by a diffuse, unpleasant and vague feeling of apprehension, often accompanied by vegetative symptoms such as headache, diaphoresis, tachycardia, chest tightness and restlessness; symptoms often vary among individuals. Systematic review of articles was realized. A literature search was conducted through digital platforms. Twenty articles published during the years 2020 and 2021 were analyzed, in English and Spanish, related to anxiety during the COVID-19 pandemic. The increase in anxiety was observed as a result of the different factors that emerged from the COVID-19 pandemic; the effects on mental health, when exceeded, can have serious consequences both at the individual and societal levels. Some indicators are the public health measures, as the main factor is social distancing, misinformation and fear of contagion. However, the factor with the greatest increase in anxiety is credited to the economy, which has been affected in all countries, generating critical situations in companies around the world, unemployment and economic difficulties for most families and individuals. Based on what was observed in this analysis, it was found that there are different types of factors that trigger an increase in anxiety, however, the main factors that had a higher rate of causing anxiety were social isolation and concern about the economy, creating uncertainty about the health emergency being experienced.

General Beliefs About Illicit Drug Use and Stigma: Perspective of People Who Use Illicit Drugs.

People who use illicit drugs are continuously subjected to harsh stigmatization from society. This study explores the perspectives of people who use illicit drugs, specifically their general beliefs about illicit drug use and related stigma. A convergent parallel mixed methods design was used, combining quantitative and qualitative methods. The participants were recruited in a Psychosocial Care Centre (CAPSad) of a municipality in the state of Sao Paulo in Brazil. Findings revealed that illicit drug use can cause individual, family, professional and social difficulties, including problems with the law. The participants indicated they felt victimized by illicit drugs and their use, but also shared prejudicial and discriminatory views, highlighting self-stigmatizing perspectives. There is a need to develop intervention studies with a psychosocial approach on the use of illicit drugs, valuing the person's participation in the treatment, covering biomedical approaches, having in mind the social impact of illicit drugs and their use.

Organized crime groups: A systematic review of individual-level risk factors related to recruitment.

Studies from multiple contexts conceptualize organized crime as comprising different types of criminal organizations and activities. Notwithstanding growing scientific interest and increasing number of policies aiming at preventing and punishing organized crime, little is known about the specific processes that lead to recruitment into organized crime. This systematic review aimed at (1) summarizing the empirical evidence from quantitative, mixed methods, and qualitative studies on the individual-level risk factors associated with the recruitment into organized crime, (2) assessing the relative strength of the risk factors from quantitative studies across different factor categories and subcategories and types of organized crime. We searched published and unpublished literature across 12 databases with no constraints as to date or geographic scope. The last search was conducted between September and October 2019. Eligible studies had to be written in English, Spanish, Italian, French, and German. Studies were eligible for the review if they: Reported on organized criminal groups as defined in this review.Investigated recruitment into organized crime as one of its main objectives.Provided quantitative, qualitative, or mixed methods empirical analyses.Discussed sufficiently well-defined factors leading to recruitment into organized crime.Addressed factors at individual level.For quantitative or mixed-method studies, the study design allowed to capture variability between organized crime members and non-members. From 51,564 initial records, 86 documents were retained. Reference searches and experts' contributions added 116 additional documents, totaling 202 studies submitted to full-text screening. Fifty-two quantitative, qualitative, or mixed methods studies met all eligibility criteria. We conducted a risk-of-bias assessment of the quantitative studies while we assessed the quality of mixed methods and qualitative studies through a 5-item checklist adapted from the CASP Qualitative Checklist. We did not exclude studies due to quality issues. Nineteen quantitative studies allowed the extraction of 346 effect sizes, classified into predictors and correlates. The data synthesis relied on multiple random effects meta-analyses with inverse variance weighting. The findings from mixed methods and qualitative studied were used to inform, contextualize, and expand the analysis of quantitative studies. The amount and the quality of available evidence were weak, and most studies had a high risk-of-bias. Most independent measures were correlates, with possible issues in establishing a causal relation with organized crime membership. We classified the results into categories and subcategories. Despite the small number of predictors, we found relatively strong evidence that being male, prior criminal activity, and prior violence are associated with higher odds of future organized crime recruitment. There was weak evidence, although supported by qualitative studies, prior narrative reviews, and findings from correlates, that prior sanctions, social relations with organized crime involved subjects, and a troubled family environment are associated with greater odds of recruitment. The available evidence is generally weak, and the main limitations were the number of predictors, the number of studies within each factor category, and the heterogeneity in the definition of organized crime group. The findings identify few risk factors that may be subject to possible preventive interventions.

Implementing a nurse-led paediatric palliative care service.

Children with life-limiting illnesses are living longer. They have complex care needs and require specialised knowledge and skills, yet paediatric palliative care is still at its infancy in most settings worldwide. To describe the process of implementing a nurse-led paediatric palliative care programme in a large tertiary hospital in Saudi Arabia. The steps that led to the implementation of this new nurse-led programme will be described through a 1-year analysis of collected data. A total of 107 children received services from the paediatric palliative care programme for over one year, with cancer being the predominant diagnosis (n=71, 66.3%). More than half of the children had a do not attempt resuscitation (DNAR) order (n=54, 50.5%). The most frequently encountered issues were the family's difficulty in coping with the disease (n=80, 74.7%) and a child's uncontrolled pain (n=72, 67.3%). The most frequent interventions were family support and counselling (n=71, 66.3%), family education about symptom management (n=69, 64,5%) and adjusted analgesics (n=60, 56%). Children in the terminal stage of their disease had significantly more issues. Effective paediatric palliative care can be successfully implemented in a healthcare setting even when resources are limited. A nurse-led service was found to be a viable option for the delivery of palliative care to children with serious illnesses.