Parental Incarceration Among Adolescents Receiving Mental Health Services

The Bureau of Justice Statistics estimates that approximately 1 in every 50 youth in the U.S. had a parent in State or Federal prison in 1999. Studies of children of incarcerated parents suggest that these youth are at risk for experiencing emotional and behavioral problems. Using a sample of 258 adolescents receiving routine mental health services, this study explored: (1) differences in demographic characteristics, lifetime exposure to risk factors, recent stressful life experiences, and clinical profiles of adolescents with and without a history of parental incarceration; and (2) the effect of parental incarceration relative to other risk factors on levels of emotional and behavioral problems and treatment outcomes. Nearly half (43%) of the youth studied had experienced the incarceration of one or both parents. Youth who experienced parental incarceration had been exposed to significantly more risk factors during their lifetimes including parental substance abuse, extreme poverty, and abuse or neglect. They were more likely than other treated youth to present with attention-deficit/hyperactivity and conduct disorders and less likely to have major depression. Findings provide preliminary evidence that parental incarceration may have a discrete negative effect on certain outcomes of treatment.     

父母教养投入对青少年情绪和行为适应的影响差异:亲子依恋的中介作用

为比较同一家庭父亲与母亲教养投入对青少年情绪和行为适应的影响及作用机制差异,采用问卷对1155名中小学生进行调查。结果表明:(1)父亲教养投入显著预测青少年情绪适应,母亲教养投入显著预测青少年行为适应;(2)父亲教养投入仅通过父子依恋的完全中介作用影响青少年的情绪和行为适应; 母亲教养投入既通过母子依恋的部分中介作用影响青少年的消极行为适应,也通过父子依恋的部分中介作用影响青少年的情绪和行为适应。结论表明:父亲与母亲教养投入对青少年情绪和行为适应的直接影响存在适应领域的特异性,其作用机制也存在差异。本研究精准地区分出父亲与母亲教养投入影响青少年适应性的特定范围及不同的作用机制,这对于同一家庭内的父亲与母亲教养投入的精准干预提供了新的视角。     

Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation

Early adversity, for example poor caregiving, can have profound effects on emotional development. Orphanage rearing, even in the best circumstances, lies outside of the bounds of a species-typical caregiving environment. The long-term effects of this early adversity on the neurobiological development associated with socio-emotional behaviors are not well understood. Seventy-eight children, who include those who have experienced orphanage care and a comparison group, were assessed. Magnetic resonance imaging (MRI) was used to measure volumes of whole brain and limbic structures (e.g. amygdala, hippocampus). Emotion regulation was assessed with an emotional go-nogo paradigm, and anxiety and internalizing behaviors were assessed using the Screen for Child Anxiety Related Emotional Disorders, the Child Behavior Checklist, and a structured clinical interview. Late adoption was associated with larger corrected amygdala volumes, poorer emotion regulation, and increased anxiety. Although more than 50% of the children who experienced orphanage rearing met criteria for a psychiatric disorder, with a third having an anxiety disorder, the group differences observed in amygdala volume were not driven by the presence of an anxiety disorder. The findings are consistent with previous reports describing negative effects of prolonged orphanage care on emotional behavior and with animal models that show long-term changes in the amygdala and emotional behavior following early postnatal stress. These changes in limbic circuitry may underlie residual emotional and social problems experienced by children who have been internationally adopted.     

The Relation of Exposure to Traumatic Events and Longitudinal Mental Health Outcomes for Children Enrolled in Systems of Care: Results from a National System of Care Evaluation

This study examined the relation between children's history of exposure to potentially traumatic events (PTEs) and clinical and functional mental health trajectories over a 18‐month period among a national sample of youth referred for services in children's behavioral health systems of care (SOCs). Using data from the national evaluation of the Comprehensive Community Mental Health Services program for communities funded from 1997 to 2000, the study sample included 9556 children and their families. Latent growth modeling was used to assess the effect of history of exposure to PTEs on trajectories in a number of behavioral health outcomes during the 3‐year period following referral to services, controlling for child demographic characteristics (gender, race, and age). Results revealed that, on average, children in SOCs exhibited significant improvements over time on all four outcome measures. Children with a history of exposure to PTEs had higher rates of internalizing and externalizing problem behaviors and functional impairments and fewer behavioral and emotional strengths at baseline, but experienced improvements in these outcomes at the same rates as children without exposure to a traumatic event. Finally, child race, gender, and age also were associated with differences in behavioral health trajectories among service recipients. Implications for SOCs, including approaches to make them more trauma‐informed, are discussed.     

Socioeconomic Status,Emotional/Behavioral Difficulties,and Social Competence among Preschool Children in Japan

Socioeconomic status (SES) is an important contextual factor influencing children’s development. However, there have been limited attempts to examine either the impact of relative poverty on child development or the relationships between specific SES indicators and mental health domains. This study elucidates these relationships in Japanese preschool children who experience high levels of relative poverty. Participants were 3218 Japanese children aged 5–6 years. Their mothers completed self-report questionnaires on SES indicators and the Strengths and Difficulties Questionnaire to measure emotional/behavioral problems. Children’s teachers evaluated children’s social competence using the Social Skills Questionnaire for Preschoolers. Each SES indicator had an inverse relationship with all emotional/behavioral problem domains in the univariate analysis. In the multivariate analysis, lower family income consistently predicted higher scores on all emotional/behavioral problem domains, whereas lower maternal and paternal education levels independently predicted higher scores in specific domains. Each SES indicator had positive relationships with all social competence dimensions in the univariate analysis. Higher family income consistently predicted higher social competence in the multivariate analysis. However, paternal education level only predicted self-control, and maternal education did not predict social competence. Family income and parental education levels were significant independent predictors of emotional/behavioral problems and social competence. Thus, this study suggests that SES does affect child outcomes in a country where there is a high level of relative poverty and underscores the importance of assessing income and education status separately in order to identify their potentially unique associations with development among preschool children.     

Corporal punishment and child adjustment

The association between corporal punishment and children's emotional and behavioral functioning was studied in a sample of 98 non-referred children with a mean age of 12.35 (SD=1.72) recruited from two school systems in the southeastern United States. Children were divided into those who had experienced no corporal punishment over approximately a two-week period, those who had experienced mild levels of corporal punishment (i.e., 1 or 2 instances), and those who had experienced high levels of corporal punishment (i.e., 3 or more instances). Results indicated that use of corporal punishment was associated with problems in both emotional and behavioral adjustment. However, these associations were strongest for children who experienced high levels of corporal punishment, for children who were impulsive, and for children who did not experience a warm and supportive family climate.     

Implementing a teacher-student relationship program in a high-poverty urban school: Effects on social, emotional, and academic adjustment and lessons learned

The primary purpose of this investigation was to examine the effects of a program designed to improve adolescents' relationships with at least one teacher in an urban high school. All participating students were nominated by teachers as having significant emotional and behavioral problems and approximately half of these youth were randomly assigned to an intervention that included increased positive involvement between each student and one teacher within the school. Teacher ratings of students' social, behavioral, emotional, and academic adjustment at pre- and post-intervention indicated that students in the intervention group had higher grade point averages than did students in the control group following the 5-month intervention but no differences were observed on other variables. Challenges associated with conducting school-based, relationship-focused interventions in high-poverty urban environments and several lessons that were learned in the process of initiating this project are discussed.     

Treating Depression During a Recession: Psychotherapy with Indigent Clients

During the last few years, the global economy has struggled and many clients have experienced significant financial hardship. It can be difficult to confront emotional problems when there are multiple life stressors impinging on clients and disrupting their daily functioning. Several recommendations are provided for helping clients to oppose their depressive tendencies when financial problems are real, significant, and lasting. First, therapists can provide a stable and supportive relationship that helps to ease the client’s emotional distress and lays the foundation for other aspects of treatment. Second, therapy can help to protect an optimistic attitude and instill hope for a better future. Third, behavioral activities can be used to encourage productive activity each day. Fourth, problem-solving skills can help many clients deal with stressors in a direct, constructive, and proactive manner. Fifth, therapy can examine ways to expand and improve the client’s social relationships. Finally, psychotherapists should collaborate with other health care professionals in order to ensure the optimal, integrated care for the client. It is hoped that these recommendations will be helpful for therapists who work with financially impoverished clients.     

Behavioral and Emotional Problems on the Teacher’s Report Form: A Cross-National,Cross-Clinic Comparative Analysis of Gender Dysphoric Children and Adolescents

For gender dysphoric children and adolescents, the school environment may be challenging due to peer social ostracism and rejection. To date, information on the psychological functioning and the quality of peer relations in gender dysphoric children and adolescents has been studied via parental report, peer sociometric methods, and social interactions in laboratory play groups. The present study was the first cross-national investigation that assessed behavior and emotional problems and the quality of peer relations, both measured by the Teacher’s Report Form (TRF), in a sample of 728 gender dysphoric patients (554 children, 174 adolescents), who were referred to specialized gender identity clinics in the Netherlands and Canada. The gender dysphoric adolescents had significantly more teacher-reported emotional and behavioral problems than the gender dysphoric children. In both countries, gender dysphoric natal boys had poorer peer relations and more internalizing than externalizing problems compared to the gender dysphoric natal girls. Furthermore, there were significant between-clinic differences: both the children and the adolescents from Canada had more emotional and behavioral problems and a poorer quality of peer relations than the children and adolescents from the Netherlands. In conclusion, gender dysphoric children and adolescents showed the same pattern of emotional and behavioral problems in both countries. The extent of behavior and emotional problems was, however, higher in Canada than in the Netherlands, which appeared, in part, an effect of a poorer quality of peer relations. Per Bronfenbrenner’s (American Psychologist, 32, 513–531, 1977) ecological model of human development and well-being, we consider various interpretations of the cross-national, cross-clinic differences on TRF behavior problems at the level of the family, the peer group, and the culture at large.     

Stigmatization and Male Identity: Norwegian Males’ Experience after Identification as BRCA1/2 Mutation Carriers

In families with hereditary breast and ovarian cancer, there is limited knowledge about the reactions of BRCA1/2 mutation positive males. In the present qualitative study, fifteen BRCA1/2 mutation positive men in Norway participated in two successive, in-depth interviews. Seven female partners participated in the second interview. The men reported strong emotional reactions to their positive test results, and they expressed a desire to keep the genetic information private. They considered discussing their test results or health related information with other males as difficult, and they perceived females as their sources of social and emotional support. Interestingly, the second interview revealed important information not communicated during the first interview. The findings of this study contribute to the discussion of whether men who test positive for a BRCA1/2 mutation should receive tailored genetic counseling sessions. Health care providers should be aware of psychological vulnerability in these men, likely stemming from fewer emotional supports in their social networks.     

What Makes Crohn's Disease Patients Difficult to Manage? The Role of Psychosocial Factors

Most GI clinicians face the problem of a small group Crohn's Disease (CD) patients who function poorly and consume inordinate amounts of service with poor outcome. This study examines the hypothesis that psychosocial factors differentiate the CD patients who function poorly from the typical CD patient. A prototypal sample of CD patients with problems functioning, more typical CD patients (not selected for having problems in functioning), and healthy controls each completed a battery of validated psychosocial measures of disease-specific quality of life, coping skills, social support and life stress, perceived medical symptoms and life history factors. Chart data on hospital admissions, ER, GI, Surgeon, and GP visits were also collected. The CD patients with problems functioning reported more symptoms (GI and non-GI) and had many more ER, GI, and GP visits than the typical group. Psychologically, those with problems functioning had poorer quality of life and were more likely to cope using emotional discharge and support seeking. They experienced significantly more stress and reported a more chaotic family history. No differences on an experimental method of information processing biases were found between the CD groups, however. These results indicated that patients with problems functioning, selected by GI staff because they were best-case examples of functional difficulties, shared little with a matched group of typical CD patients. These patients likely require psychological as well as medical intervention to best manage their illness.     

A comparison of behavioral and emotional functioning in children and adolescents with Autistic Disorder and PDD-NOS.

Behavioral symptomatology was compared in 26 children and adolescents with Autistic Disorder ("autism") and 25 children and adolescents with Pervasive Developmental Disorder, Not Otherwise Specified ("PDD-NOS"). Relative to individuals with PDD-NOS, those with autism had more symptoms of depression, social withdrawal, atypical behavior, and immature social skills--and fewer family problems. These differences remained even when group differences in intellectual ability were statistically controlled. No group differences emerged in somatization, anxiety, or hyperactivity. Findings suggest that although both groups demonstrate considerable evidence of behavioral and emotional problems, those with autism are at particularly high risk for comorbid behavioral and emotional disabilities.     

Social support and cancer: Adult patients' desire for support from family,friends, and health professionals

Examined cancer patients' desire for social support from family, friends, and health professionals upon whom they most depended for support. Before a single interaction with each of these sources, nonhospitalized adult cancer patients (N = 64) completed a questionnaire indicating their desire for support from the source on 11 functional components. Results indicated that emotional and instrumental functions of support were distinct and required separate examination. Distinctiveness of primary sources was manifest by patients' overall preference for tangible aid from family, modeling from friends who had cancer, and open communication and clarification from health professionals. Family and friends were equally preferred sources for dealing with affective reactions to the stressfulness of cancer. All three sources were similarly desired for self-esteem enhancement and for relief from decision-making and problem-solving responsibilities. Finally, patients' perceived prognosis but not the objective severity of their illness was associated with a heightened desire for support, especially for instrumental support functions.     

La représentation des causes de l’état de santé par les infirmiers et les points de vue envisagés des patients et des aidants naturels : une approche socionormative

This study examines the representation of the determining factors of patients’ states of health in therapeutic care situations. We describe the average representation of experienced hospital nurses (n=44) and the differences which they consider to exist between their own and their patients’ points of view. Taking as our starting point the purpose of the care provided and the asymmetry of the carer/patient relationship, we hypothesize, on the one hand, that nurses will have a representation of their patients’ state of health which is based on the care to be provided, with the factors determining the state of health being necessarily perceived as having a general impact on patients’ lives while still being remediable, i.e. capable of changing and being controlled by the provided care. On the other hand, we expect them to attribute a passive position and attitude to their patients, with the factors determining their state of health being necessarily perceived as being out of their own control. The results and the analysis of the representations reported as being those of the patients and their families seem to justify this perception and role of carer: the supposed representations of the latter would appear to be convergent but less focused on health problems and would tend to minimize the patient’s involvement, in particular when the state of health declines. The results are discussed with reference to the Health Belief Model and the social norm of internality as well as the professional practices observed in hospital environments.     

The Network Structure of Childhood Psychopathology in International Adoptees

International adoptees are at an increased risk of emotional and behavioral problems, especially those who are adopted at an older age. We took a new approach in our study of the network structure and predictability of emotional and behavioral problems in internationally adopted children in Finland. Our sample was from the on-going adoption study and comprised 778 internationally adopted children (387 boys and 391 girls, mean age 10.5 (SD 3.4) years). Networks were estimated using Gaussian graphical models and lasso regularization for all the children, and separately for those who were adopted at different ages. The results showed that anxiety/depressive symptoms, social problems, and aggressiveness were the most central symptom domains. Somatic symptoms were the least central and had the weakest effect on the other domains. Similarly, aggressiveness, social problems, and attention problems were high in terms of predictability (73–65%), whereas internalizing problems were relatively low (28–56%). There were clear but local age-group differences in network structure, symptom centrality, and predictability. According to our findings, network models provide important additional information about the centrality and predictability of specific symptom domains, and thus may facilitate targeted interventions among international adoptees.     

Stress reactions following acute situations involving moral challenges among health care professionals

Many health care professionals have to make morally difficult decisions during acute, stressful situations. The aim was to explore the applicability of an existing qualitatively developed model of individual reactions among professional first responders following such situations using a quantitative approach. According to the model, the interaction of antecedent individual and contextual characteristics affect the immediate emotional reactions to acute, stressful events involving a moral dilemma. Continuous coping efforts and the quality of social support will also affect the long‐term positive and negative reactions to the event. The participants (n = 204, about 50% response rate) represented three Swedish health care professions stationed at a university hospital and a regional hospital: Physicians (n = 50), nurses (n = 94) and “others” (n =60, mainly social welfare officers and assistant nurses). Except for the personality dimension emotional stability which was measured using an established instrument, all measurement scales were operationalizations of codes and categories from the qualitative study (ten scales altogether). Four multiple regression analyses were performed with long‐term positive and negative reactions in everyday acute and morally extremely taxing situations respectively as dependent variables. The outcome showed that long‐term positive reactions covaried with much use of the coping strategies Emotional distancing and Constructive emotional confrontation and a perception of a well‐functioning Formal social support. Regarding long‐term negative reactions, higher age and little use of Emotional distancing accounted for much of the variance. Immediate emotional reactions also contributed significantly. Conclusion: the results largely supported the model concepts and their assumed relationships.     

优抚医院疗养对象的社会支持与幸福感的关系:心理健康的中介作用

考察优抚医院疗养对象的幸福感现状,探讨其心理健康、社会支持与幸福感的关系。采用老年人心理健康问卷、社会支持评定量表、纽芬兰纪念大学幸福度量表对103名平均年龄82.43岁的优抚医院疗养对象进行调查。结果表明:(1)优抚医院疗养对象的幸福感与全国常模无显著差异,心理健康水平与社会支持状况都显著低于对照组;(2)优抚医院疗养对象的社会支持、心理健康水平和幸福感各维度之间存在显著正相关;(3)心理健康在社会支持对幸福感的影响中起中介作用;心理健康的情绪体验维度在客观支持对幸福感的影响中起部分中介作用。     

Perinatal maternal mental health and infant socio-emotional development: A growth curve analysis using the MPEWS cohort

Pregnancy and the early post partum period are widely understood as a critical period for the infant’s emotional development and the earliest influence shaping social interaction. The present study aims to understand the potential influence of both antenatal and postnatal maternal anxiety and depressive symptoms on socio-emotional outcomes in offspring aged 12 months. The study used longitudinal data from a prospective cohort study on Australian pregnant women and their children. Data were available for 282 mothers and their children. Maternal depressive and anxiety symptoms were measured in early pregnancy, trimester three of pregnancy, six and 12 months postpartum. Social and emotional development in children was measured using the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 12 months. Using growth curve analysis of 4 waves of repeated measurement to examine intercept and slope, we found that both initial maternal depression and anxiety symptom levels, and the growth of these symptoms over time, predicted more problems with children’s social and emotional development. In the final model anxiety accounted for 19% of the variance in child socio-emotional problems and depression 23% of variance. The results emphasise the importance of perinatal maternal mental health as a potential risk factor for child development. This carries important implications for policy development, such as the need to build early identification and early intervention models in to the current clinical practice for perinatal care, specifically, to develop targeted screening, assessment and interventions to address maternal mental health issues for at-risk parents during pregnancy, and continuing monitoring of young children whose mothers have experienced perinatal mental health difficulties.     

亲子关系和朋友支持对流动儿童情绪和行为适应的保护作用

以1008名初中流动儿童为研究对象,在压力背景下探讨亲子关系和朋友支持对流动儿童不同情绪适应（孤独感、社交焦虑）和行为适应结果（问题行为、亲社会行为）的保护作用,并揭示二者保护作用的适用领域及其差异。结果表明：（1）亲子关系显著预测行为适应,朋友支持显著预测情绪适应和亲社会行为。（2）亲子关系能够缓解压力事件对流动儿童问题行为的消极作用。（3）朋友支持能够缓解压力事件对流动儿童孤独感和社交焦虑的消极作用。（4）尽管亲子关系和朋友支持都能够缓解压力事件对流动儿童亲社会行为的消极作用,但压力事件较少时二者的保护效应更强。这提示流动儿童与父母和朋友的紧密情感联结能够缓解压力事件对其情绪和行为适应的消极作用：父母是缓解行为适应问题的保护因素,朋友是缓解情绪适应问题的保护因素;积极行为适应能够同时获益于父母和朋友支持。     

Correlates of Victimization in a Juvenile Justice Population

The Practical Adolescent Dual Diagnostic Interview is a structured diagnostic interview designed to gather basic information about mental health conditions; past emotional, physical, and sexual abuse; suicide attempts; and substance use disorders. This instrument was administered to 435 males and 61 females in juvenile justice facilities and adolescent diversion courts to assess prevalence of mental health and substance use disorders relative to maltreatment (defined as physical, sexual, and/or emotional abuse). Results showed that the majority of juveniles who experienced maltreatment were more likely to have diagnostic indications of behavioral health conditions. Additionally, for both males and females the odds of the individual having attempted suicide were more than twice as high for those acknowledging some form of maltreatment.