Breast Cancer Genetics Knowledge and Testing Intentions among Nigerian Professional Women

Genetic testing services for breast cancer are well established in developed countries compared to African populations that bear a disproportionate burden of breast cancer (BC). The objective of this study is to examine the knowledge of professional Nigerian women about BC genetics and their intentions to utilize genetic testing services when it is made available in Nigeria. In this study, 165 lecturers and 189 bankers were recruited and studied using a validated self-administered questionnaire. The respondents’ mean age was 34.9 years (SD?=?10.9), 6.5% had family history of BC, and 84.7% had limited knowledge of breast cancer genetics. The proportion of women with genetic testing intentions for breast cancer was 87.3%. Health care access (OR?=?2.35, 95% CI, 1.07–5.13), religion (OR?=?3.51, 95% CI, 1.03–11.92), and perceived personal risk if a close relative had breast cancer (OR?=?2.31, 95% CI, 1.05–5.08) independently predicted testing intentions. The genetic testing intentions for BC were high despite limited knowledge about breast cancer genetics. Promotion of BC genetics education as well as efforts to make BC genetic testing services available in Nigeria at reduced cost remains essential.     

Patient Perceptions of Telephone vs. In-Person <Emphasis Type="Italic">BRCA1/BRCA2</Emphasis> Genetic Counseling

Telephone genetic counseling (TC) for hereditary breast/ovarian cancer risk has been associated with positive outcomes in high risk women. However, little is known about how patients perceive TC. As part of a randomized trial of TC versus usual care (UC; in-person genetic counseling), we compared high risk women’s perceptions of: (1) overall satisfaction with genetic counseling; (2) convenience; (3) attentiveness during the session; (4) counselor effectiveness in providing support; and (5) counselor ability to recognize emotional responses during the session. Among the 554 participants (TC, N?=?272; UC, N?=?282), delivery mode was not associated with self-reported satisfaction. However, TC participants found counseling significantly more convenient than UC participants (OR?=?4.78, 95 % CI?=?3.32, 6.89) while also perceiving lower levels of support (OR?=?0.56, 95 % CI?=?0.40–0.80) and emotional recognition (OR?=?0.53, 95 % CI?=?0.37–0.76). In exploratory analyses, we found that non-Hispanic white participants reported higher counselor support in UC than in TC (69.4 % vs. 52.8 %; OR?=?3.06, 95 % CI?=?1.39–6.74), while minority women perceived less support in UC vs. TC (58.3 % vs. 38.7 %; OR?=?0.80, 95 % CI?=?0.39–1.65). We discuss potential research and practice implications of these findings which may further improve the effectiveness and utilization of TC.     

Infant and Toddler Crying,Sleeping and Feeding Problems and Trajectories of Dysregulated Behavior Across Childhood

Infant and toddler regulatory problems (RPs) including crying, sleeping and feeding, are a frequent concern for parents and have been associated with negative behavioral outcomes in early and middle childhood. Uncertain is whether infant and toddler RPs predict stable, trait-like dysregulated behavior across childhood. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). RPs at 6, 15–18, & 24–30 months and childhood dysregulated behavior at 4, 7, 8, & 9.5 years were assessed using mother report. Latent Class Growth Analysis (LCGA) indicated that trajectories of childhood dysregulated behavior were stable over time. All single RPs (i.e., crying, sleeping & feeding problems) were significantly associated with childhood dysregulated behavior. For example, crying problems at 6 months after controlling for confounders (Odds Ratios; 95 % Confidence Intervals): Moderate dysregulated behavior: OR?=?1.50, 95 % CI [1.09 to 2.06], high dysregulated behavior: OR?=?2.13, 95 % CI [1.49 to 3.05] and very high dysregulated behavior: OR?=?2.85, 95 % CI [1.64 to 4.94]. Multiple RPs were especially strongly associated with dysregulated behavior. For example, the RP composite at 15–18 months: 1 RP, very high dysregulated behavior: OR?=?2.79, 95 % CI [2.17 to 3.57], 2 RPs, very high dysregulated behavior: OR?=?3.46, 95 % CI [2.38 to 5.01], 3 RPs, very high dysregulated behavior: OR?=?12.57, 95 % CI [6.38 to 24.74]. These findings suggest that RPs in infants and toddlers predict stable dysregulated behavior trajectories across childhood. Interventions for early RPs could help prevent the development of chronic, highly dysregulated behavior.     

Socioeconomic Factors in Relation to Discrepancy in Parent versus Teacher Ratings of Child Behavior

Discrepancies between observers are common in studies of child behavior problems that rely on behavior ratings. Although modest concordance between informants is well-documented, little is known about characteristics that predict discrepancies. In 477 children aged 5 to 12 years, maternal age and indicators of socioeconomic status (SES; maternal education, family income) were evaluated in relation to score discrepancies between the Child Behavior Checklist and Teacher Report Form for Total, Externalizing and Internalizing Problems. Family income <?$35,000 was independently associated with discrepancies in which mothers rated more clinically significant child behavior problems than teachers for Total, Externalizing and Internalizing Problems [odds ratio (OR)?=?3.26, 95 % confidence interval (CI), 1.19–8.96, OR?=?2.76, 95 % CI 1.03–7.34 and OR?=?3.07, 95 % CI 1.30–7.26, respectively]. Maternal education was not associated with discrepancies, but younger mothers were less likely to rate child’s behavior in the clinical range for Externalizing Problems than teachers (OR per year of age?=?0.88, 95 % CI 0.81–0.96). These results suggest that studies that utilize only maternal or teacher report of child behavior may have misclassification of outcomes that is dependent on SES and could produce biased results.     

What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’

Evidence suggests between 1% and 6% of women develop post-traumatic stress disorder (PTSD) after childbirth. ‘Hotspots’ are moments of extreme distress during traumatising events that are implicated in symptoms of PTSD. This cross-sectional internet survey of hotspots examined (1) the content of intrapartum hotspots and (2) whether particular events, cognitions or emotions during hotspots are related to PTSD. Women (N?=?675) who experienced a difficult or traumatic birth completed a questionnaire composed of a validated measure of PTSD, questions concerning the existence of hotspots, and a newly developed measure of emotions and cognitions during hotspots. The majority of women (67.4%) reported at least one hotspot during birth and 52.9% had re-experiencing symptoms of these hotspots. Women were more likely to have PTSD if hotspots involved fear and lack of control (odds ratio (OR) 1.30, 95% CI 1.17–1.43) or intrapartum dissociation (OR 1.12, 95% CI 1.05–1.19). Risk of PTSD was higher if hotspots concerned interpersonal difficulties (OR 4.34, 95% CI 2.15–8.77) or obstetric complications (OR 3.35, 95% CI 1.64–6.87) compared to complications with the baby.     

High-Risk Behavior Among Young Adolescents in The Central and Northern Region of Peninsular Malaysia: Baseline Data from The MyHeART Study

The onset of high-risk behaviors in adolescents are associated with family, social and behavioral factors. This study aims to describe the prevalence of high-risk behaviors among young adolescents in Peninsular Malaysia and determine the relationship between high-risk behaviors and family sociodemographics and behaviors. The data utilized are from the Malaysian Health and Adolescents Longitudinal Research Study, a prospective cohort analysis conducted in three large states of Peninsular Malaysia: Selangor, Perak, and the Federal Territory of Kuala Lumpur. The sample included 13-year-old adolescents in their first year of secondary school. Students and parents or guardians were given separate, standardized self-administered questionnaire. A high-risk behavior variable was determined on the basis of exposure to substance use (tobacco, alcohol, and illicit drugs), gambling, and online pornography or violence. The exploratory variable of interest (family sociodemographics) was defined as parents’ demographics, employment status, education level, and socioeconomic status. The analysis included 1341 adolescents and 1146 parents. Of the school-going adolescents, 4.7?% (n?=?52) reported HRBs. Tobacco use (9?%, n?=?1 19) and watching pornography or violent content on the Internet (5?%, n?=?72) accounted for most of the behaviors, whereas illicit drug use contributed the least (2?%, n?=?32). More adolescents from the higher socioeconomic groups, than from the middle groups exhibited high-risk behaviors (odds ratio ?=?3.039, 95?% confidence interval?=?2.884–3.202); by contrast, the odds ratio of high-risk behavior among adolescents with a low socio-economic status was 2.246 (95?% CI?=?2.014–2.397). Future intervention programs for adolescents should focus on overcoming high-risk behaviors and sustain behavioral changes.     

Integrated Treatment Programmes for Mothers with Substance Use Problems: A Systematic Review and Meta-analysis of Interventions to Prevent Out-of-home Child Placements

Approximately half of mothers receiving substance use treatment are involved with childcare proceedings. This review aims to determine whether integrated treatment programmes for mothers with substance use problems are effective in preventing out-of-home placement (temporally/permanent) and influencing other maternal factors such as patterns of substance use, treatment completion and parenting behaviours. Six trials were identified—two randomised controlled trials and four non-randomised controlled studies. The pooled sample of participants was 1717. The results showed that mothers who participated in integrated treatment programmes were significantly less likely to have the children removed from their care (Odds Ratio (OR)?=?0.40, 95% CI?=?0.27, 0.61), more likely to complete substance use treatment (OR?=?3.01, 95% CI?=?1.79, 5.06), and more likely to reduce their alcohol consumption (Standardised Mean Difference (SMD)?=??0.40, 95% Cl?=??0.78, ?0.01) and drug use (SMD?=??0.30, 95% CI?=??0.53, ?0.07). However, non-significant reductions were observed for parent–child conflict (SMD?=??0.35, 95% CI?=??0.72, 0.03) and child abuse risk (SMD?=??0.03, 95% CI?=??0.36, 0.31). While the findings from this review suggest that mothers involved in integrated treatment programmes could potentially be less likely to experience out-of-home child placements and more likely to improve substance use treatment outcomes, little evidence exists for the effectiveness of these interventions. Further research, particularly high-quality RCTs, is required to demonstrate and persuade health and public policy on the far-reaching value of the integrated approaches.

     

Self-efficacy for health-related behaviour change in patients with TIA or minor ischemic stroke

Abstract

Objective: To assess levels of self-efficacy for health-related behaviour change and its correlates in patients with TIA or ischemic stroke.

Methods: In this prospective cohort study, 92 patients with TIA or ischemic stroke completed questionnaires on self-efficacy for health-related behaviour change and fear, social support and depressive symptoms. Relations between fear, social support, depressive symptoms, cognitive impairment, vascular risk factors and history and demographic characteristics and low-self-efficacy were studied with univariable and multivariable logistic regression.

Results: Median total self-efficacy score at baseline was 4 (IQR 4–5). Older age (OR 1.05, 95% CI 1.01–1.09), depressive symptoms (OR 1.09, 95% CI 1.03–1.16), presence of vascular history (OR 2.42, 95% CI 0.97–6.03), higher BMI (OR 1.15, 95% CI 1.01–1.30), fear (OR 1.06, 95% CI 1.01–1.12) and low physical activity (OR 1.49, 95% CI 1.01–2.21) were significantly associated with low self-efficacy.

Conclusion: Patients with recent TIA or ischemic stroke report high self-efficacy scores for health-related behaviour change. Age, vascular history, more depressive symptoms, higher BMI, less physical activity and fear were correlates of low self-efficacy levels.

Practice implications: These correlates should be taken into account in the development of interventions to support patients in health behaviour change after TIA or ischemic stroke.     

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Evaluation of a Heredofamilial Cancer Unit in Increasing Family History Collection and Genetic Counseling Referrals Among Spanish Oncologists at a University Hospital

A comprehensive family history is essential to identify patients at risk for hereditary cancer who could benefit from genetic counseling (GC). In a previous study, we observed a low occurrence of family history record (FHR) collection rate and GC referral among oncologists at our institution. The present work analyzes whether the implementation of a heredofamilial cancer unit (HFCU) would improve these parameters. We retrospectively compared the FHR rate in clinical records, National Cancer Institute (NCI) general criteria for hereditary cancer suspicion, GC referrals and FHR quality in two cohorts: cohort 1 (patients diagnosed before HFCU creation) and cohort 2 (after HFCU creation). Of 1,175 patients (590 cohort 1 and 585 cohort 2), FHRs were consigned in 27.3 % and 52.5 % of patients, respectively (p?<?0.001). The GC referral of patients with any NCI criterion was 13.6 % xin cohort 1 vs. 40.5 % in cohort 2 (p?<?0.001). FHR quality improved in terms of the total number of relatives (164 vs. 314, p?=?0.1, N.S.) and number of healthy relatives consigned (80 vs. 191, p?<?0.01). Nine mutations (6 BRCA, 1 MEN1, 2 Lynch), 4 unknown significance variants (all in BRCA) and 2 with no mutation were identified among patients referred from cohort 2. We conclude that the creation of a heredofamilial cancer unit has changed both FHR and GC referrals among oncologists at our institution, although continuous educational efforts are required.     

Concussion is associated with altered preparatory postural adjustments during gait initiation

Gait initiation is a useful surrogate measure of supraspinal motor control mechanisms but has never been evaluated in a cohort following concussion. The aim of this study was to quantify the preparatory postural adjustments (PPAs) of gait initiation (GI) in fifteen concussion patients (4 females, 11 males) in comparison to a group of fifteen age- and sex-matched controls. All participants completed variants of the GI task where their dominant and non-dominant limbs as the ‘stepping’ and ‘support’ limbs. Task performance was quantified using the centre of pressure (COP) trajectory of each foot (computed from a force plate) and a surrogate of the centre of mass (COM) trajectory (estimated from an inertial measurement unit placed on the sacrum).Concussed patients exhibited decreased COP excursion on their dominant foot, both when it was the stepping limb (sagittal plane: 9.71 mm [95% CI: 8.14–11.27 mm] vs 14.9 mm [95% CI: 12.31–17.49 mm]; frontal plane: 36.95 mm [95% CI: 30.87–43.03 mm] vs 54.24 mm [95% CI: 46.99–61.50 mm]) and when it was the support limb (sagittal plane: 10.43 mm [95% CI: 8.73–12.13 mm] vs 18.13 mm [95% CI: 14.92–21.35 mm]; frontal plane: 66.51 mm [95% CI: 60.45–72.57 mm] vs 88.43 mm [95% CI: 78.53–98.32 mm]). This was reflected in the trajectory of the COM, wherein concussion patients exhibited lower posterior displacement (19.67 mm [95% CI: 19.65 mm–19.7 mm]) compared with controls (23.62 mm [95% CI: 23.6–23.64]). On this basis, we conclude that individuals with concussion display deficits during a GI task which are potentially indicative of supraspinal impairments in motor control.     

Childbirth and Alcohol Consumption Impact of Recent Childbirth on Alcohol Consumption

While the devastating effects of parental alcohol use on children’s health are well known, the specific impact of childbirth on parental alcohol consumption has rarely been examined in the general population. We sought to examine patterns of alcohol use associated with childbirth. Data were drawn from the US National Epidemiologic Survey on Alcohol and Related Conditions. We compared successively the characteristics of alcohol use among females living with a child under 1 year with (i) those of females not living with children under 1 year and (ii) those of females living with an older child. Mean daily ethanol intake was lower among females living with a child under 1 than among females either not living with children under 1 year (p?<?0.001) or living with an older child (p?<?0.01). Moreover, low-to-mild drinking frequencies fell among females living with a child under 1, compared with females either not living with children under 1 year (adjusted odds ratio (AOR)?=?0.56; 95% CI [0.40, 0.80] for at least once a month and AOR?=?0.40; 95% CI [0.27, 0.58] for less than once a month) or living with an older child (AOR?=?0.52; 95% CI [0.36, 0.75] for at least once a month and AOR?=?0.66, 95% CI [0.46, 0.94] for less than a month). No significant difference was found for males. Our study suggests that childbirth, as opposed to motherhood per se, reduces several (though not all) dimensions of alcohol consumption in females, but not in males.     

The Effect of Cancer on Suicide among Elderly Holocaust Survivors

Jewish‐Israelis of European origin with cancer have higher suicide rates relative to their counterparts in the general population. We investigated whether this effect results from the high proportion of Holocaust survivors among them, due to vulnerabilities arising from the earlier traumas they sustained. The study was based on all Jewish‐European persons with cancer, 60 years and over, diagnosed in Israel between 1999 and 2007. The standardized incidence ratios were not significantly different between the exposed and nonexposed groups (men: 0.90, 95% CI 0.60–1.19; women: 0.95, 95% CI 0.55–1.37). Past exposure to maximum adversity did not increase the suicide risk among persons with cancer.     

Evaluation of Violence Prevention Approaches Among Early Adolescents: Moderating Effects of Disability Status and Gender

High prevalence rates of aggression during adolescence and associated adjustment difficulties for perpetrators and victims highlight the need for effective violence prevention programs. School-based prevention programs are advantageous as they occur in a key setting for youths' social and emotional development. The current study compared the efficacy of a combined universal violence prevention approach that included individual-level skill-building (i.e., lessons from Second Step) and school environment (i.e., Olweus Bullying Prevention Program; OBPP) interventions to OBPP alone. Participants were 231 sixth, seventh, and eighth graders (ages 11–15; M?=?12.6, SD?=?1.0) in middle school (48?% male, 67?% African American). A total of 14 classrooms were randomly assigned to the combined intervention (seven) or OBPP only comparison (seven) condition, split evenly across grades. Intervention effects were moderated by disability status and gender. Among students without disabilities those who received the combined intervention reported greater increases in anger regulation coping skills than those in the comparison condition. In contrast, among youth with disabilities greater increases in teacher-rated social skills were found for students in the combined intervention than students in the comparison condition at posttest. Gender-moderated effects included greater decreases in teacher ratings of externalizing problems and bullying behaviors for boys in the combined intervention versus the comparison condition at posttest. Study results inform school-based violence prevention programs and are discussed along with implications.     

The Role of Exposure to Violence and Psychopathy on Violent Crime Perpetration

Exposure to violence strongly predicts violent behavior. However, not all individuals who are exposed to violence engage in violent behavior. Personality is one factor that influences the translation from exposure to violence to engagement in violent behavior. Previous research in adolescents showed that psychopathy (a personality disorder) mediated the relationship between exposure to violence and violent behavior. However, this research has not: been conducted in adults, despite evidence of instability in exposure to violence and psychopathy across the lifespan; examined the specificity of this relationship to different expressions of psychopathy, such as subcomponent Factors and primary/secondary subtypes; and, considered other environmental experiences that may impact this relationship. In two samples of adults (community [N?=?232] and prison [N?=?313]), psychopathy affected the relationship between exposure to violence and violence (community indirect effect?=?0.03, SE?=?0.02, 95% CI?=?0.004, 0.07; prison indirect effect?=?0.14, SE?=?0.05, 95% CI?=?0.05, 0.25). These effects appeared to be related more strongly to the impulsive-antisocial traits of psychopathy and the secondary (high-anxious) subtype of psychopathy. Results were robust against demographic and other environmental experiences. Ultimately, our findings indicate that psychopathy is an important factor affecting the link between exposure to violence and violent behavior.

     

Encountering the Body at the Site of the Suicide: A Population‐Based Survey in Sweden

Encountering the body of a child who died by suicide at the site of death is believed to be especially harmful for bereaved parents. We investigated the association between encountering the body at the site of the suicide and psychological distress in 666 suicide‐bereaved parents. Parents who had encountered their child's body at the site of the suicide (n = 147) did not have a higher risk of nightmares (relative risk [RR] 0.95, 95% confidence interval [CI] 0.67–1.35), intrusive memories (RR 0.97, 95% CI 0.84–1.13), avoidance of thoughts (RR 0.97, 95% CI 0.74–1.27), avoidance of places or things (RR 0.91, 95% CI 0.66–1.25), anxiety (RR 0.93, 95% CI 0.64–1.33), or depression (RR 0.94, 95% CI 0.63–1.42) compared with parents who had not encountered the body (n = 512). Our results suggest that losing a child by suicide is sufficiently disastrous by itself to elicit posttraumatic responses or psychiatric morbidity whether or not the parent has encountered the deceased child at the site of death.     

Neurocognitive Functioning in Depressed Young People: A Systematic Review and Meta-Analysis

Background: Depression is among the most common mental health problems for young people. In adults, depression is associated with neurocognitive deficits that reduce the effectiveness of treatment and impair educational and vocational functioning. Compared to adults, less is known about the neurocognitive functioning of young people with depression, and existing research has reported inconsistent findings. Method: This systematic review and meta-analysis synthesized the literature on neurocognitive functioning in currently depressed youth aged 12–25 years in comparison to healthy controls. Results: Following a systematic review of the literature, 23 studies were included in the meta-analysis. Poorer performance in the domains of attention (SMD: .50, 95% CI: .18–.83, p?=?.002), verbal memory (SMD: .78, 95% CI: .50–1.0, p?<?.001), visual memory (SMD: .65, 95% CI: .30–.99, p?<?.001), verbal reasoning/knowledge (SMD: .46; 95% CI: .14–.79; p?<?0.001) and IQ (SMD: .32; 95% CI: .08–.56; p?=?0.01) were identified in depressed youth. Relative weaknesses in processing speed/reaction time and verbal learning were also evident, however, these findings disappeared when the quality of studies was controlled for. Moderator analysis showed a tendency for poorer set-shifting ability in younger depressed participants relative to controls (although non-significant; p?=?.05). Moderator analysis of medication status showed taking medication was associated with poorer attentional functioning compared to those not taking medication. Conclusion: The findings suggest that currently depressed young people display a range of neurocognitive weaknesses which may impact treatment engagement and outcome. The findings support the need to consider neurocognitive functioning when treating youth with depression.     

A Meta-Analysis of Universal School-Based Prevention Programs for Anxiety and Depression in Children

Anxiety and depression are among the most common mental health issues experienced in childhood. Implementing school-based prevention programs during childhood, rather than adolescence, is thought to provide better mental health outcomes. The present meta-analysis aimed to investigate the efficacy of universal school-based prevention programs that target both anxiety and depression in children (aged 13 years or below), and examine three moderators (i.e., program type, primary target of program, and number of sessions) on prevention effects. PsycINFO, PubMED, and Google Scholar were systematically searched for relevant articles published up to and including January 2018. Fourteen randomised controlled trials, consisting of 5970 children, met eligibility criteria. Prevention programs led to significantly fewer depressive symptoms at post-program (g?=?0.172) and at long-term follow-up periods (g?=?0.180), but not at short-term follow-up. Programs were not found to prevent anxiety symptoms across any time point. Considerable heterogeneity was observed for all effects. Program type and length were found to moderate the relationship between prevention program and outcomes. Prevention programs were effective in preventing depressive symptoms at post-program and long-term follow-up, while no significant preventative effect on anxiety symptoms was observed. The FRIENDS Program and programs which contained a greater number of sessions showed beneficial effects on anxiety and depressive symptoms. Universal programs aimed at preventing both anxiety and depression in children are limited. Future research should investigate the long-term evaluation of school-based prevention programs for anxiety and depression in children.