Effects of Child Psychopathology on Maternal Depression: The Mediating Role of Child-Related Acute and Chronic Stressors

In light of recent research highlighting the potential effects of children’s behavior on mothers’ mental health, the current study examined 679 mothers and their adolescent children from a community-based sample to determine the effects of youth psychopathology on maternal depression and levels of child-related stress in mothers’ lives. It was hypothesized that the number of past clinical diagnoses in 15-year-old adolescents would predict the presence of maternal depression at youth age 15 and 5 years later, as well as more episodes of maternal depression during the follow-up period. Furthermore, it was hypothesized that increased levels of child-related stress in mothers’ lives would mediate these relationships. Regression analyses indicated that past youth diagnoses do confer risk for the presence of current and future maternal depression, as well as more episodes of maternal depression, and mediation analyses revealed that child-related acute and chronic stress were mediators of the relationship between youth diagnoses and the presence of maternal depression at follow-up. Findings suggest that increased levels of child-related objective stress in mothers’ lives are one mechanism by which children’s psychopathology affects mothers’ future risk for depression.     

Social Cognition and Externalizing Psychopathology: An Investigation of the Mediating Role of Language

The present study integrates findings from three lines of research on the association of social cognition and externalizing psychopathology, language and externalizing psychopathology, and social cognition and language functioning using Structural Equation Modeling (SEM). To date these associations have been examined in pairs. A sample of 354 clinic-referred children (aged 7 to14 years) recruited from a children’s mental health centre were tested on measures of language, social cognition, working memory, and child psychopathology. We compared a hypothesized model presenting language functioning as a mediator of the association between social cognition and externalizing psychopathology to a model presenting the independent contribution of language and social cognition to externalizing psychopathology. As hypothesized, we found that the mediation model fits the data better than the alternative model. Our findings have implications for developing and modifying intervention techniques for children with dual language and externalizing psychopathology. This research was supported by a grant from Health Canada (NHRDP, 6606-4835) to the third author.     

Adjustment of Siblings of Children with Mental Health Problems: Behaviour, Self-Concept, Quality of Life and Family Functioning

This study examined the adjustment of siblings of children with mental health problems. The participants had brothers or sisters receiving treatment at a Child and Adolescent Mental Health Service within the Hunter New England Health Service, New South Wales, Australia. Seventy-five siblings completed questionnaires on their self-concept, quality of life and family functioning. Their carers completed questionnaires on the sibling’s behaviours, family demographics and family functioning. The diagnosis and severity of disability of index children were attained from the treating clinician. The study revealed the siblings had significantly higher rates of psychopathology, poorer quality of life and lived in more dysfunctional families than normally developing children. Regression modelling predicted variables related to the three main behaviour scales of the Child Behaviour Checklist (CBCL). Family functioning, family communication and the extreme ends of family cohesion and balance, were the most significant contributors to regression model. The sibling self-concept domains of global self-worth, athletic competence and behavioural conduct, contributed to the model. Additionally, a smaller family size was associated with more internalising behaviour disorders in the siblings. The diagnosis and severity of mental health problem of the index child and other family demographic factors did not impact on the sibling’s behavioural functioning. This study highlights that siblings of children with mental health difficulties are a group vulnerable to adjustment difficulties regardless of the index child’s diagnosis or the severity of impairment. Overall, family functioning had a greater impact on the siblings than other factors.     

Intergenerational Transmission of Multiple Problem Behaviors: Prospective Relationships between Mothers and Daughters

Much of the research examining intergenerational continuity of problems from mother to offspring has focused on homotypic continuity (e.g., depression), despite the fact that different types of mental health problems tend to cluster in both adults and children. It remains unclear whether mothers with multiple mental health problems compared to mothers with fewer or no problems are more likely to have daughters with multiple mental health problems during middle childhood (ages 7 to 11). Six waves of maternal and child data from the Pittsburgh Girls Study (n = 2,451) were used to examine the specificity of effects of maternal psychopathology on child adjustment. Child multiple mental health problems comprised disruptive behavior, ADHD symptoms, depressed mood, anxiety symptoms and somatic complaints, while maternal multiple mental health problems consisted of depression, prior conduct problems and somatic complaints. Generalized Estimating Equations (GEE) was used to examine the prospective relationships between mother’s single and multiple mental health problems and their daughter’s single and multiple mental health problems across the elementary school-aged period (ages 7–11 years). The results show that multiple mental health problems in the mothers predicted multiple mental health problems in the daughters even when earlier mental health problem of the daughters, demographic factors, and childrearing practices were controlled. Maternal low parental warmth and harsh punishment independently contributed to the prediction of multiple mental health problems in their daughter, but mediation analyses showed that the contribution of parenting behaviors to the explanation of girls’ mental health problems was small.     

Mental Illness and Mental Health: The Two Continua Model Across the Lifespan

Mental health has long been defined as the absence of psychopathologies, such as depression and anxiety. The absence of mental illness, however, is a minimal outcome from a psychological perspective on lifespan development. This article therefore focuses on mental illness as well as on three core components of positive mental health: feelings of happiness and satisfaction with life (emotional well-being), positive individual functioning in terms of self-realization (psychological well-being), and positive societal functioning in terms of being of social value (social well-being). The two continua model holds that mental illness and mental health are related but distinct dimensions. This model was studied on the basis of a cross-sectional representative internet survey of Dutch adults (N = 1,340; 18–87 years). Mental illness was measured with the Brief Symptom Inventory and mental health with the Mental Health Continuum Short Form. It was found that older adults, except for the oldest-old, scored lower on psychopathological symptoms and were less likely to be mentally ill than younger adults. Although there were fewer age differences for mental health, older adults experienced more emotional, similar social and slightly lower psychological well-being. In sum, today’s older adults have fewer mental illness problems, but they are not in a better positive mental health than today’s younger adults. These findings support the validity of the two continua model in adult development.     

Children and Violence: The Role of Children’s Regulation in the Marital Aggression–Child Adjustment Link

Exposure to marital psychological and physical abuse has been established as a risk factor for children’s socio-emotional, behavioral, and cognitive problems. Understanding the processes by which children develop symptoms of psychopathology and deficits in cognitive functioning in the context of marital aggression is imperative for developing efficient and effective treatment programs for children and families, and has far-reaching mental health implications. The present paper outlines our research program, Child Regulation and Exposure to Marital Aggression, which focuses on children’s emotional and physiological reactivity and regulation as pathways in the marital aggression–child development link. Findings from our research program, which highlight the importance of children’s regulatory processes for understanding children’s adjustment in contexts of intimate partner violence, are presented, and future directions in this line of inquiry are outlined.     

The Application of Behavior Change Theory to Family-Based Services: Improving Parent Empowerment in Children’s Mental Health

We describe the development of a parent empowerment program (PEP) using a community-based participatory research approach. In collaboration with a group of dedicated family advocates working with the Mental Health Association of New York City and state policy makers, academic researchers took an iterative approach to crafting and refining PEP to better prepare family advocates to help bridge the gaps in service access among children with emotional and behavioral problems. Despite the growth of family-led, family support programs nationally, research that demonstrates the positive benefits of such programs is scarce in the children’s mental health literature. The PEP model is based on research data about barriers families face in mental health service utilization (e.g., stigma, perceptions of providers, attitudes towards mental illness, service availability, etc.). PEP is premised on (a) the concept of empowerment as a process, (b) the need to engage parents in becoming active agents of change, and (c) the application of an integrated framework to empower parents, called the Parents as Agents of Change model. Our paper focuses on describing the application of a Unified Theory of Behavior Change as a theoretical framework to help activate parents as change agents in meeting their children’s mental health needs. Based on an integrated model of grassroots driven Principles of Parent Support and research-based Unified Theory of Behavior Change, PEP’s Parents as Agents of Change model provides a conceptual framework for testing the effectiveness of family support services in children’s mental health, a much-needed area for future research.     

Engaging African Americans in Therapy: Integrating a Public Policy and Family Therapy Perspective

The field of marriage and family therapy faces a growing imperative to reach historically underserved populations. African Americans are a prime example of a minority group in the United States that continues to be underserved by the current mental health system. We integrate Andersen’s (1995, Journal of Health and Social behavior, 36, 1–10) public policy model of health service use with Fox et al. (1995, Journal of Health Care for the Poor and Underserved, 6, 434–468) revision of the rural de facto mental health services model (Regier and Goldberg, 1978, Archives of General Psychiatry, 35, 685–693) to develop a more inclusive and culturally sensitive framework that captures salient factors influencing African Americans’ entry into and engagement in therapy. Recommendations for overcoming barriers and suggestions for future research are presented.     

Differential relationships in the association of the Big Five personality traits with positive mental health and psychopathology

According to the two continua model of mental health, psychopathology and positive mental health (emotional, psychological, and social well-being) are related but distinct continua. This study investigates the two continua model by examining whether psychopathology and positive mental health show differential associations with the Big Five personality traits. The paper draws on data of the representative LISS panel (CentERdata). Participants (N = 1161; age 18-88) filled out questionnaires on personality, psychopathology, and positive mental health. Personality traits were differentially related to psychopathology and positive mental health, supporting the two continua model. Emotional stability (reversed neuroticism) is the main correlate of psychopathology, whereas the personality traits extraversion and agreeableness are uniquely associated with positive mental health.     

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients. This article is based in part on a presentation by the first author at the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC) in May of 2007 in Minneapolis, Minnesota.     

Psychiatry and Psychology in the Writings of L. Ron Hubbard

Objectives: Celebrity followers of the Church of Scientology have recently used their public forum to attack the modern practice of mental health. The practice of Scientology is rooted in the religious writings of its founder, L. Ron Hubbard. This paper will review the religious writings of L Ron Hubbard to understand Scientology’s position on mental health. Method: This paper reviews four of the major religious books written by L Ron Hubbard, in addition to a comprehensive overview of Scientology compiled by Scientology staff. Results: Hubbard’s theory of mind borrowed heavily from the earlier writings of Freud, until Hubbard’s psychological theory extended to include a spiritual existence that goes beyond the material world. The goal of Hubbard’s psychology and religion were to optimize the freedom of the individual, and he viewed psychiatry and psychology as inherently anti-spiritual and opposed to personal freedom and self-realization. Ultimately Hubbard presents a world view of potential nuclear world cataclysm, fueled by the geopolitical climate and mental health theories that dominated the mid 20th century. Conclusions: Hubbard’s writings mirrored the times in which he lived. His views that mental health practices are inherently anti-religious, freedom-inhibiting, and brain damaging do not reflect the modern-day practices of mental health. Dr. McCall is presently Professor and Chairman of the Department of Psychiatry and Behavioral Medicine at the Wake Forest University School of Medicine. He completed his medical degree and post-graduate psychiatric training at Duke University. He completed a Masters degree in Epidemiology from Wake Forest University. He is board certified in general psychiatry, geriatric psychiatry, and sleep disorders medicine. His research interests include depression, electroconvulsive therapy, quality of life, and insomnia. His research has been continuously funded by the National Institute of Mental Health since 1995, and he is author of more than 100 peer-reviewed journal articles. He is Editor of the Journal of ECT, Immediate-Past President of the Association for Convulsive Therapy, and a prior Director of the Board of the American Academy of Sleep Medicine.     

Equanimity to Excess: Inhibiting the Expression of Negative Emotion is Associated with Depression Symptoms in Girls

Emotion dysregulation is often invoked as an important construct for understanding risk for psychopathology, but specificity of domains of emotion regulation in clinically relevant research is often lacking. In the present study Gross’ (2001) model of emotion regulation is used to generate hypotheses regarding the relative contribution of two specific types of deficits in emotion regulation, inhibited and disinhibited expression of negative emotion, to individual differences in depressive symptoms in preadolescent girls. A sample of 232 9-year-old girls was recruited from a community based study. Depression symptoms were assessed via diagnostic interview. The mother and interviewer rated the girl’s level of impairment. Questionnaires and observations were used to assess inhibited and disinhibited expression of negative emotion. Differences in inhibited expression of negative emotion typically explained more variance in depressive symptoms and impairment across informants than did disinhibited expression of negative emotion. Although disinhibited expression of negative emotion is associated with depression and impairment, inhibited expression appeared to be a necessary ingredient, suggesting that inhibited expression may be a particularly relevant deficit in emotion regulation in the development of depression in females.     

An Investigation of the Relationships Between Spirituality, Health Status and Quality of Life in Adolescents

This study examines the relationships between six spirituality-related attributes and quality of life (QOL) in adolescents, and the extent to which these relationships are mediated by perceived physical and mental health status and five important life domains (family, friends, living environment, school experiences, and perception of self). The data were obtained via a cross-sectional health survey of 8,225 adolescents in British Columbia, Canada. Structural equation modeling was used to test the hypothesized relationships. All spiritual attributes are significantly associated with three or more of the life domains, and four of the attributes significantly explain global QOL after controlling for the other variables in the multivariate model. The attributes indicative of adolescents’ feelings about their future and other existential matters were found to be relatively most explanatory with respect to global QOL. The predominant mediators include adolescents’ satisfaction with their family, their perceived self, and their perceived mental health status. Spirituality is important with respect to adolescents’ QOL. The multivariate model provides preliminary insights into the relevance of several attributes of spirituality and the possible mechanisms by which these attributes may contribute to adolescents’ QOL.     

Maternal Depression,Maternal Expressed Emotion,and Youth Psychopathology

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors–maternal depression within the child’s lifetime and maternal EE–in a study of children at risk for depression. One hundred and seventy-one youth, ages 8–12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist–Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children’s own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers’ reports of children’s Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers’ reports of children’s Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children’s depression diagnoses.     

Reducing the Risk for Preschool Expulsion: Mental Health Consultation for Young Children with Challenging Behaviors

Increasing numbers of young children are being expelled from child care settings because of their problem behavior. Access to mental health consultation is related to lower rates of expulsion, but additional data are needed to document the pathways through which mental health consultation reduces the risk of expulsion. We report on outcomes from a 4-year project designed to reduce the number of children expelled for problem behavior in a large suburban county in Maryland. Two master’s-level professionals provided behavioral consultation to child care providers who identified nearly 200 children at imminent risk for expulsion. Child care providers rated children’s social skills and problem behaviors at referral and discharge using the Preschool Kindergarten Behavior Scales and the Brief Infant Toddler Social Emotional Assessment. Statistically significant increases in social skills and reductions in problem behaviors were seen for children who received individualized consultation. More than three-quarters of the children who were at risk for expulsion were able to be maintained in their current child care placement; of those that changed placements, only half (n = 13) were removed involuntarily. These findings provide additional support for mental health consultation as a promising strategy to reduce the risk for expulsion for young children with problem behaviors.     

Chuang Tzu,Butterfly and Wittgenstein: An Exploration of the Relationship Between Psychological Factors and Philosophical Thinking in the Life of Ludwig Wittgenstein

This is a preliminary attempt at exploring the relationship between psychology and philosophical thinking. It first looks at Chuang Tzu’s analogy of the butterfly representing the spirit of spontaneity that is central in Taoist philosophy. Second, it explores the psychology of self-consciousness that inhibits spontaneity, and lastly, it looks at the impact of psychopathology in the life of Ludwig Wittgenstein and his philosophical thinking by focusing on his struggle with mental illness and two philosophical transitions: the movement toward mysticism as an attempt to quiet his obsession and his later writings on ordinary language philosophy as a way out of the pain of self-consciousness. This article puts forth the argument that Wittgenstein’s development of ordinary language philosophy is closely connected with his personal struggle with mental illness. It is a philosophical attempt at coping with his existential psychological struggle, the quest for the butterfly.     

Polishing the Mirror: Mental Health from a Bahá’í Perspective

While various authors have explored multiple religious theories of mental health in an effort to become more responsive to clients’ needs, there is a dearth of information on the Bahá’í conception of this important subject despite the faith’s growth across the world. This article will present a Bahá’í perspective on mental health by examining the faith’s basic tenets and teachings, its affinities and dissimilarities with various traditional psychotherapeutic theories, its views on psychological functioning, and its sources of healing. Common therapeutic issues of Bahá’ís will also be explored to aid counselors in conceptualizing and treating these clients.Michelle Maloney is a licensed clinical professional counselor and adjunct faculty at the University of Great Falls. She is a doctoral student at North Central University.     

Some correlates of health locus of control among multicultural individuals

The relationship of locus of control to depression, anxiety, hostility, and physical health was assessed in a sample of multicultural college students (N = 162). Powerful Others Health Locus of Control was correlated with depression, anxiety, hostility, and recent physical symptoms while Chance Health Locus of Control (CHLC) was correlated with all of the above as well as chronic physical symptoms and major health problems. When controlling for a variety of health risk factors (viz., age, sex, body mass, exercise, smoking, salt, alcohol, and caffeine), only CHLC remained significant in the physical health models. Results support the cognitive model of mental health which emphasize the importance of adaptive beliefs. Specifically, they suggest that issues about control are related to negative affect and indicate that the often-cited relationship of an external locus of control to depression and anxiety also holds for hostility. The findings do not, however, support the view that anxiety and depression are associated with different types of external locus of control but rather suggest a unified set of locus of control beliefs underlying the three types of negative affect. In addition, evidence is provided for the external validity of the Multidimensional Health Locus of Control (MHLC) Scales with respect to mental health. Further, the results indicate that belief about one’s health may play a significant role in one’s physical health and that the health behavior model of the relationship between locus of control and physical health is insufficient to explain the relationship. As the Chance and Powerful Others MHLC scales were not related to health habits in this sample but were related to mental health (viz., depression, anxiety, and hostility), locus of control beliefs may be related to physical health via their relationship with mental health.     

The Interface between Mental Health Providers, Families, and Schools: Parent and Child Attitudes about Information-Sharing

Youth with emotional and behavioral disorders (EBD) are at an increased risk for school problems and negative consequences into adulthood, increasing the need for collaboration between families, school personnel and mental health providers. Current treatment guidelines emphasize the importance of information-sharing between providers and schools, yet few studies have addressed parents’ or students’ attitudes and preferences about this process or about the disclosure of mental health-related information to school professionals. Using a sample of 73 pairs of parents and their adolescents seeking outpatient treatment, this study assessed parental and adolescent attitudes about disclosure of mental health treatment information to school personnel. The majority of parents reported that the school should be informed that their adolescent was receiving counseling or medication for EBD, and that they should be the primary informant, rather than providers. By comparison, adolescents preferred more discretion about their involvement in treatment. Taken together, the study results highlight a number of implications relevant to the therapeutic relation and the process of obtaining and sharing mental health-related treatment information with various school personnel. Future research directions regarding the consultative and collaborative process with school personnel are also discussed.     

Parents of Adolescents with Mental Disorders: Improving Their Caregiving Experience

Several studies have demonstrated that the family members of adolescents with mental diseases experience distress, anxiety and depression, as well as economic strain, all of which contribute to physical and psychological caregiver morbidity. The aim of this study was to assess the effectiveness of intervention to improve the caregiving experience of the parents of mentally ill adolescents. The parents of 20 patients were assessed with the Experience of Caregiving Inventory (ECI) and the Working Alliance Inventory (WAI), while patients’ functioning and psychopathology were evaluated with the Global Assessment of Functioning (GAF) scale and the Child Behavior Check List (CBCL), respectively. Assessments were conducted over 9 months, comparing the experimental group receiving the intervention with a control group that received “standard” care. While there were no significant differences in the patients’ psychopathologies, the caregivers in the experimental group had better ECI and WAI scores. Intervention focusing on the parents seemed to improve the caregivers’ understanding of the disease’s impact on their lives irrespective of the severity of their children’s condition. This finding may be useful in developing adequate measures for the parents of adolescents with severe mental diseases to help contain their psychological distress.