Mediation of Childhood Adversity and Health by Relationship Quality in Diverse Couples

Individuals with economic disadvantage experience greater (a) adverse childhood experiences (ACE), (b) risk for low relationship quality and relationship dissolution, and (c) disparity in physical and mental health. Thus, a critical need exists to understand the connections between areas of disparity in family and relational health on physical and mental health for those most vulnerable to the deleterious effects. The researchers therefore tested a dyadic model for the mediation of ACE and health by relationship quality with data from 503 couples with economic disadvantage and a racial or ethnic minority background (76.9%). The data fit the proposed model and explained a majority of the variance in health, 82.3% of the variance in menʼs health and 56.5% in womenʼs health—both large effects. Moreover, the significant indirect pathway between ACE and health through relationship quality contributed 98.05% and 57.40% of the total effects for men and women, respectively. Overall, a significant relationship existed between ACE, relationship quality, and health for men and women at the actor-level and the dyadic influence between members of a couple contributed to the overall model fit. Results add to support for the role of relationship quality as a dyadic social determinant of health disparities with implications for prevention and intervention.     

A Model‐Based Cluster Analysis of Maternal Emotion Regulation and Relations to Parenting Behavior

In a diverse community sample of mothers (N = 108) and their preschool‐aged children (M_age = 3.50 years), this study conducted person‐oriented analyses of maternal emotion regulation (ER) based on a multimethod assessment incorporating physiological, observational, and self‐report indicators. A model‐based cluster analysis was applied to five indicators of maternal ER: maternal self‐report, observed negative affect in a parent–child interaction, baseline respiratory sinus arrhythmia (RSA), and RSA suppression across two laboratory tasks. Model‐based cluster analyses revealed four maternal ER profiles, including a group of mothers with average ER functioning, characterized by socioeconomic advantage and more positive parenting behavior. A dysregulated cluster demonstrated the greatest challenges with parenting and dyadic interactions. Two clusters of intermediate dysregulation were also identified. Implications for assessment and applications to parenting interventions are discussed.     

Predictors of Engagement in Family Mediation and Outcomes for Families that Fail to Engage

An important limitation to the effectiveness of family mediation in assisting separated parents is parents failing to engage in the mediation process. In 524 parents who presented to a telephone‐based mediation service, 113 (22%) initiating parents withdrew from mediation before the other parent was invited to participate, 241 (46%) initiating parents had respondent parents who declined to participate in mediation, and 170 cases (33%) completed mediation. We tested whether socio‐demographic variables, psychological distress, coparental acrimony, parenting problems, or children's behavioral difficulties predicted mediation engagement. High interparental acrimony predicted failure to engage in mediation, but none of the other variables predicted mediation engagement. We followed a sample of 131 families that did not mediate and found they showed elevated psychological distress, acrimony, parenting problems and child adjustment difficulties, which remained unchanged 6 months later. Further research is needed to explore strategies to enhance respondent parent engagement with mediation, and to address the negative outcomes for those separated families not proceeding with mediation.     

Counselor–Advocate–Scholar Model: Changing the Dominant Discourse in Counseling

Discourse represents the languages, ideas, and images that together shape one's understanding of the world. In counseling, discourse determines clinical practice. The authors posit that dominant discourse in counseling promotes an intrapsychic status quo that discounts the relationship between individuals and their environment, which often leads to office‐bound interventions that are inadequate in addressing issues of oppression. The counselor–advocate–scholar model (Ratts & Pedersen, 2014 ) is introduced to expand current discourse to include advocacy and research to better address systems of oppression. El discurso representa los idiomas, ideas e imágenes que, en su conjunto, dan forma a nuestra comprensión del mundo. En la consejería, el discurso determina la práctica clínica. Los autores proponen que el discurso dominante en la consejería promueve un status quo intrapsíquico que no tiene en cuenta la relación entre los individuos y su medio, lo que con frecuencia lleva a intervenciones limitadas a la oficina que no resuelven de forma adecuada los problemas relacionados con la opresión. Se introduce el modelo consejero‐defensor‐investigador (Ratts & Pedersen, 2014 ) para expandir el discurso actual de forma que incluya la defensoría e investigación, y así abordar mejor los sistemas de opresión.     

DOES FATHERS' PRENATAL MENTAL HEALTH BEAR A RELATIONSHIP TO PARENTING STRESS AT 6 MONTHS?

This study aimed to explore fathers’ mental health and retrospectively reported adverse childhood experiences during pregnancy, as well as various pathways predicting self‐reported stress at 6 months’ postpartum as assessed by the Parenting Stress Index (PSI; R.R. Abidin, 1990 ). A total of 835 fathers contributed data to the study. Data collection comprised five time points during pregnancy and one at 6 months’ postpartum. The main analyses were performed using linear regression and path analyses. First, linear regression analyses showed that paternal anxiety symptoms during pregnancy predicted stress scores in the PSI child domain at 6 months (coefficient = 0.36). Second, path analyses showed that depressive symptoms during pregnancy predicted parenting stress in the child domain, mediated by spousal disharmony at 6 months’ postpartum (coefficient = 0.77). Third, adverse childhood experiences scores predicted parenting stress in the child domain by two different pathways: one mediated by anxiety symptoms in pregnancy (coefficient = 0.29) and the other by depressive symptoms in pregnancy and experienced spousal disharmony at 6 months’ postpartum (coefficient = 0.77). The findings suggest that fathers’ symptoms of anxiety and depression during pregnancy as well as adverse childhood experiences predict paternal stress and a negative perception of their children's behavior at 6 months’ postpartum.     

La « préparation magistrale » en droit français : un lot exclusif par patient ?

Outpatient pharmaceutical needs are not always met by industrial products and do not necessarily justify hospitals activation. Preparing in advance and storing a batch of compounded drugs for one or more patients with identical/recurrent needs – as part of compound outsourcing in ambulatory sector – raises issues. While the french law does not expressly provide (and according to prevailing interpretations excludes) this hypothesis, it seems to us to be possible – in contrast to the prominent french judicial and administrative courts, as well as to the European Court of justice. We here propose to reset the debate within both the existing laws and a systemic perspective, and call for a normative clarification.     

Heteronormative Relationship Education for Same‐Gender Couples

In recent years, same‐gender group‐based relationship education has emerged as a viable intervention to prevent relationship distress among same‐gender couples. However, many of these programs are conducted in metropolitan areas and lack the ability to reach rural populations. The current study sought to investigate whether two wide‐reaching web‐based heteronormative relationship education programs could positively impact same‐gender relationships. In a sample of 49 same‐gender couples, heteronormative relationship education had small (Cohen's d = 0.16–0.39) but reliably positive effects on key areas of relationship functioning and perceived stress relative to a waitlist control group. Additionally, when same‐gender couples were matched with different‐gender individuals with similar baseline characteristics, no reliable differences between the two groups emerged even though the program effects were sometimes half as large for same‐gender couples. Finally, same‐gender participants were as satisfied with the program as the matched different‐gender individuals. Though the results of the present study indicate that heteronormative relationship education can be helpful for same‐gender couples, additional tailoring should be undertaken to ensure that same‐gender couples experience as much benefit as possible. Estimates from the current study could be used in future studies to detect what might be small‐sized differences.