Family therapy for persons with schizophrenia: neglected yet important.

Since the 1950s, the observed disturbances in family relationships in which a member has been diagnosed as having schizophrenia has led many systemic family therapists to the hypothesis that these family interactions may have preceded the onset of illness and contributed to it. However, attempts at using traditional family therapy with families of patients with schizophrenia were not successful or widely adopted. With the introduction of neuroleptic medication, the treatment of schizophrenia changed dramatically, and patients often returned to their family in varying stages of partial remission, increasing the burden on relatives. Furthermore, research based on the expressed emotion concept demonstrated that the chance of relapse increases by a factor of 2.5 when a patient returns to a high-EE-family in contrast to a low-EE-family environment; consequently, the vulnerability-stress model started to guide treatment development. Based on these developments, since 1980, several psychoeducational family management programs have been evaluated showing a significant reduction in relapse when compared to standard psychiatric care from 49 to 13%. To date, at least 50 RCT studies have been published showing the effectiveness of family interventions in various culturally diverse countries. Therefore, according to the NICE and other guidelines, family intervention should be offered to all families of people with psychosis who live with or are in close contact with the patient, in conjunction with neuroleptic treatment. Despite this strong recommendation, family involvement is under-implemented in mental health care, despite its strong scientific, economic, legal and moral basis. To improve the psychosocial health of patients with psychotic disorders and their relatives, more research is necessary, as well as more training for professionals in effective family interventions.

Interparental Relationship Adjustment, Parenting, and Offspring's Cigarette Smoking at the 10-Year Follow-up.

Familial influences on children's cigarette smoking have been established, yet little is known about whether these influences in childhood relate to offspring's smoking behavior in adolescence. Drawing on prior work showing that children's emotional and behavioral problems (i.e., internalizing and externalizing behavior problems) are influenced by both interparental and parent-child relationships, we examined whether children's emotional and behavioral problems would further predict their smoking behavior in adolescence. Two hundred and twenty-one families were followed from early childhood (Mage  = 4.05 years) to the 10-year follow-up. Interparental relationship adjustment and disagreement, dysfunctional parenting, and children's emotional and behavioral problems were reported by both mothers and fathers. Adolescents' self-reported cigarette smoking status was assessed along with other demographic variables. Using structural equation modeling, the hypothesis was only supported based on mothers' reports, suggesting that early couple relationship adjustment and parenting relate to children's emotional and behavioral problems, which associate with smoking behavior in adolescence. When the hypothesized model was tested with emotional and behavioral problems separately, only behavioral problems were related to adolescent smoking for both parents. Findings from this study support models of family environment and children's behavioral problems, providing evidence of the long-term links with adolescent cigarette smoking behaviors. Further family-focused research and preventive work, for instance, testing the combination of partner support and parent training, are needed.

Se han establecido las influencias familiares en el consumo de cigarrillos de los niños, sin embargo, se sabe poco acerca de si estas influencias en la niñez se relacionan con la conducta de consumo de cigarrillos de los niños en la adolescencia. Teniendo en cuenta trabajos anteriores que demuestran que los problemas conductuales y emocionales de los niños (p. ej.: los problemas de conductas de exteriorización e interiorización) están influenciados tanto por las relaciones interparentales como por las relaciones entre padres e hijos, analizamos si los problemas emocionales y conductuales de los niños predecirían, además, su conducta de consumo de cigarrillos en la adolescencia. Se siguió a doscientas veintiuna familias desde la primera infancia (edad promedio = 4.05 años) hasta el control a los diez años. Tanto las madres como los padres informaron adaptación y desacuerdo en las relaciones interparentales, crianza disfuncional y problemas conductuales y emocionales de los niños. Se evaluó la situación de consumo de cigarrillos autoinformada por los adolescentes junto con otras variables demográficas. Utilizando modelos de ecuaciones estructurales, se respaldó la hipótesis solo sobre la base de los informes de las madres, lo cual sugiere que la adaptación temprana en la relación de pareja y la crianza se relacionan con los problemas emocionales y conductuales de los niños, los cuales se asocian con la conducta de fumar en la adolescencia. Cuando el modelo hipotetizado se probó con problemas conductuales y emocionales por separado, solo los problemas conductuales se relacionaron con el consumo de cigarrillos de los adolescentes para ambos padres. Los hallazgos de este estudio respaldan los modelos de entorno familiar y los problemas conductuales de los niños, ya que ofrecen indicios de los vínculos a largo plazo con las conductas de consumo de cigarrillos en los adolescentes. Se necesitan más investigaciones centradas en la familia y trabajos preventivos, por ejemplo, la evaluación de la combinación de apoyo para padres y de capacitaciones para padres.

Escalation and Regulation of Emotional Arousal in Couples Predicts Relationship Satisfaction Concurrently and 25 Years Later.

Relationship distress and divorce are major risk factors for the development or exacerbation of psychopathology and psychosocial impairments. Given that heightened negative emotions within couples' interactions may portend negative relationship outcomes, it is critical to understand how emotions unfold across a conversation and how partners may influence each other's immediate emotional experiences. This study examined whether these regulatory dynamics within one interaction predicted relationship satisfaction concurrently and 25 years later. Vocally-encoded emotional arousal (f0 ) was measured during couples' (N = 25 couples) conversations about a relationship issue. Across different analytical strategies, results demonstrate that one partner's f0 dynamics had immediate and long-term associations with the other partner's satisfaction. Partners were less satisfied if the other partner (a) expressed higher f0 overall and (b) escalated more in f0 across the conversation. Yet, partners were more satisfied when their f0 escalated across the conversation. Also, women specifically were more satisfied if their f0 remained elevated longer before regulating back to their emotional baseline. Thus, higher f0 was associated with higher satisfaction in the same partner, but associated with less satisfaction in the other partner-particularly when these emotions come from women. It may be that partners have to decide whether to prioritize expressing their emotions fully or limit expression in the service of their partner's happiness. These findings challenge us to think of ways to address this "win-lose" scenario so that couples can balance both partners' emotional needs and preserve relationship quality across the life span.

El distrés relacional y el divorcio son grandes factores de riesgo para el desarrollo o la exacerbación de alteraciones psicopatológicas y psicosociales. Teniendo en cuenta que las emociones negativas intensificadas dentro de las interacciones de las parejas pueden predecir consecuencias negativas en las relaciones, es fundamental comprender cómo se revelan las emociones a lo largo de una conversación y cómo los integrantes de la pareja pueden influenciar las experiencias emocionales inmediatas del otro. Este estudio examinó si esta dinámica reguladora dentro de una interacción predijo la satisfacción con la relación inmediatamente y 25 años después. Se midió la codificación vocal de la excitación emocional (f0 ) durante las conversaciones de las parejas (N = 25 parejas) acerca de un problema en la relación. Entre diferentes estrategias analíticas, los resultados demuestran que la dinámica de la f0 de uno de los integrantes de la pareja tuvo asociaciones inmediatas y a largo plazo con la satisfacción del otro integrante de la pareja. Los integrantes de la pareja se sentían menos satisfechos si el otro integrante de la pareja (a) expresaba una f0 más elevada en general y (b) escalaba más en la f0 durante la conversación. Sin embargo, los integrantes de la pareja estaban más satisfechos cuando su f0 escalaba a lo largo de la conversación. También, las mujeres estaban específicamente más satisfechas si su f0 se mantenía elevada más tiempo antes de regularla para volver a su momento basal emocional. Por lo tanto, una f0 más elevada se asoció con una mayor satisfacción en el mismo integrante de la pareja, pero se asoció con una menor satisfacción en el otro integrante de la pareja, particularmente cuando estas emociones vienen de las mujeres. Es posible que los integrantes de la pareja tengan que decidir si priorizar la expresión completa de sus emociones o limitar la expresión al servicio de la felicidad de su pareja. Estos resultados nos plantean el desafío de pensar en maneras de abordar esta situación en la que "se gana o se pierde", de manera que las parejas puedan equilibrar las necesidades emocionales de ambos integrantes de la pareja y conservar la calidad de la relación durante su tiempo de vida.

[How do Adolescents see their Parents? Prevalences, Predictors and Relationships in Longitudinal and Cross-Section Research]. / Welches Bild haben Jugendliche von ihren Eltern? Prävalenzen, Prädiktoren und Zusammenhänge im Längs- und Querschnitt.

How do Adolescents see their Parents? Prevalences, Predictors and Relationships in Longitudinal and Cross-Section Research The parent-child relationship has a significant influence on the psychological and social development of a young person in adolescence. The parental image from the perspective of the adolescent has rarely been examined. The aim of this study is to examine the parental images of adolescents in terms of family cohesion, conflicts and overprotection for differences between the paternal and the maternal images and between girls and boys. Furthermore, a cross-section examines the relationship between the parental images and psychological disorders, and, in a longitudinal 10-year study, whether the parental images can be predicted through risk factors in childhood. The sample includes 343 young people with an average age of 14 years, 46 % are girls. The parental images were recorded with the "Elternbildfragebogen" (Parental Image Questionnaire; EBF-KJ; Titze u. Lehmkuhl, 2010). Compared to fathers, mothers are assessed more positively in terms of their cohesion, but at the same time they also show more conflictual and higher overprotection behavior. Very few differences were found between girls and boys. There were consistently significant correlations between the parental images and internalizing and externalizing symptomatology, such that cohesion is a protective factor and conflicts and overprotection are risk factors for the development of psychological disorders. Some aspects of the images of the mother and father can be significantly predicted by the parents' education and by psychological disorders in childhood. Future research should examine the influence of possible mediators and moderators.

[Interactions between Partnership Quality, Life Satisfaction and Partnership Stability of Mothers with Underage Children - A Ten-Year Follow-up Study]. / Wechselseitige Einflüsse von Beziehungsqualität, Lebenszufriedenheit und Partnerschaftsstabilität bei Müttern mit minderjährigen Kindern ­ eine Zehn-Jahres-Untersuchung.

BACKGROUND: Although a stable and satisfactory relationship is an important aim in life, every third marriage is currently being divorced. Life satisfaction as well as the transition to parenthood seem to be significant factors. Therefore, the current longitudinal study examines the association between relationship quality, stability, life satisfaction of mothers and other family characteristics over a ten-year period. METHODS: Longitudinal data from N=249 mothers were analyzed in terms of partnership stability, quality, life satisfaction and other variables using regression analyses. RESULTS: Mother's satisfaction with life remained relatively stable over 10 years, while relationship quality decreased significantly over time. Especially the interindividual life satisfaction seemed to be a significant predictor for long-term partnership quality, mental health of mother and child, social status and critical life events. The initial relationship quality also appeared to be a significant predictor for the perceived life satisfaction and mothers' mental health. Only marginal correlations were found between life satisfaction and partnership stability. CONCLUSION: This study shows bidirectional associations between relationship quality and life satisfaction over the course of 10 years. Especially life satisfaction seemed to have an impact on diverse family factors. The findings should be used to develop new or existing prevention and intervention programs for partnership, whereas life satisfaction of the individual should be spotlighted.

[Resilience: A Longitudinal Study of Children with Risk Factors]. / Resilienz: Längsschnittliche Betrachtung von Kindern mit Risikofaktoren.

Resilience: A Longitudinal Study of Children with Risk Factors This study examines the development of children who have grown up with severe early childhood stress. A distinction was made between resilient and maladapted child developments. On the one hand, the aim was to identify longitudinal protective factors that can contribute to the development of resilience. On the other hand, we cross-sectionally examined in which psychological areas resilience manifests itself. The sample consists of 343 children who were examined first in early childhood (M = 4 years) and then ten years later in adolescence. 24 % of the children belonged to the risk group of which 14 % showed a resilient and 9 % a maladapted development. An active temperament, higher intelligence, and more self-control in early childhood proved to be protective factors with medium effect sizes. The proportion of resilience was increased among migrants. Cross-sectionally we found differences with small and medium effect sizes in addictive behavior (alcohol, tobacco and drug use), internet dependency, overweight, and school grades.

When the "U" is not Inverted: Trajectories of Expressed Emotional Arousal Predict Relationship Satisfaction.

Maladaptive emotional reactivity and dysfunctional communication during couple conflict are both destructive to couple functioning, and observational research has elucidated how conflict escalates. However, much of the evidence is based on measures that combine content (i.e., what was said) and the emotion with which it was said, which are then examined using sequential analyses. Despite the general presumptions about underlying emotional reactivity and escalation in negative emotions as part of relationship distress and deterioration, little empirical data are available that directly examine these continuous shifts in emotions. The current study examined concurrent and longitudinal associations between relationship satisfaction and trajectories of change in vocally expressed emotional arousal during couple conflict in 62 couples who participated in a relationship education program. Contrary to expectations and patterns found in distressed couples, trajectories followed a U-shape rather than an inverted U-shape curve, with steeper and more persistent decreases in emotional arousal predicting more stable relationship satisfaction over time. In addition, there were within-couple effects. These results suggest that early signs for relationship deterioration may be less in the form of overt escalation as would be seen in distressed couples. Instead, couples who subsequently deteriorate more are less effective in calming emotional arousal. They also are less able to remain at lower emotional arousal. It is possible that the more pronounced escalation toward the end of the conversation in more at-risk couples is a precursor of the greater escalation patterns seen in distressed couples; this should be examined empirically. Limitations and implications are discussed.

La reactividad emocional desadaptativa y la comunicación disfuncional durante el conflicto de pareja son destructivas para el funcionamiento de la pareja, y la investigación observacional ha dilucidado cómo escala el conflicto. Sin embargo, gran parte de la evidencia está basada en mediciones que combinan el contenido (p. ej.: lo que se dijo) y la emoción con la que se dijo, que luego se analizan usando análisis secuenciales. A pesar de las presunciones generales acerca de la reactividad emocional subyacente y la escalada de las emociones negativas como parte del distrés y el deterioro de la relación, existen pocos datos empíricos que analicen directamente estos cambios continuos en las emociones. El presente estudio analizó las asociaciones simultáneas y longitudinales entre la satisfacción con la relación y las trayectorias de cambio en la agitación emocional expresada vocalmente durante el conflicto de pareja en 62 parejas que participaron en un programa de capacitación en relaciones. Contrariamente a las expectativas y los patrones hallados en las parejas problemáticas, las trayectorias siguieron una forma de U en lugar de una curva con forma de U invertida, con disminuciones más pronunciadas y más constantes de la agitación emocional que predicen una satisfacción más estable con la relación en el transcurso del tiempo. Además, hubo efectos dentro de la pareja. Estos resultados sugieren que las primeras señales de deterioro de la relación pueden ser menores en forma de escalada abierta de lo que se vería en las parejas problemáticas. En cambio, las parejas que posteriormente se deterioran más son menos eficaces a la hora de calmar la agitación emocional. También son menos capaces de permanecer en una agitación emocional más baja. Es posible que la escalada más pronunciada hacia el final de la conversación en las parejas con mayor riesgo sea una precursora de los patrones de mayor escalada observados en las parejas problemáticas; esto debería analizarse empíricamente. Se debaten las limitaciones y las consecuencias.

Addendum to "Four-Year Follow-Up of a Randomized Controlled Trial of Triple P Group for Parent and Child Outcomes".

A previous article published in Prevention Science 3 years ago (Heinrichs et al. 2014) presented the results of a randomized controlled trial of the Triple P group program 4 years (FU4) after administration as a universal prevention approach in preschools. The present addendum resolves inconsistencies in outcome reporting (e.g., total scores of scales versus subscale scores) and provides information on measures that were additionally available to analyze further potential effects of the intervention. Effects in secondary outcome domains not reported in Heinrichs et al. (2014) are furthermore analyzed and reported. The original data analyses were varied using a different statistical model in this addendum. Re-analyses supported the original results, including changes in self-reported maternal and paternal positive parenting, in maternal dysfunctional parenting behavior as well as in maternal reports of child behavior. In addition, when analyzing the externalizing and internalizing dimensions, analysis revealed a statistically significant change in externalizing but not internalizing child symptoms. No significant intervention effects were found for secondary outcome domains. Considering important limitations in the study design [such as baseline differences at pre-assessment with mothers from intervention preschools reporting more child behavioral problems prior to introducing the intervention and predominantly non-significant effects from (a) fathers perspective, (b) teacher ratings at 1-year follow up (FU1), and (c) behavioral observations at FU1], we believe that this trial alone cannot be taken as sufficient evidence for a significant and meaningful change in child behavioral problems, which is the ultimate goal of child prevention programs. Therefore, future studies need to replicate and extend upon these results by including larger sample sizes and overcome the discussed limitations.

Experiences in Disseminating Evidence-Based Prevention Programs in a Real-World Setting.

The primary aim of family-based prevention programs is to promote children's health. Unfortunately, it is difficult to reach families with such evidence-based prevention programs (EBP). Therefore, implementing EBP on a population level could be a promising approach to reach more families, including those faced with socioeconomic challenges who are usually less likely to participate in randomized controlled trials (RCT). Is a population rollout appropriate to reach more and different families than those participating in RCT, especially those representative of the target population? We implemented three EBP in a city in an uncontrolled trial. The effects of this population rollout were tracked on the level of the participating families and on the level of all families living in the city. More than 3480 families (30 % of the population) with children up to 12 years of age participated based on practitioner report. Analyses indicate that a greater percentage of low socioeconomic-status families attended a program compared with a randomly surveyed sample from the city's general population. The sizes of the within-subject effect for parental strategies, child behavior problems, and children's quality of life for a subsample of n = 411 families were similar to those of other uncontrolled EBP studies. The study contributes to highly needed type 2 translation research. The population-based dissemination of EBP could be a promising approach to reach families at risk. However, there are considerable barriers to the implementation process, which currently limit the effectiveness of this rollout in a community.

Four-year follow-up of a randomized controlled trial of triple p group for parent and child outcomes.

Approximately 15-20% of children experience behavioral and/or emotional difficulties. Evidence-based treatment will likely not be sufficient to reduce the prevalence of these difficulties in children and adolescents. Effective prevention programs are therefore also needed to enable families access to support at multiple points across the lifecourse. The aim of the current investigation was to evaluate the 4-year efficacy of the group-based Triple P (Positive Parenting Program) as a prevention program administered universally. Seventeen preschools were randomly assigned to Triple P (n = 11 preschools, 186 families) or a no parenting intervention control group (n = 6 preschools, 94 families). Long-term efficacy was analyzed with hierarchical linear models using maternal and paternal self-report measures. Mothers and fathers from the intervention preschool group reported significant reductions in dysfunctional parenting behavior (d = 0.24 and 0.19, respectively). Mothers also reported a less steep decline from pre- to post-intervention in positive parenting behavior, which was maintained 4 years later (d = 0.38). Fathers from intervention preschools reported a delayed less steep decline in positive parenting during the follow-up (d = 0.33). In addition, mothers from intervention preschools reported immediate improvement in child behavior problems during the program while mothers from control preschools did not report this immediate change. However, with mothers from intervention preschools reporting more child behavior problems at baseline, the effect disappeared by the fourth year (d = 0.19). The results support the long-term efficacy of the Triple P-group program as a universal prevention intervention for changing parenting behavior while there was little evidence for maintenance of change in behavior problems.

Dyadic associations and prediction of maternal and paternal sexual satisfaction in couples-Findings from an 18-year longitudinal study.

Background: : Sexual satisfaction is one of many crucial factors for the long-term success of romantic relationships. Longitudinal studies examining the dyadic associations between maternal and paternal factors in middle adulthood for predicting sexual satisfaction in later adulthood are scarce. Method: The German longitudinal intervention study "Future Family" followed families with at least one child over 18-years (Pre: N = 477, mothers: M = 35.2 years, fathers: M = 38.8 years, children: M = 4.1 years). At the time of the 18-year follow-up, N = 150 mothers (M = 54.1 years) were still living together with the biological fathers (M = 56.1 years; mean relationship duration: 32 years). Dyadic associations between individual and dyadic factors at Pre were analyzed with Actor-Partner Interdependence models to predict sexual satisfaction 18 years later. Results: Higher relationship quality was significantly associated with higher levels of one's own sexual satisfaction 18 years later. Higher levels of maternal and paternal mental health problems were linked to lower levels of sexual satisfaction in both the individual themselves and their partner. General life satisfaction of mothers and fathers only predicted their own sexual satisfaction. The model for dysfunctional parenting yielded no significant effects. Conclusions: The results indicate that relationship quality, mental health problems, and general life satisfaction of both parents could be starting points for preventive and therapeutic interventions to achieve long-term effects in sexual satisfaction in married couples.

Mental health, partnerships, and sexual behavior of German university students after the third wave of the COVID-19 pandemic.

Objective: This study examined the state of mental health, partnerships, and sexual activity of German university students after the third wave of the COVID-19 pandemic. Participants and methods: In June and July 2021, 928 students (23.6 years; 63.5% female) from four universities in Germany participated in an online survey that assessed depressive and anxiety symptoms as well as data on partnerships and sexuality. Results: Of the students, 56.4% were above the cutoff for clinically relevant depressive symptoms and 35.7% were above the cutoff for clinically relevant anxiety symptoms. Female gender, higher academic-related stress, lower financial resources, higher strain due to COVID-19, and more loneliness were associated with more severe symptoms. A quarter of the students each reported an improvement or deterioration in their partnerships. Conclusions: Student mental health appears to be worse compared to pre-pandemic and first wave data. It should be examined whether symptoms decrease when universities reopen.

For better or worse: Associations among psychopathology symptoms, interpersonal emotion dynamics, and gender in couples.

Communication has long been associated with the well-being of a couple's relationship, and it is also important to explore associations with individual well-being. This study examined the associations between emotions communicated within couple interactions and each partner's psychopathology symptoms concurrently and up to 3 years later. Vocally-encoded emotional arousal (f0) was measured during couples' (N = 56) conversations. Analyses examined each partner's trajectories of f0 and how each partner influenced the other's f0 across the conversation. The findings indicated that women experienced higher symptoms if they (a) decreased more steeply in f0 overall and (b) returned to their baseline in f0 more quickly. Moreover, women had higher symptoms if they had a steeper return to baseline because of men's elevated f0. In contrast, men experienced higher symptoms when men (a) more slowly returned to baseline and (b) changed their f0 trajectory because of women's elevated f0. That is, women who expressed less emotional arousal, independently and as a result of the influence of their male partner, experienced more symptoms. In contrast, men's symptoms were differentially associated with their own independent experience of emotional arousal (in which he experienced fewer symptoms when changing arousal more quickly) from how they responded to women's arousal. Given how differently men's and women's psychopathology were associated with emotional expression, these findings raise questions about how partners can communicate to protect their own and their partner's mental health in the short- and long-term. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Early childhood parenting and adolescent bullying behavior: Evidence from a randomized intervention at ten-year follow-up.

RATIONALE: Bullying in education is a significant public health problem with long-run life cycle consequences, but efforts to reduce bullying were met with mixed results. We ask whether improving early childhood parenting can reduce subsequent bullying behavior by the children. METHOD: We analyze ten-year follow-up of a randomized intervention where the parents of preschool children received a training aimed at improving parenting techniques, such as disciplinary strategies. 280 parents in 17 preschools were cluster-randomized at the preschool level (intervention group, cluster = 11, n = 186 vs. control group, cluster = 6, n = 94). Their children were followed ten years later, at ages between 12 and 16, with overall attrition rate of 12.5%. Ordinary least squares is used to estimate the intent-to-treat effects, controlling for the baseline characteristics of the child and the mother. Multiple imputation and inverse probability weighting are used to account for attrition and wild-cluster bootstrap test is used for statistical inference with few clusters. We estimate treatment-on-the-treated effects using two-stage least squares to account for noncompliance in the intervention group. Finally, we examine the associations between bullying and externalizing behavior. RESULTS: Adolescent children are significantly less likely to bully their peers if their parents received the parenting training when their children were in preschools. The effects are stronger for boys and for aggressive forms of bullying such as 'beating' and 'threatening'. Treatment-on-the-treated effects are greater in magnitude and more significant than intent-to-treat effects, suggesting that the effects are driven by program participants. No effect is found for cyberbullying and for victimization. The results were robust to using multiple imputation and inverse probability weighting. We also find suggestive evidence that the effects on bullying are not explained by changes in externalizing behavior. CONCLUSION: We show that improving early childhood parenting can have important public health benefits through reduction in adolescent bullying behavior.

Persistence and course of mental health problems from childhood into adolescence: results of a 10-year longitudinal study.

BACKGROUND: Mental health problems (MHP) in children and adolescents (CA) are common. This longitudinal study analyzed the prevalence, course, and persistence of MHP over 10 years from childhood into adolescence based on a sample from the Future Family project (N = 230). METHODS: At the pre-assessment point the children were on average 5 (SE = 1) and the mothers 35 (SE = 5) years old. Descriptive methods, Chi2-tests, binary logistic regression, and different analytical approaches (number chains, transition probability) were used. RESULTS: Approximately 24% of the CA suffered from borderline clinical or clinically relevant MHP. The largest proportion of the sample was stable healthy (70%), whereas 15% of the CA showed chronic mentally ill, 8% transient, 4% negative and 4% positive courses. The mental health of the mother proved to be a decisive predictor for chronic mentally ill courses. Short-term persistence rates ranged between 60 and 70% from one assessment point to the next one. On the other hand, long-term persistence rates (from childhood into adolescence) were lower (51-59%). CONCLUSION: One in seven children in this sample suffered from chronic MHP, while only one third of the CA in Germany with clinically relevant MHP take advantage of psychological or psychiatric care. Prevention programs should be considered as an effective and economic approach to reduce childhood suffering in Germany.

Cohabitation, Relationship Stability, Relationship Adjustment, and Children's Mental Health Over 10 Years.

Understanding risk factors for relationship dissolution and poor relationship adjustment among couples has been an active area of research in relationship science. One risk factor, non-marital cohabitation, has shown to predict higher rates of relationship dissolution and relationship instability in some samples, but the associations among German parents with children over time are less clear. In this study, we examined the links between non-marital cohabitation and 10-year outcomes (relationship dissolution, relationship adjustment over time, and child internalizing and externalizing symptoms) in 220 German families with preschool-aged children at the initial assessment followed into adolescence. Families were assessed 7 times over the 10 years and retention at the 10-year follow-up was over 92%. After accounting for multiple testing, only mother's report of better initial interparental communication predicted whether parents were likely to stay together over the course of the 10 years. Adolescents of parents who cohabited were at higher risk for externalizing symptoms 10 years later compared to children of married parents. In addition, although there were no differences between cohabiting couples and married couples at the initial assessment in relationship adjustment, cohabiting mothers who stayed with their partner over the 10 years showed significantly greater declines in relationship adjustment over the 10 years compared to married mothers. Findings indicate the need for further research that explores family structure and dynamics over time to inform refinement of prevention programs targeting relationships and children's mental health.

Cognitive mediation of clinical improvement after intensive exposure therapy of agoraphobia and social phobia.

BACKGROUND: The present study investigated cognitive mediation of clinical improvement in patients with agoraphobia (N=427) or social phobia (N=98) receiving high-density exposure therapy in a naturalistic clinical treatment setting. METHODS: Patients were assessed before therapy, 6 weeks after the end of therapy, and 1 year thereafter, using a self-report assessment battery. Lower level mediation analyses provided support for the notion that cognitive changes partially mediate clinical improvement after exposure therapy. RESULTS: Changes in cognitions relating to physical catastrophes mediated treatment outcome only for patients with agoraphobia, whereas changes in cognitions about loss of control mediated outcome for both agoraphobia and social phobia patients. Changes in relationship satisfaction did not mediate symptomatic improvement. CONCLUSIONS: The results extend previous findings by demonstrating mediation in an unselected clinical sample and by providing evidence for the specificity of mediation effects. They further support the importance of cognitive changes in cognitive-behavior therapy.

Fundamental frequency during cognitive preparation and its impact on therapy outcome for panic disorder with Agoraphobia.

BACKGROUND: Cognitive preparation plays a crucial role in CBT with exposure for panic disorder and agoraphobia. High emotional arousal while developing the exposure rationale might impair patients' cognitive capacities for processing information about treatment and impede therapeutic outcome. OBJECTIVE: This study investigates whether patients' vocally encoded emotional arousal, assessed by fundamental frequency (f0), during rationale development is associated with premature treatment dropout, insight into the rationale, and symptom reduction. METHODS: Patients' (N = 197, mean age 36.1 years, 79.2% female) f0 during rationale development was measured based on treatment videos from a randomized controlled trial of CBT for panic disorder and agoraphobia. Insight was rater assessed. Symptom severity was self- and rater assessed at the beginning and end of therapy. RESULTS: Higher f0 mean during rationale development was associated with lower probability of insight and less reduction in avoidance behavior. f0 was not associated with dropout. Insight was associated with lower probability of dropout and partially mediated the association between f0 and avoidance reduction. DISCUSSION: This study highlights the importance of emotional arousal during cognitive preparation for exposure. Therapists should ensure that patients are not too highly aroused while learning about the exposure rationale as an important step in treatment.

A genome-wide association meta-analysis of prognostic outcomes following cognitive behavioural therapy in individuals with anxiety and depressive disorders.

Major depressive disorder and the anxiety disorders are highly prevalent, disabling and moderately heritable. Depression and anxiety are also highly comorbid and have a strong genetic correlation (rg ≈ 1). Cognitive behavioural therapy is a leading evidence-based treatment but has variable outcomes. Currently, there are no strong predictors of outcome. Therapygenetics research aims to identify genetic predictors of prognosis following therapy. We performed genome-wide association meta-analyses of symptoms following cognitive behavioural therapy in adults with anxiety disorders (n = 972), adults with major depressive disorder (n = 832) and children with anxiety disorders (n = 920; meta-analysis n = 2724). We estimated the variance in therapy outcomes that could be explained by common genetic variants (h2SNP) and polygenic scoring was used to examine genetic associations between therapy outcomes and psychopathology, personality and learning. No single nucleotide polymorphisms were strongly associated with treatment outcomes. No significant estimate of h2SNP could be obtained, suggesting the heritability of therapy outcome is smaller than our analysis was powered to detect. Polygenic scoring failed to detect genetic overlap between therapy outcome and psychopathology, personality or learning. This study is the largest therapygenetics study to date. Results are consistent with previous, similarly powered genome-wide association studies of complex traits.

[How well do parents and teachers' reports agree on behaviour problems in pre-school-aged children?]. / Wie gut stimmen Eltern und Erzieherinnen in der Beurteilung von Verhaltensproblemen bei Kindergartenkindern überein?

OBJECTIVES: The purpose of the present study is to examine the extent of parental and teacher agreement on behaviour problems in preschool-aged children. METHOD: Families were recruited from preschools in Braunschweig. In total, N=310 children aged three to six years were evaluated by their mothers and fathers and by their preschool teachers using the Child Behavior Checklist and the Caregiver-Teacher Report for ages 1(1)/(2) to 5. RESULTS: The inter-parental agreement on behaviour problems was high. Parents consistently reported more problem behaviour than did preschool teachers. The median of intra-class correlation between the evaluations by the mothers with those by the fathers was 0.65, and 0.18 (0.17) for parent-teacher dyads. For the agreement between parents with respect to the borderline/clinical range a mean of kappa=0.41 was found, while there was no agreement between parents and teachers. CONCLUSIONS: The results are integrated into the literature, and implications, particularly those for clinical assessment procedures at preschool age, are discussed.