Are virtual services equivalent for mood, anxiety, and bonding? examining a perinatal intensive outpatient program.

PURPOSE: Perinatal Intensive Outpatient Programs (IOPs) address severe perinatal mood and anxiety disorders (PMADs) and mother-infant relationship concerns. Given the impact of PMADs on mothers and infants, rapid transitions to virtual services (telehealth) amid COVID-19, and service expansions to populations in need, it is critical to evaluate how effectively virtual and in-person perinatal IOP services treat PMADs and mother-infant bonding. METHODS: This quality-improvement record review examined patient records (n = 361) for a perinatal IOP from May 2016 to July 2023, amid multiple transitions between in-person and virtual services related to COVID-19, influenza, and respiratory syncytial virus. Patients in the completed measures sample (n = 115) completed depression (EPDS), anxiety (GAD-7, PASS), and mother-infant bonding (PBQ) measures over the first 3 weeks of treatment. Patients also anonymously provided program satisfaction ratings and qualitative feedback. RESULTS: While anxiety and depression symptoms improved similarly across service settings, mother-baby bonding only significantly improved with in-person treatment. Patient symptom outcomes also differed by public/private insurance, race, and number of children. Patients reported high service ratings and overall satisfaction, and available feedback indicates some preference for in-person services. CONCLUSION: As perinatal mental health services and IOPs continue to expand, virtual services can similarly address anxiety and depression symptoms and help to reach in-need populations. However, for perinatal IOPs, the core treatment target of mother-infant bonding may be uniquely addressed via in-person services.

Young Children's Development and Behavior: Associations with Timing of Household Food Insecurity in a Racially and Ethnically Diverse Early Head Start Sample.

OBJECTIVE: The objective of this study was to assess the impact of household food insecurity (HFI) over time on behavioral and developmental health in early childhood while considering the impact of timing/persistence of HFI and potential differences among racially or ethnically minoritized children. METHODS: Families from the Early Head Start Family and Child Experiences Study (N = 760) were followed longitudinally until age 3 years. Caregiver interview data were collected on HFI, problem behaviors (PBs), delays in development (DD), and sociodemographic information. Analysis of Covariances examined differences between persistent vs transient HFI. Multiple regressions examined the impact of HFI on PB and DD and whether this relation was stronger in racially or ethnically minoritized children. RESULTS: The timing of HFI differentially affected PB, such that those with persistent HFI demonstrated greater PB than those with only early or only late HFI. A different pattern was identified for DD, in which those with late HFI had more DD than those with persistent HFI. Over and above other sociodemographics, including maternal risk factors and an income-to-needs ratio, HFI was associated with greater PB for children of all races and ethnicities. HFI was associated with more DD in non-Latino/a/e/x White families compared with non-Latino/a/e/x Black and Latino/a/e/x families. CONCLUSION: Meaningful differences were found in how the persistence/timing of HFI is differentially associated with PB and DD. In addition, while controlling for socioeconomic risk, a cumulative risk effect was not observed in how HFI affected racially or ethnically minoritized children.

Management of Chronic Pain and PTSD in Veterans With tDCS+Prolonged Exposure: A Pilot Study.

INTRODUCTION: Chronic pain and posttraumatic stress disorder (PTSD) are prevalent comorbid conditions, particularly in Veterans; however, there are few integrated treatments for chronic pain and PTSD. Instead, interventions are typically implemented separately and may involve addictive opioids. Although there are highly effective, non-pharmacological treatments for PTSD, they are plagued by high dropout, which may be exacerbated by comorbid pain, as these PTSD treatments typically require increased activity. Importantly, a noninvasive pain treatment, tDCS (transcranial direct current stimulation) shows indications of effectiveness and may be integrated with psychological treatments, even when delivered via telehealth. This study examines the feasibility and initial efficacy of integrating home telehealth tDCS with prolonged exposure (PE), an evidence-based PTSD treatment. MATERIALS AND METHODS: Thirty-nine Veterans were contacted, 31 consented to evaluation, 21 were enrolled, and 16 completed treatment and provided pre- and post-treatment data at one of two Veterans Affairs Medical Centers. Transcranial direct current stimulation sessions corresponded with PE exposure assignments, as there is theoretical reason to believe that tDCS may potentiate extinction learning featured in PE. RESULTS: Patients evinced significant improvement in both pain interference and PTSD symptoms and a trend toward improvement in depression symptoms. However, a significant change in pain intensity was not observed, likely because of the small sample size. DISCUSSION: The findings provide initial support for the feasibility of an entirely home-based, integrated treatment for comorbid PTSD and pain.

Racial Differences in Children's Trauma Symptoms Following Complex Trauma Exposure.

Complex trauma exposure has been defined as multiple or chronic interpersonal trauma that begins early in life, which leads to widespread dysregulation. Previous studies have reported that minorities may be at greater risk for trauma exposure and symptoms; yet, racial differences have not been investigated in the context of complex trauma. The aim of the present study was to determine if there are racial disparities in children's trauma exposure and outcomes among 167 child survivors of complex trauma (3-18 years, M = 9.90, SD = 3.92; 61.67% female; 62.2% Black). Black children endorsed a greater number of trauma types and were more likely to have experienced community violence and have been placed in child protective custody than White children. Caregivers of White children endorsed higher levels of select internalizing symptoms and social concerns whereas Black children reported higher levels of sexual concerns than White children. White children who experience complex trauma may be at higher risk for some trauma-related difficulties. Alternatively, caregivers of White children may perceive them to have, or be more willing to acknowledge, higher levels of symptoms than Black children. Future work is needed to further investigate the role of race in disclosure of trauma exposure and related symptoms.

Parenting stress and children's behavior: Transactional models during Early Head Start.

Parenting stress and children's behavior problems have frequently been linked, with bidirectional relations spanning from early childhood through adolescence. However, this association has not been well studied in infancy or toddlerhood, and prospective mediators have not been thoroughly explored. This prospective, longitudinal study utilized two transactional models to examine bidirectional relations between parenting stress and children's behavior problems and explore perceived family conflict and parental supportiveness as potential mediators. Data were taken from the Early Head Start Family and Child Experiences Study, where 835 parent-child dyads were assessed at 1, 2, and 3 years. Parenting stress and behavior problems were measured at all 3 time points, while family conflict and observed parental supportiveness were measured at ages 2 and 3. Results indicated that parenting stress and children's behavior problems were relatively stable over time and had bidirectional or cross-lagged associations. Family conflict mediated the relation between children's behavior problems at age 1 and parenting stress at age 3, while parental supportiveness mediated the relation between parenting stress at age 1 and behavior problems at age 3, suggesting both "child" and "parent" effects that function through two different mechanisms. These findings suggest that early prevention programs should focus on both children's behavior and parenting stress in the first year and work to reduce family conflict and increase parental supportiveness in order to disrupt this negative cycle. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Children's trauma-related symptoms following complex trauma exposure: Evidence of gender differences.

Complex trauma exposure has been operationalized as multiple or chronic interpersonal traumas that begin early in life and is thought to result in widespread self-regulation difficulties across several domains of functioning. Prior research has demonstrated that there are gender differences in trauma exposure as well as trauma-related symptoms; however, gender discrepancies have not previously been examined in the context of child survivors of complex trauma. The aim of the present study was to determine whether there are gender differences in both caregiver and child-reported trauma exposure and symptoms among 167 children who have experienced complex trauma (3-18 years, M = 9.90, SD = 3.92; 61.67% female). Male children were somewhat more likely to have been exposed to domestic violence, while female children were more likely to have experienced sexual abuse as well as more likely to have been abused by a caregiver. Gender differences were observed for several of the caregiver-reported symptom domains, with female children exhibiting higher levels of depression, dissociation, posttraumatic stress disorder (PTSD) hyperarousal symptoms, and total PTSD symptoms. Female children also self-reported higher levels of sexual concerns, and marginally more re-experiencing and total PTSD symptoms. Secondary analyses utilizing only children who experienced sexual abuse revealed that gender differences largely remained, again with females manifesting higher levels of symptoms. Thus, following complex trauma, female children may be at higher risk for trauma-related difficulties, which has implications for research and clinical interventions.