Psychological distress and mental health diagnoses in adults by disability and functional difficulty status: Findings from the 2021 national health interview survey.

BACKGROUND: Evidence suggests that disabled people have worse mental health than non-disabled people, but the degree to which disability contributes to mental health is unclear. OBJECTIVE: This paper uses 2021 National Health Interview Survey (NHIS) data to estimate the association between disability and depression and anxiety diagnoses as well as psychological distress among adults. METHODS: We calculated disability population prevalence and mental health diagnoses and associated symptoms among 28,534 NHIS respondents. Logistic regressions estimated the odds of depression or anxiety diagnoses and recent psychological distress, controlling for disability and mental health diagnoses. We measured disability using binary and continuum measures of functional disability with the Washington Group Short Set on Functioning. RESULTS: Disabled people have significantly greater odds of both depression and anxiety diagnoses compared to non-disabled people. Those with high functional disability have 552 % greater odds of an anxiety diagnosis (95 % CI: 5.61-7.58; p < 0.01) and 697 % greater odds of a depression diagnosis (95 % CI: 6.97-9.12; p < 0.01) compared to those with no functional disability. Similarly, those with any level of functional disability are more likely to have elevated psychological distress in the past 30 days compared to those with no functional disability. CONCLUSIONS: Findings support the idea that mental health is worse for disabled people compared to non-disabled people, with increasing functional disability associated with worse mental health. This suggests that mental health is not being adequately addressed for those with the greatest functional disability. Future work should seek to better understand the systemic causes of disparities.

"I'm dealing with a health care system that doesn't get it": Barriers and facilitators to inclusive healthcare for autistic adults.

LAY ABSTRACT: Research has suggested that autistic adults may have a bigger chance of having mental health and physical health conditions such as depression, anxiety, sleep disorders, diabetes, obesity, and heart problems than adults without autism. Unfortunately, the unique healthcare needs of autistic adults are often overlooked, so it is not clear why autistic adults have worse health or what can be done to improve it. This study wants to find out the challenges autistic adults experience in taking care of their health and in going to different doctors. Researchers interviewed autistic adults across the country about their healthcare experiences. The interviewed autistic adults told the researchers about the barriers (things that did not help) and facilitators (things that did help) that impacted whether they received the care they needed. The researchers then organized what they learned from the autistic adults into a model called the Systems Engineering Initiative for Patient Safety model of work system and patient safety. This model explains how different parts of a healthcare system (person, tasks, technology and tools, environment, and organization) interact with one another and impact the healthcare experiences and outcomes of the patients in their care, like autistic adults. Overall, this study advocates for a systems-level approach to improving the healthcare experiences of autistic adults and their health outcomes.

Positive socialization mechanisms in secure and insecure parent-child dyads: two longitudinal studies.

BACKGROUND: Implications of early attachment have been extensively studied, but little is known about its long-term indirect sequelae, where early security organization moderates future parent-child relationships, serving as a catalyst for adaptive and maladaptive processes. Two longitudinal multi-trait multi-method studies examined whether early security amplified beneficial effects of children's willing, receptive stance toward the parent on socialization outcomes. METHODS: We examined parent-child early attachment organization, assessed in the Strange Situation at 14-15 months, as moderating links between children's willing stance toward parents and socialization outcomes in Study 1 (108 mothers and children, followed to 73 months) and Study 2 (101 mothers, fathers, and children, followed to 80 months). Children's willing stance was observed as committed compliance at 14 and 22 months in Study 1, and as responsiveness to the parent in naturalistic interactions and teaching contexts at 25 and 67 months in Study 2. Socialization outcomes included children's internalization of maternal prohibition, observed at 33, 45, and 56 months, and maternal ratings of children's externalizing problems at 73 months in Study 1, and mothers' and fathers' ratings of children's oppositional defiant disorder and conduct disorder symptoms at 80 months in Study 2. RESULTS: Indirect effects of attachment were replicated across both studies and diverse measures: Attachment security significantly amplified the links between children's willing stance to mothers and all outcomes. Secure children's willing, cooperative stance to mothers predicted future successful socialization outcomes. Insecure children's willing stance conferred no beneficial effects. CONCLUSIONS: Implications of early attachment extend to long-term, indirect developmental sequelae. Security in the first year serves as a catalyst for future positive socialization processes.

Rearing Difficult Children: Parents' Personality and Children's Proneness to Anger as Predictors of Future Parenting.

OBJECTIVE: This multi-method study of 102 mothers, fathers, and children examined children's difficult temperament as a moderator of the links between parental personality and future parenting. METHODS: Parents described themselves on the Big Five traits and Optimism. Children's difficult temperament was observed at 25 and 38 months in paradigms that assessed proneness to anger. Each parent's responsive, affectively positive parenting was observed in lengthy naturalistic interactions at 67 months. RESULTS: Regardless of child temperament, for mothers, low Neuroticism, and for fathers, high Extraversion predicted more positive parenting. For difficult, anger-prone children, mothers' low and high Optimism and fathers' low and high Openness were associated, respectively, with less or more positive parenting. CONCLUSIONS: Challenges due to children's difficult temperaments appear to amplify links between parental personality traits and parenting.

Children's conscience during toddler and preschool years, moral self, and a competent, adaptive developmental trajectory.

We investigated whether children's robust conscience, formed during early family socialization, promotes their future adaptive and competent functioning in expanded ecologies. We assessed two dimensions of conscience in young children (N = 100) at 25, 38, and 52 months in scripted laboratory contexts: internalization of their mothers' and fathers' rules, observed when the child was alone, and empathic concern toward each parent, observed in simulated distress paradigms. We also assessed the child's self-perception on moral dimensions (the moral self), using a puppet interview at 67 months. At 80 months, parents and teachers produced an overall measure of competent, adaptive functioning by rating children on multiple scales of competent, prosocial, rule-abiding behavior and antisocial behavior. As expected, children with histories of a stronger internalization of both parents' rules were more competent and better socialized; for maternal rules, that link was mediated by the child's moral self. The link between the child's history of empathy toward the mother and future socialization was also significant, but it was not mediated by the moral self. This study elucidates the roles of classic components of morality--moral conduct, affect, and self--as antecedents of an adaptive developmental trajectory from toddler to early school age.