Interactions of gender inequality and parental discipline predicting child aggression in low- and middle-income countries.

Children in low- and middle-income countries (LMICs) are disproportionately at risk of not meeting their developmental potential. Parental discipline can promote and hinder child outcomes; however, little research examines how discipline interacts with contextual factors to predict child outcomes in LMICs. Using data from 208,156 households with children between 36 and 59 months (50.5% male) across 63 countries, this study examined whether interactions between gender inequality and discipline (shouting, spanking, beating, and verbal reasoning) predicted child aggression. Results showed aggression was higher in countries with high gender inequality, and associations between discipline and child aggression were weaker in countries where gender inequality was higher. Improvements in country-level gender parity, in addition to parenting, will be necessary to promote positive child outcomes in LMICs.

Eight-year trajectories of behavior problems and resilience in children exposed to early-life intimate partner violence: The overlapping and distinct effects of individual factors, maternal characteristics, and early intervention.

Childhood exposure to intimate partner violence (IPV) can have lasting effects on well-being. Children also display resilience following IPV exposure. Yet, little research has prospectively followed changes in both maladaptive and adaptive outcomes in children who experience IPV in early life. The goal of the current study was to investigate how child factors (irritability), trauma history (severity of IPV exposure), maternal factors (mental health, parenting), and early intervention relate to trajectories of behavior problems (internalizing and externalizing problems) and resilience (prosocial behavior, emotion regulation), over 8 years. One hundred twenty mother-child dyads participated in a community-based randomized controlled trial of an intervention for IPV-exposed children and their mothers. Families completed follow-up assessments 6-8 months (N = 71) and 6-8 years (N = 68) later. Although intention-to-treat analyses did not reveal significant intervention effects, per-protocol analyses suggested that participants receiving an effective dose (eight sessions) of the treatment had fewer internalizing problems over time. Child irritability and maternal parenting were associated with both behavior problems and resilience. Maternal mental health was uniquely associated with child behavior problems, whereas maternal positive parenting was uniquely associated with child resilience. Results support the need for a dyadic perspective on child adjustment following IPV exposure.

Culturally grounded strategies for suicide and alcohol risk prevention delivered by rural Alaska Native communities: A dynamic wait-listed design evaluation of the Qungasvik intervention.

We examined the effectiveness of the Qungasvik (Tools for Life) intervention in enhancing protective factors as a universal suicide and alcohol prevention strategy for young people ages 12-18 living in highly affected rural Alaska Native communities. Four communities were assigned to immediate intervention or to a dynamic wait list. Outcomes were analyzed for 239 young people at four time points over two years of community intervention. Outcomes assessed two ultimate variable protective factors buffering suicide and alcohol risk, and three intermediate variable protective factors at the individual, family, and community level. Dose dependent intervention effects were associated with growth in ultimate but not intermediate variables. This evaluation of the Qungasvik intervention provides support for the effectiveness of its Indigenous strategies for suicide and alcohol misuse prevention in this rural Alaska Native setting. Though findings did not provide support for a theory of change where growth in ultimate variables is occasioned through effects on intermediate variables, research designs focused on young people who enter intervention at lower levels of preexisting protection hold promise for better understanding of intervention change processes. The Qungasvik intervention is responsive to an acute public health need for effective rural Alaska Native suicide and alcohol risk prevention strategies.

The prevalence and correlates of running away among adolescents in the United States.

Runaway youth may experience a myriad of challenges associated with significant risks to health and well-being. To examine the prevalence and correlates of running away from home among US youth. Annual US nationally representative samples of 8th and 10th graders between 2005 and 2017 from the Monitoring the Future study. Self-reports of nationally representative samples of 8th and 10th graders in the US Annual survey data from 8th and 10th graders spanning 2005-2017, n = 116,520. The primary outcome of this study, running away from home in the past 12 months, was examined using multivariable weighted logistic regression. Predictor measures included: parent and peer relationships, school factors (e.g., grade point average [GPA]), internalizing symptoms, externalizing behavior, and substance use (alcohol, marijuana, and cigarettes). Demographic measures in the model were grade level (8th or 10th), gender (boys or girls), parent education, and race/ethnicity. The annual prevalence of running away decreased significantly from 8.3% in 2005 to 6.1% in 2017. Demographically, running away from home was significantly lower among boys compared with girls. Multivariable logistic regression model results revealed that higher levels of parental involvement, GPA, and self-esteem are all significantly related to lower odds of running away from home. Having peers who drop out of school, going on more date nights, self-derogation, interpersonal aggression, sensation seeking, theft, and property damage, as well as past 12-month alcohol use, past 12-month marijuana use, and past 30-day cigarette use were all associated with higher odds of running away from home. Annual prevalence of running away from home has been decreasing, but still affects a large number of teens. Running away is associated with numerous challenges across social, behavioral, and health domains that can further negatively impact the health and well-being of this already vulnerable population.

Predictors of Intimate Partner Violence Victimization by Multiple Partners Over a Period of 8 Years.

Intimate partner violence (IPV) is a pervasive social issue with broad physical and mental health implications. Although 35%-56% of women report IPV victimization with more than one violent partner, few studies have identified factors that increase the risk of experiencing IPV across multiple partners (i.e., IPV reengagement). In the current study, multilevel modeling was used to examine the roles of trauma exposure, mental health, and sociodemographic factors in the risk for reengagement in a sample of women (N = 120) with IPV victimization. Participants were drawn from a randomized control trial of an intervention for mothers who had experienced IPV. The results revealed that more psychological but less sexual IPV was associated with increased reengagement. Higher degrees of posttraumatic reexperiencing symptoms were associated with less reengagement. Depressive symptoms were also significantly associated with reengagement such that lower levels of positive affect and increased somatic symptoms were associated with increased reengagement. Higher income levels and less housing instability were associated with more reengagement, ßrange = -.13-.16. Finally, compared to the control condition, participation in the intervention program was significantly associated with lower levels of reengagement at 8-year follow-up, ß = -.75, p = .001. These findings suggest that it is not what happened (i.e., experiences of abuse) but rather a woman's posttraumatic experience (i.e., posttraumatic stress and depressive symptoms) that creates risk for reengagement. The findings support the long-term effectiveness of a brief intervention in reducing reengagement.

Technology-Assisted, Group-Based CBT for Rural Adults' Depression: Open Pilot Trial Results.

Purpose: This pilot study assesses the association of Raising Our Spirits Together (ROST), a technology-assisted, group-based cognitive behavioral therapy for depression, with rural adults' depressive symptoms and anxiety. Method: Nine adults from rural Michigan participated in an open pilot of ROST. Clergy facilitated pilot groups. The pilot began in February 2020 in-person. Due to COVID-19, the pilot was completed virtually. Results: Mean depressive symptom scores, based on the PHQ-9, significantly decreased from pre-treatment (M = 14.4) to post-treatment (M = 6.33; t (8) = 6.79; P < .001). Symptom reduction was maintained at 3-month follow-up (M = 8.00), with a significant pattern of difference in depressive symptoms over time (F(2) = 17.7; P < .001; eta-squared = .689). Similar patterns occurred for anxiety based on the GAD-7. Participants attended an average of 7.33 of 8 sessions. Fidelity ratings were excellent. Discussion: ROST is a potentially feasible intervention for rural adults' depressive symptoms. ROST offers a promising model for increasing treatment access and building capacity in rural areas.

Adverse Childhood Experiences and Spanking Have Similar Associations with Early Behavior Problems.

OBJECTIVES: To examine whether adverse childhood experiences (ACEs) and physical punishment (ie, spanking) are unique risk factors for behavior problems in early childhood, and whether ACEs moderate the associations of spanking with child behavior problems. STUDY DESIGN: We conducted prospective, longitudinal analyses on 2380 families in the Fragile Families and Child Wellbeing Study. Mothers reported outcomes of externalizing and internalizing behavior problems at age 5 years; and the main predictors, ACEs and spanking, at age 3 years. ACEs included 9 items: physical abuse, emotional abuse, physical neglect, emotional neglect, mother's exposure to intimate partner violence, parental mental health problem, parental substance use, parental incarceration, and parental death. Multilevel models examined the associations between ACEs, spanking, and behavior problems, and the moderating effect of ACEs in the associations of spanking with behavior problems. Analyses were adjusted for preexisting behavior problems, demographics, and neighborhood conditions. RESULTS: ACEs (ß = 0.028; P < .001) and spanking (ß = 0.041; P < .001) at 3 years were unique risk factors for increased externalizing behavior problems at 5 years, after controlling for covariates. The magnitude of the associations of ACEs and spanking with externalizing behavior were statistically indistinguishable. ACEs did not moderate the association between spanking and externalizing behavior. CONCLUSIONS: ACEs and spanking have similar associations in predicting child externalizing behavior. Results support calls to consider physical punishment as a form of ACE. Our findings also underscore the importance of assessing exposure to ACEs and physical punishment among young children and providing appropriate intervention to children at risk.

Does community violence exposure moderate the associations between maternal spanking and early child behavior problems?

A robust research literature links parental spanking with negative behavioral outcomes for children, however, it remains unclear whether conditions in the community may moderate the associations between spanking and behavior problems in early childhood. In the current study, we examined whether community violence exposure moderated the associations of maternal spanking with externalizing and internalizing behavior problems of young children. The sample used in this study was urban families and their children ages 3-5 (n = 2,472). We used fixed effects regression models, which yield stronger statistical control for baseline behavior problems, selection bias, and omitted variables bias. Mother's spanking was associated with elevated levels of both externalizing (ß = .037, p < .001) and internalizing (ß = .016, p < .001) behavior problems. Community violence exposure also predicted higher levels of externalizing (ß = .071, p < .01) and internalizing (ß = .043, p < .05) behavior problems. Community violence exposure did not moderate the associations between maternal spanking and behavior problems. Professionals working with families should promote the use of nonphysical disciplinary practices, regardless of the level of violence and crime in the community in which the family resides.

Dyadic Profiles of Posttraumatic Stress Symptoms in Mothers and Children Experiencing Intimate Partner Violence.

Children who witness intimate partner violence (IPV) develop posttraumatic stress disorder at alarmingly high rates. Research suggests that caregivers' symptoms of posttraumatic stress (PTSS) often co-occur alongside children's PTSS, a phenomenon termed "relational posttraumatic stress." The goal of this study is to use dyad-centered analyses to examine heterogeneity in relational PTSS presentations in mother-child dyads, and to determine factors differentiating relational PTSS profiles. Data were drawn from a sample of 231 IPV-exposed, ethno-racially diverse mother-child dyads, with children ranging from ages 4 to 12. The results of a latent profile analysis indicated that a two-profile model was the best fit with the data. Both profiles indicated similar levels of PTSS across the dyad; however, they differed in overall symptom severity. Parenting and IPV severity significantly predicted profile membership; however, age did not. Results suggest that similarities in PTSS presentation should be expected in mother-child dyads, at least in families who experience IPV.

Father Early Engagement Behaviors and Infant Low Birth Weight.

Objective To examine the association of father early engagement behaviors and infant low birth weight (LBW) among unmarried, urban couples. Methods Participants were from the Fragile Families and Child Wellbeing Study, a birth-cohort study of urban families. We conducted cross-sectional analyses of data from interviews with unmarried mothers and fathers (N = 2726) that took place at the time of their child's birth. Early engagement behaviors were based on fathers' self-report of whether during the pregnancy they gave mothers money to buy things for the baby, helped in other ways like providing transportation to prenatal clinics, and attended the birth. Results Most (68.9%) fathers engaged in all three early engagement behaviors; 22% engaged in 2 behaviors; and 9.1% engaged in 1 or 0 early engagement behaviors. LBW more than doubled when comparing infants of fathers who engaged in all three early engagement behaviors (9.6% predicted probability of LBW) to those fathers who engaged in no early engagement behaviors (over 22% predicted probability of LBW). Conclusion Infant and maternal health may benefit from intervention to encourage positive father engagement during pregnancy.

Moms' Empowerment Program participation associated with improved physical health among Latinas experiencing intimate partner violence.

OBJECTIVE: To evaluate whether participation in the Moms' Empowerment Program (MEP), a 10-week, 10-session intervention designed to provide support and increase access to available community resources for women experiencing intimate partner violence (IPV), enhanced the physical health of participants who self-identified as Latina. METHODS: Mothers of children ages 4-12 who self-identified as Latina and had experienced IPV within the past two years were recruited at three intervention sites in Michigan, Ohio, and Texas, via community postings and referrals from agencies serving IPV-exposed families. Selected study participants (n = 93) were assigned to one of two groups: Treatment (immediate enrollment in the MEP) or Control (placement on a waitlist with an invitation to participate in the MEP after the 10-week study period). Data were drawn from two structured interviews, one at the time of recruitment for the study (Time One), and one following the intervention or wait period (Time Two). RESULTS: After controlling for age, educational attainment, and partner residence (living with a violent partner at the time of the interview), multilevel modeling revealed that improvement in physical health over time was significantly greater among women who participated in the intervention relative to controls. CONCLUSIONS: These data suggest that enhancing interpersonal connectedness and access to resources positively affects physical health for Latinas experiencing IPV.

Trajectories of Children's Attitudes and Beliefs About Violence in Families Exposed to Intimate Partner Violence.

Intimate partner violence (IPV) poses serious risks to the health of women. Numerous studies link children's IPV exposure to various forms of developmental psychopathology. One possible explanatory factor appears to be children's beliefs and attitudes about the violence they have witnessed. Little research has investigated how these beliefs may change over time. The sample consisted of 109 mother-child pairs where the mother experienced IPV in the past 2 years. Multilevel modeling was used to examine change in children's attitudes and beliefs over time. Maternal depression and corporal punishment were associated with higher initial levels of maladaptive beliefs about family violence. Children's beliefs about violence improved over time. Findings indicate that while cognitive treatments may offer some utility for intervening with children, providing intervention support for the broader family system (i.e., around maternal depression and use of corporal punishment) may also be important pathways to supporting families exposed to IPV.

Predictors of Parental Use of Corporal Punishment in Ukraine.

Despite a great deal of evidence that corporal punishment is harmful, corporal punishment is still very prevalent worldwide. We examine predictors of different types of corporal punishment among Ukrainian mothers in 12 communities across Ukraine. Findings suggest that maternal spirituality, maternal coping styles, family communication, and some demographic characteristics are predictive of mothers' use of corporal punishment.

Ethno-Racial Differences in Children's Attitudes and Beliefs About Violence.

One in 15 children in the United States are exposed to intimate partner violence (IPV) each year. Although much is known about the adverse effects of witnessing IPV on children, little attention has been given to the impact of IPV on children of diverse ethno-racial backgrounds. In particular, the association between IPV and children's attitudes and beliefs about violence across different ethno-racial populations remains to be explored. One hundred ninety children between the ages of 4 and 12 years of varying ethno-racial backgrounds who had witnessed recent IPV were interviewed regarding their attitudes and beliefs about IPV. Results show that younger children and White, Black, and Biracial children exhibited more deleterious attitudes and beliefs about violence after exposure to IPV than did older and Latina or Latino children. These findings may indicate the need for more tailored intervention programs that target the specific maladaptive beliefs expressed by children of various demographic groups.

An Efficacy Trial of an Intervention Program for Children Exposed to Intimate Partner Violence.

Children exposed to intimate partner violence (IPV) are at high risk for adjustment problems, especially internalizing disorders. Few evidence-based interventions are available to address internalizing behavior problems in this population. An efficacy trial compared outcomes for 4-6 year old children randomly assigned to a program designed to address the effects of exposure to IPV with those allocated to a waitlist comparison condition. Mothers (N = 120) and children from the United States and Canada were assessed at baseline, 5 weeks later (post-intervention) and at 8-month follow-up. The evaluation compared rates of change over time for child internalizing problems. Results were analyzed using both intent-to-treat (ITT) and per-protocol (PP) approaches. ITT analyses indicated the program reduced internalizing problems for girls at follow-up. PP analyses indicated the program reduced internalizing problems for both boys and girls at post-intervention. In this study, child internalizing problems were significantly reduced through an intervention for the mother and the child.

Longitudinal Effects of Electronic Dating Violence on Depressive Symptoms and Delinquent Behaviors Across Adolescence.

Depressive symptoms and delinquent behaviors that emerge during adolescence pose both short- and long-term negative outcomes. Though there is growing evidence that exposure to teen dating violence is also associated with a greater likelihood of depressive symptoms and delinquent behaviors such as engaging in peer violence and substance use, less is known about the effects of specific forms of electronic dating violence (i.e., electronic harassment, electronic coercion, and electronic monitoring) across adolescence on depressive symptoms and delinquent behaviors. Data were drawn from a 4-year prospective longitudinal study of two cohorts of youth followed from age 12 to 15 (n = 526, 52% female) and age 15 to 18 (n = 592, 53% female). Two mixed-effects models (stratified by cohort) were employed to evaluate depressive symptoms and delinquent behavior outcomes by exposure to electronic harassment, electronic coercion, and electronic monitoring, while accounting for verbal dating violence, physical dating violence, sexual dating violence, exposure to threat-based adverse childhood experiences, exposure to deprivation-based adverse childhood experiences, and gender across all four waves of data collection. Higher exposure to electronic sexual coercion was predictive of increased depression (ß = .015, p = .018). Increased exposure to electronic sexual coercion (ß = .007, p = .004) and electronic monitoring (ß = .008, p = .045) were both predictive of more delinquency across adolescence. By delineating the effects of in-person verbal, physical, and sexual dating violence with unique electronic domains, we found unique additional risk from domains of electronic dating violence, which was particularly pronounced for youth who reported electronic sexual coercion. Electronic sexual coercion heightens the risk of depressive symptoms and delinquent behaviors in males and females beyond the risk presented by in-person forms of dating violence and should be accounted for in prevention and intervention programs. Future research should explore the effect of perceived normativity on the prevalence of electronic harassment and subsequent influence on outcomes.

Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial.

OBJECTIVE: Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT). METHODS: This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups. RESULTS: ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ2 = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ2 = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP. CONCLUSION: A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.

Collaborative chronic care models for mental health conditions: cumulative meta-analysis and metaregression to guide future research and implementation.

OBJECTIVE: Prior meta-analysis indicates that collaborative chronic care models (CCMs) improve mental and physical health outcomes for individuals with mental disorders. This study aimed to investigate the stability of evidence over time and identify patient and intervention factors associated with CCM effects to facilitate implementation and sustainability of CCMs in clinical practice. METHODS: We reviewed 53 CCM trials that analyzed depression, mental quality of life (QOL), or physical QOL outcomes. Cumulative meta-analysis and metaregression were supplemented by descriptive investigations across and within trials. RESULTS: Most trials targeted depression in the primary care setting, and cumulative meta-analysis indicated that effect sizes favoring CCM quickly achieved significance for depression outcomes, and more recently achieved significance for mental and physical QOL. Four of 6 CCM elements (patient self-management support, clinical information systems, system redesign, and provider decision support) were common among reviewed trials, whereas 2 elements (health care organization support and linkages to community resources) were rare. No single CCM element was statistically associated with the success of the model. Similarly, metaregression did not identify specific factors associated with CCM effectiveness. Nonetheless, results within individual trials suggest that increased illness severity predicts CCM outcomes. CONCLUSIONS: Significant CCM trials have been derived primarily from 4 original CCM elements. Nonetheless, implementing and sustaining this established model will require health care organization support. Although CCMs have typically been tested as population-based interventions, evidence supports stepped care application to more severely ill individuals. Future priorities include developing implementation strategies to support adoption and sustainability of the model in clinical settings while maximizing fit of this multicomponent framework to local contextual factors.

The association of neighborhood characteristics and domestic violence in Santiago, Chile.

The growing tension between conservative attitudes and liberal policies on gender issues in Chile is reflected by the high rates of domestic violence juxtaposed by a strong governmental policy aimed at preventing this social problem. Attempts to understand factors associated with domestic violence in Chile, and in other countries as well, have not paid much attention to neighborhood-level factors. This manuscript examined the extent to which selected neighborhood characteristics were associated with domestic violence against women. Relying on theories of social disorganization and social stress, this study conceptualized residence in a disadvantaged neighborhood as a source of stress and examined the relationship between detrimental physical and social characteristics of neighborhoods and the chance of women experiencing domestic violence. Results revealed that a higher level of trash in neighborhoods was associated with increased rates of domestic violence above and beyond individual characteristics. Findings also suggested that the relationship between high levels of trash in neighborhoods and domestic violence was greater for women with higher levels of financial stress. Given the potential role of neighborhood environments in reducing domestic violence, a comprehensive approach incorporating both neighborhood- and individual-level factors may be critical in designing effective preventive interventions for domestic violence.