Resilience and Positive Wellbeing Experienced by 5-12-Year-Old Children with Refugee Backgrounds in Australia: The Childhood Resilience Study.

Refugee research tends to be deficit based and focused on the risks threatening positive adaptation and wellbeing. High rates of mental (and physical) health issues have been reported for refugee adults and children, including intergenerational trauma. This study uses the new Child Resilience Questionnaire (CRQ), co-designed with refugee background communities, to describe resilience and positive wellbeing experienced by children of refugee-background. The Childhood Resilience Study (CRS) recruited 1132 families with children aged 5-12 years in Victoria and South Australia, Australia. This included the recruitment of 109 families from 4 refugee background communities: Assyrian Chaldean (Iraq, Syria), Hazara (Afghanistan), Karen (Burma, Thailand) and Sierra Leonean families. CRQ-parent/caregiver report (CRQ-P/C) scores were categorised into 'low', 'moderate' and 'high'. The child's emotional and behavioural wellbeing was assessed with the Strengths and Difficulties Questionnaire, with positive wellbeing defined as <17 on the total difficulties score. Tobit regression models adjusted for a child's age. The CRQ-P/C scores were not different for boys and girls of refugee background. Children of refugee-background (n = 109) had higher average CRQ-P/C scores than other CRS children (n = 1023) in the personal, school and community domains, but were lower in the family domain. Most children with 'high' resilience scores had positive wellbeing for both children of refugee-background (94.6%) and other CRS children (96.5%). Contrary to common stereotypes, children of refugee-background show specific individual, family, school and cultural strengths that can help them navigate cumulative and complex risks to sustain or develop their positive wellbeing. A better understanding as to how to build strengths at personal, family, peer, school and community levels where children are vulnerable is an important next step. Working in close collaboration with refugee communities, schools, policy makers and key service providers will ensure the optimal translation of these findings into sustainable practice and impactful public policy.

Patterns of intimate partner violence exposure across the first 10 years of life and children's emotional-behavioural outcomes at 10 years.

BACKGROUND: Childhood exposure to intimate partner violence (IPV) is associated with emotional-behavioural problems. However, little is known about children's emotional-behavioural outcomes following exposure to different long-term patterns of IPV. OBJECTIVE: The current study aimed to investigate the emotional-behavioural functioning of children at 10 years of age following exposure to different patterns of IPV across the first 10 years of life. PARTICIPANTS AND SETTING: Data for this study was drawn from the Mothers' and Young People's Study- a longitudinal study of 1507 first time mothers and their first born child. METHODS: Women were recruited during pregnancy from six public hospitals in Victoria, Australia. Data was collected during pregnancy, and at one, four and ten years postpartum. Four patterns of IPV exposure were previously identified: (a) minimal IPV exposure; (b) early IPV; (c) Increasing IPV; and (d) persistent IPV. Logistic regression was used to assess associations between IPV exposure and emotional-behavioural outcomes. RESULTS: Exposure to early, increasing, or persistent IPV was associated with increased odds of experiencing emotional-behavioural difficulties (OR 2.15-2.97). Children exposed to a persistent pattern of IPV experienced over 6 times the odds of conduct problems (OR = 6.15 CI = 2.3-16.44). CONCLUSIONS: Children exposed to early, increasing, or persistent IPV experienced increased odds of emotional-behavioural problems at age 10, regardless of the duration or type of violence they were exposed to. However, children exposed to persistent IPV across childhood appeared to experience the highest odds of emotional-behavioural difficulties.

The Childhood Resilience Study: Resilience and emotional and behavioural wellbeing experienced by Australian Aboriginal and Torres Strait Islander boys and girls aged 5-9 years.

BACKGROUND: Resilience is a process of drawing on internal or external strengths to regain, sustain or improve adaptive outcomes despite adversity. Using a child resilience measure co-designed with Aboriginal and Torres Strait Islander communities, we investigate: 1) children's personal, family, school and community strengths; 2) gender differences; and 3) associations between resilience and wellbeing. METHODS: 1132 parent/caregivers of children aged 5-12 years were recruited to the Childhood Resilience Study, including through the Aboriginal Families Study. The Aboriginal Families Study is a population-based cohort of 344 mothers of an Aboriginal and/or Torres Strait Islander child. This paper focuses on the wave 2 survey data on child resilience at age 5-9 years (n = 231). Resilience was assessed with the Child Resilience Questionnaire-parent/caregiver report (CRQ-P/C), categorised into tertiles of low, moderate and high scores. Child emotional/behavioural wellbeing and mental health competence was assessed with the parent-report Strengths and Difficulties Questionnaire. All Tobit regression models adjusted for child age. OUTCOMES: Aboriginal and Torres Strait Islander girls had higher resilience scores compared to boys (Adj.ß = 0·9, 95%CI 0·9-1·4), with higher School Engagement, Friends and Connectedness to language scale scores. Resilience scores were strongly associated with wellbeing and high mental health competence. A higher proportion of girls with low resilience scores had positive wellbeing than did boys (73.3% versus 49.0%). High resilience scores were associated with lower SDQ total difficulties score after adjusting for child age, gender, maternal age and education and family location (major city, regional, remote) (Adj.ß = -3.4, 95%CI -5.1, -1.7). Compared to the Childhood Resilience Study sample, Aboriginal Families Study children had higher mean CRQ-P/C scores in the personal and family domains. INTERPRETATION: High family strengths can support Aboriginal and Torres Strait Islander children at both an individual and cultural level. Boys may benefit from added scaffolding by schools, family and communities to support their social and academic connectedness.

Experiences of physical and emotional intimate partner violence during the COVID-19 pandemic: a comparison of prepandemic and pandemic data in a longitudinal study of Australian mothers.

OBJECTIVE: There is a lack of longitudinal population-based research comparing women's experiences of intimate partner violence (IPV) prior to and during the COVID-19 pandemic. Using data from the Mothers' and Young People's Study, the prevalence of physical and emotional IPV in the first year of the pandemic is compared with earlier waves of data. DESIGN: A prospective pregnancy cohort of first-time mothers in Melbourne, Australia was followed up over the first decade of motherhood, with a quick response study conducted during the COVID-19 pandemic. 422 women completed the primary exposure measure (IPV; Composite Abuse Scale) in the 1st, 4th and 10th year postpartum and the additional pandemic survey (June 2020-April 2021). OUTCOME MEASURES: Depressive symptoms; anxiety symptoms; IPV disclosure to a doctor, friends or family, or someone else. RESULTS: Maternal report of emotional IPV alone was higher during the pandemic (14.4%, 95% CI 11.4% to 18.2%) than in the 10th (9.5%, 95% CI 7.0% to 12.7%), 4th (9.2%, 95% CI 6.8% to 12.4%) and 1st year after the birth of their first child (5.9%, 95% CI 4.0% to 8.6%). Conversely, physical IPV was lowest during the pandemic (3.1%, 95% CI 1.8% to 5.0%). Of women experiencing IPV during the pandemic: 29.7% were reporting IPV for the first time, 52.7% reported concurrent depressive symptoms and just 6.8% had told their doctor. CONCLUSIONS: Findings suggest that the spike in IPV-related crime statistics following the onset of the pandemic (typically incidents of physical violence) is the tip of the iceberg for women's IPV experiences. There is a need to increase the capacity of health practitioners to recognise emotional as well as physical IPV, and IPV ought to be considered where women present with mental health problems.

Understanding cannabis use and mental health difficulties in context with women's experiences of stressful events and social health issues in pregnancy: The Aboriginal Families Study.

BACKGROUND: Few population-based data sources fully recognise the intersections between stressful events, social health issues, and cannabis use in pregnancy, and little is known about sequelae for women's mental health. METHODS: We draw on two waves of population-based data for 344 families participating in the Aboriginal Families Study longitudinal cohort. We examine women's mental health in the first year postpartum and when children were aged 5-9 years in context with life experiences and use of cannabis in pregnancy. OUTCOMES: One in five women (19·5%) used cannabis during pregnancy (with or without co-use of tobacco). Within this group of women, 88·3% experienced 3 or more (3+) stressful events or social health issues. Psychological distress (Kessler-5 scale, K-5) in the year postpartum was substantially higher amongst women who had used cannabis or experienced 3+ stressful events or social health issues. High proportions of women met criteria for support and referral for depression and/or anxiety (52·5% of women who had used cannabis compared to 20·9% amongst women who had neither used cannabis nor tobacco; 43·2% of women who had experienced 3+ stressful events or social health issues compared to 15·6% amongst women who had not indicated these experiences). Similar patterns of psychological distress, depressive (9-item adapted Personal Health Questionnaire, aPHQ-9) and anxiety symptoms (7-item Generalised Anxiety Disorder score, GAD-7) were evident when the study children were aged 5-9 years. INTERPRETATION: Amongst women who had used cannabis in pregnancy, a high burden of psychological distress, depression, and anxiety is evident in the postpartum period and as their children turn 5-9 years. The overlay of stressful events and social health issues and the high proportion of women meeting criteria for referral for mental health assessment and support indicate an urgent need to offer women opportunities for safe disclosure of cannabis use and opportunities to access sustained holistic services. Reducing the harms of cannabis use on Aboriginal and Torres Strait Islander families must be coupled with culturally safe ways of addressing the social, historical, and structural determinants of mental health distress and harmful use of substances.

Intimate partner violence exposure during infancy and social functioning in middle childhood: An Australian mother and child cohort study.

Social functioning of children with experiences of intimate partner violence (IPV) between caregivers in early childhood has received less attention than emotional-behavioral outcomes. Drawing on data from 1507 ten-year-old Australian-born children and their mothers participating in a community-based longitudinal study, this study examined the associations between IPV exposure during infancy and social development during middle childhood. IPV during the first 12 months of life was associated with lower social skills, higher peer problems, and peer victimization at age 10 years, while accounting for concurrent IPV. This study provides evidence for the long-term impacts of early-life IPV exposure on children's social functioning, and the importance of prevention and early intervention programs focused on social development following experiences of IPV.

Pre-pandemic adversity and maternal mental health during the COVID-19 pandemic: the mediating role of pandemic stress and family relationships.

BACKGROUND: The COVID-19 pandemic was a time of increased stress for families. Parents with a history of adversity may have been at higher risk of experiencing mental health problems during this time. The current study aims to investigate the relationship between pre-pandemic adversity pandemic related stressors and maternal mental health outcomes during the pandemic. METHODS: Data was drawn from the Mothers' and Young People's Study (MYPS), a longitudinal of first time mothers and their children. Participants were 418 mothers who completed the MYPS COVID-19 sub-study. Data was collected during pregnancy, at 1, 4, 10 years postpartum, and during the COVID-19 pandemic (approximately 14 years postpartum). Path-analysis was used to test the relationship indirect relationship between pre-pandemic adversity and maternal depressive and anxiety symptoms, via family functioning and pandemic related stress. RESULTS: The hypothesised model was a good fit to the data accounting for 34 % and 33 % of the variance in maternal depressive and anxiety scores, respectively. A significant indirect effect was found between pre-pandemic adversity and both maternal anxiety and depressive systems via family relationships during the pandemic and pandemic related stress. LIMITATIONS: MYPS participants who took part in the COVID-19 sub-study were more likely to be older, have a higher level of education, and speak English as a first language, compared to the total MYPS sample. CONCLUSIONS: Family inclusive service responses which aim to strengthen family relationships may be particularly important for families where there is a history of adversity to support parental mental health.

Mothers' experiences of emotional abuse from an intimate partner and its associations with children's developmental outcomes at 5 years.

BACKGROUND: Intimate partner violence (IPV) is associated with an increased risk of poorer child development. Existing research has focused on physical abuse with less known about the associations with emotional IPV. OBJECTIVE: To describe the period prevalence of mother's experiences of emotional IPV during children's preschool years and associations with child mental, physical, social, and cognitive development. METHODS: Secondary analysis of control group data (n = 194) from an Australian randomised trial (right@home), which recruited pregnant women experiencing social adversity from antenatal clinics in 2013-14. Women reported emotional abuse (Composite Abuse Scale) at child ages 3-5 years. Measures of child development at 5 years included: Strengths and Difficulties Questionnaire, Social Skills Improvement System, Pediatric Quality of Life Inventory, Clinical Evaluation of Language Fundamentals, School Entry Alphabetic and Phonological Awareness Readiness Test, NIH executive function subtests, sleep and health. The prevalence of emotional IPV from 3 to 5 years was estimated. Regression models compared developmental outcomes according to emotional IPV exposure, adjusted for child age, child gender, and maternal education. Missing data were accounted for using multiple imputation. RESULTS: From 3-5 years, emotional IPV was experienced by 57% of women. Emotional IPV exposure was consistently associated with poorer child developmental outcomes. Differences were most apparent for SDQ internalising (mean difference 1.2, 95% CI 0.2 to 2.1) and externalising difficulties (1.2, 95% CI -0.1 to 2.4). CONCLUSIONS: Emotional IPV was highly prevalent amongst families experiencing social adversity. Developing acceptable and effective identification processes and interventions that prioritise families experiencing co-occurring social adversities should be a public health priority.

Refugee child health: a systematic review of health conditions in children aged 0-6 years living in high-income countries.

This study describes the extent, quality and cultural appropriateness of current research on the health conditions of refugee children aged 0-6 years settled in high-income countries. A systematic review was conducted, including original articles published on the health conditions experienced by refugee children. A total of 71 papers were included. The studies varied considerably in their research design, population characteristics and health conditions. Studies included information on 37 different health conditions, with the majority non-communicable diseases, in particular growth, malnutrition and bone density. Although the studies identified a wide range of health issues, a coordinated effort to prioritise research on particular health topics was lacking, and health conditions studied do not align with the global burden of disease for this population. Additionally, despite being rated medium-high quality, most studies did not describe measures taken to ensure cultural competency and community involvement in their research. We suggest a coordinated research effort for this cohort, with greater emphasis on community engagement to improve the evidence-base of the health needs of refugee children after settlement.

Patterns of Health and Health Service Use in a Prospective Cohort of Aboriginal and Torres Strait Islander Children Aged 5-9 Years Living in Urban, Regional and Remote Areas of South Australia.

Despite longstanding recognition of disparities in Aboriginal and Torres Strait Islander child health, progress to reduce disparities is slow. To improve the capacity of policy makers to target resources, there is an urgent need for epidemiological studies providing prospective data on child health outcomes. We undertook a prospective population-based study of 344 Aboriginal and Torres Strait Islander children born in South Australia. Mothers and caregivers reported on child health conditions, use of health services and the social and familial context of the children. A total of 238 children with a mean age of 6.5 years participated in wave 2 follow-up. Overall, 62.7% of the children experienced one or more physical health conditions in the 12 months prior to wave 2 follow-up, 27.3% experienced a mental health condition and 24.8% experienced a developmental condition. The 12-month period prevalence of physical, developmental and mental health conditions was similar for children living in urban, regional and remote areas. While most children had had at least one visit with a general practitioner, some children experiencing physical, developmental and mental health conditions appear to be missing out on specialist and allied health care. Greater efforts by governments and policy makers are needed to strengthen outreach, recognition, referral and follow-up.

Mental health trajectories of women experiencing differing patterns of intimate partner violence across the first 10 years of motherhood.

Intimate partner violence is commonly experienced by women and associated with poor mental health outcomes. Evidence regarding the patterns of IPV across time, and the associated long term course of depressive symptoms is lacking. The current study aimed to (a) identify patterns of physical and emotional IPV experienced by women over the 10 years since having their first child, and (b) identify trajectories depressive symptoms across the 10-year period for each pattern of IPV exposure. Data was drawn from the Mothers' and Young People's Study (MYPS), a longitudinal study of 1507 mothers and their first born child. Data was collected during pregnancy and at one, four, and ten years postpartum. Using Latent Class Analysis, four distinct classes of IPV were identified: (1) Minimal IPV, (2) Early IPV exposure, (3) Increasing IPV, and (4) Persistent IPV. Latent growth modelling revealed that all classes characterised by some IPV exposure experienced elevated trajectories of depressive symptoms in comparison to the minimal IPV class. Those experiencing increasing and persistent IPV experienced the most severe course of depressive symptoms.

A Systematic Review of Child Health, Developmental and Educational Outcomes Associated with High Mobility in Indigenous Children from Australia, Canada and New Zealand.

Indigenous families tend to move house more often, especially families with young children. However, little is known about the impact of high mobility on children's well-being and development. The aim of this systematic review was to examine the relationship between residential mobility and children's health, developmental, and educational outcomes for Australian, Canadian, and New Zealand Indigenous children (0-12 years). Four databases were investigated with pre-determined inclusion and exclusion criteria. The search identified 243 articles after independent screening by two authors. Eight studies assessing four child health outcomes were included, six quantitative and two qualitative. Child health outcomes were classified into four broad categories-physical health, social and emotional behavior, learning and development, and developmental risk. The review identified limited evidence; possible links were identified between high mobility and emotional and behavioral difficulties for younger children. One study identified evidence of a linear relationship between the number of houses a child has lived in since birth and developmental risk. Further research is needed to fully understand the impact of high residential mobility for Indigenous children at different developmental stages. Prioritizing the involvement, collaboration, and empowerment of Indigenous communities and leadership is critical for future research.

Physical health and comorbid anxiety and depression across the first year postpartum in Ireland (MAMMI study): A longitudinal population-based study.

INTRODUCTION: Little is known of the associations between physical health issues and mental health issues such as anxiety, depression and comorbid anxiety and depression (CAD) occurring in the perinatal period. METHODS: A longitudinal cohort study with 3009 first-time mothers giving birth in Ireland collected physical and mental health data in pregnancy and at 3, 6, 9 and 12 months postpartum. Mental health was measured using the depression and anxiety subscales of the Depression, Anxiety and Stress Scale. Experience of eight common physical health issues (e.g. severe headaches/migraines, back pain) were assessed in pregnancy, with an additional six assessed at each postpartum data collection point. RESULTS: 2.4 % of women reported depression alone in pregnancy and 4 % reported depression across the first postpartum year. Anxiety alone was reported by 3.0 % of women in pregnancy, and 2 % in the first year postpartum. Prevalence of comorbid anxiety/depression (CAD) was 1.5 % in pregnancy and almost 2 % postpartum. A higher proportion of women reporting, compared to women not reporting, postpartum CAD were younger, not partnered, not in paid employment in pregnancy, have fewer years of education, and had a caesarean birth. Extreme tiredness/exhaustion and back pain were the most common physical health issues in pregnancy and postpartum. Constipation, haemorrhoids, bowel issues, breast issues, infection and pain in the perineum or caesarean wound, pelvic pain and urinary tract infections were highest at three months postpartum and gradually decreased thereafter. Women reporting depression alone or anxiety alone were equivalent in terms of physical health issues. However, women without mental health symptoms reported significantly fewer physical health issues than women reporting depressive or anxiety symptoms alone or CAD at every time point. Women with CAD reported a significantly higher number of health issues than women reporting depression alone or anxiety alone at 9 and 12 months postpartum. CONCLUSION: Reports of mental health symptoms are associated with higher physical health burden demonstrating a need for integrated approaches in mental and physical health care pathways in perinatal services.

Timing of Physical and Emotional Intimate Partner Violence Exposure and Women's Health in an Australian Longitudinal Cohort Study.

Drawing on data from a prospective pregnancy cohort (N = 1,507), this study examines the relationship between exposure to physical and emotional intimate partner violence (IPV) across the first 10 years of motherhood and women's mental and physical health. A measure of IPV (Composite Abuse Scale) was included at 1, 4, and 10 years postpartum. Past year and prior experiences of IPV were associated with mental and physical health issues at 10 years, both for mothers who had experienced combined IPV and emotional IPV alone. Awareness of the health issues associated with different types of IPV can assist in tailoring responses for women who experience IPV.

Visualising Patterns in Women's Experiences of Intimate Partner Violence in the First 10 years of Motherhood.

Intimate partner violence (IPV) can involve patterns of physical, sexual and emotional abuse. Women typically experience physical IPV in combination with emotional IPV, while emotional IPV is often experienced in the absence of other types of IPV. There is very little known about women's experiences of these different types of IPV over time. The primary aim of this paper is to describe patterns in women's individual experiences of physical and/or emotional IPV across the first 10 years of motherhood. Data were drawn from a prospective pregnancy cohort of 1507 first-time mothers in Melbourne, Australia. Emotional, physical, and combined physical and emotional IPV were reported in the first, fourth and tenth year of motherhood using the Composite Abuse Scale. The overall prevalence of each type of IPV remained consistent across the three time-points, with emotional IPV alone being the most prevalent. There was substantial variability in women's experiences of IPV over time and there was no common progression from one type of IPV to another. Women were more likely to report IPV at more than one time-point if they experienced combined physical and emotional IPV, while for women who reported emotional or physical IPV alone this was more likely to be at a single time-point. A number of socio-demographic characteristics in early pregnancy were associated with a higher risk of reporting IPV at all three time-points, including being unemployed (RRR = 3.6; 95% CI: 2.1, 6.2) and being aged 18-24 years (RRR = 3.1; 95% CI: 1.8, 5.4). Knowledge of the variability and persistence of IPV in the first 10 years of motherhood, and factors associated with these experiences, can help tailor effective health and social service responses.

Development of a multidimensional culturally and socially inclusive measure of factors that support resilience: Child Resilience Questionnaire-Child report (CRQ-C)-a community-based participatory research and psychometric testing study in Australia.

OBJECTIVE: Development and testing of a comprehensive and social and culturally inclusive child-report measure of resilience factors supporting positive outcomes in the face of adversity. DESIGN: The measure is based on a socioecological model of resilience and was developed and revised using community-based participatory research methods with Aboriginal and refugee background communities. Pilot testing and validation of the child-report version (Child Resilience Questionnaire-Child report (CRQ- C)) is described in this paper. SETTING: Australia. PARTICIPANTS: Children aged 7-12 years from culturally and socially diverse backgrounds completed the CRQ- C in the pilot (n=387) and validation study (n=775). Families recruited via hospital clinics, Aboriginal and refugee background communities and nested follow-up of participants in an existing cohort study. ANALYSIS: The factor structure and construct validity of CRQ-C scales were assessed using exploratory and confirmatory factor analyses. Preliminary assessment of criterion validity was conducted usinghe Strengths and Difficulties Questionnaire (SDQ). Internal consistency of final scales was assessed using Cronbach's alpha. RESULTS: Conceptually developed CRQ-C was over inclusive of resilience factors and items. Exploratory factor analyses and confirmatory factor analyses supported 10 subscales reflecting personal resilience factors (positive self/future, managing emotions) and connectedness to family, school and culture. Excellent scale reliability (α=0.7-0.9) for all but one scale (Friends, α=0.6). Significant negative correlation between CRQ-C and SDQ total difficulty score supporting criterion validity (rs=-0.317, p<0.001). CONCLUSION: The CRQ-C is a new culturally and socially inclusive self-report measure of resilience factors in childhood, with demonstrated content, construct and scale reliability. Further testing of criterion validity required. Availability of child and parent report CRQ supports broad applications in clinical, research and intervention work. Socially inclusive and culturally appropriate tools are fundamental to create the evidence needed to assess and guide intervention efforts.

Development, acceptability and construct validity of the Aboriginal Women's Experiences of Partner Violence Scale (AEPVS): a co-designed, multiphase study nested within an Australian Aboriginal and Torres Strait Islander birth cohort.

OBJECTIVE: Few studies employ culturally safe approaches to understanding Indigenous women's experiences of intimate partner violence (IPV). The aim of this study was to develop a brief, culturally safe, self-report measure of Aboriginal and Torres Strait Islander women's experiences of different types of IPV. DESIGN: Multistage process to select, adapt and test a modified version of the Australian Composite Abuse Scale using community discussion groups and pretesting. Revised draft measure tested in Wave 2 follow-up of an existing cohort of Aboriginal families. Psychometric testing and revision included assessment of the factor structure, construct validity, scale reliability and acceptability to create the Aboriginal Women's Experiences of Partner Violence Scale (AEPVS). SETTING: South Australia, Australia. PARTICIPANTS: 14 Aboriginal women participated in discussion groups, 58 women participated in pretesting of the draft version of the AEPVS and 216 women participating in the Aboriginal Families Study completed the revised draft version of the adapted measure. RESULTS: The initial version of the AEPVS based on item review and adaptation by the study's Aboriginal Advisory Group comprised 31 items measuring physical, emotional and financial IPV. After feedback from community discussion groups and two rounds of testing, the 18-item AEPVS consists of three subscales representing physical, emotional and financial IPV. All subscales had excellent construct validity and internal consistency. The AEPVS had high acceptability among Aboriginal women participating in the Aboriginal Families Study. CONCLUSIONS: The AEPVS is the first co-designed, multidimensional measure of Aboriginal women's experience of physical, emotional and financial IPV. The measure demonstrated cultural acceptability and construct validity within the setting of an Aboriginal-led, community-based research project. Validation in other settings (eg, primary care) and populations (eg, other Indigenous populations) will need to incorporate processes for community governance and tailoring of research processes to local community contexts.

Patterns of health service utilisation of mothers experiencing mental health problems and intimate partner violence: Ten-year follow-up of an Australian prospective mother and child cohort.

OBJECTIVES: Few studies have investigated health service use of mothers experiencing mental health problems or intimate partner violence (IPV). The aim of this study was to investigate health service utilisation of mothers experiencing mental health problems and intimate partner violence ten years after having a first baby. METHODS: Prospective cohort of 1507 first-time mothers recruited in Melbourne, Australia. Follow-up at ten years incorporated: Center for Epidemiologic Studies Depression Scale, Beck Anxiety Inventory, Posttraumatic Stress Disorder Checklist, Composite Abuse Scale. RESULTS: At ten years postpartum, one in four mothers (26.1%) reported depressive, anxiety or posttraumatic stress symptoms, and almost one in five (19.4%) reported recent IPV. Two-fifths of mothers reporting clinically significant mental health symptoms had experienced recent IPV (Odds Ratio = 5.6, 95% CI 3.9-8.1). Less than half of mothers experiencing mental health problems at ten-year follow-up had discussed their mental health with a general practitioner and around one in three had talked to a mental health professional. Two-thirds of mothers experiencing recent IPV had not disclosed this to a general practitioner or mental health professional. CONCLUSIONS: The findings highlight the extent to which many women deal with IPV and mental health problems without the support that primary health care and mental health care could provide and point to the need for more concerted efforts to strengthen health system responses to these frequently related issues.

Development and validation of a multidimensional, culturally and socially inclusive Child Resilience Questionnaire (parent/caregiver report) to measure factors that support resilience: a community-based participatory research and psychometric testing study in Australia.

OBJECTIVE: Develop a comprehensive socially inclusive measure to assess child resilience factors. DESIGN: A socioecological model of resilience, community-based participatory research methods and two rounds of psychometric testing created the Child Resilience Questionnaire (parent/caregiver report, child report, school report). The parent/caregiver report (CRQ-P/C) is the focus of this paper. SETTING: Australia. PARTICIPANTS: Culturally and socially diverse parents/caregivers of children aged 5-12 years completed the CRQ-P/C in the pilot (n=489) and validation study (n=1114). Recruitment via a large tertiary hospital's outpatient clinics, Aboriginal and refugee background communities (Aboriginal and bicultural researchers networks) and nested follow-up of mothers in a pregnancy cohort and a cohort of Aboriginal families. ANALYSIS: Exploratory and confirmatory factor analyses conducted to assess the structure and construct validity of CRQ-P/C subscales. Cronbach's alpha used to assess internal consistency of subscales. Criterion validity assessed with the Strengths and Difficulties Questionnaire (SDQ) parent report. RESULTS: Conceptually developed CRQ comprised 169 items in 19 subscales across five socioecological domains (self, family, friends, school and community). Two rounds of psychometric revision and community consultations created a CRQ-P/C with 43 items in 11 scales: self (positive self, positive future, managing emotions), family (connectedness, guidance, basic needs), school (teacher support, engagement, friends) and culture (connectedness, language). Excellent scale reliability (α=0.7-0.9), except basic needs scale (α=0.61) (where a highly endorsed item was retained for conceptual integrity). Criterion validity was supported: scales had low to moderate negative correlations with SDQ total difficulty score (Rs= -0.2/-0.5. p<0.001); children with emotion/behavioural difficulties had lower CRQ-P/C scores (ß=-14.5, 95% CI -17.5 to -11.6, adjusted for gender). CONCLUSION: The CRQ-P/C is a new multidomain measure of factors supporting resilience in children. It has good psychometric properties and will have broad applications in clinical, educational and research settings. The tool also adds to the few culturally competent measures relevant to Aboriginal and refugee background communities.

Maternal mental health in the first year postpartum in a large Irish population cohort: the MAMMI study.

PURPOSE: The international perinatal literature focuses on depression in the postpartum period. Prevalence and pathways of depression, anxiety and stress from pregnancy through the first postpartum year are seldom investigated. METHODS: MAMMI is a prospective cohort study of 3009 first-time mothers recruited in pregnancy. Depressive, anxiety and stress symptoms measured using the Depression, Anxiety and Stress Scale (DASS 21) in pregnancy and at 3-, 6-, 9- and/or 12-months postpartum. RESULTS: Prevalence of depressive and stress symptoms was lowest in pregnancy, increasing to 12-months postpartum. Anxiety symptoms remained relatively stable over time. In the first year after having their first baby, one in ten women reported moderate/severe anxiety symptoms (9.5%), 14.2% reported depression symptoms, and one in five stress symptoms (19.2%). Sociodemographic factors associated with increased odds of postpartum depression, anxiety and stress symptoms were younger age and being born in a non-EU country; socioeconomic factors were not living with a partner, not having postgraduate education and being unemployed during pregnancy. Retrospective reporting of poor mental health in the year prior to pregnancy and symptoms during pregnancy were strongly associated with poor postpartum mental health. CONCLUSIONS: The current findings suggest that the current model of 6-week postpartum care in Ireland is insufficient to detect and provide adequate support for women's mental health needs, with long-term implications for women and children.