Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States.

The Project to Learn About Youth-Mental Health (PLAY-MH; 2014-2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%-17.8%) and higher in Ohio (33.3%). PLAY-MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.

Separation Anxiety Assessment Scale-Parent Version: Spanish Validation (SAAS-P: Spanish Validation).

The objective of this research is to validate the Spanish adaptation of the Separation Anxiety Assessment Scale-Parent Version (SAAS-P). We conducted two studies with parents of schoolchildren aged 8-11 years: (1) exploratory factor analysis: 910 parents completed the Spanish version of the SAAS-P; (2) confirmatory factor analysis, reliability, and discriminant validity: 4127 parents completed the SAAS-P and 392 children were interviewed using the ADIS-IV. We identified four factors which explained 51.56% of the variance and these were confirmed by factor analysis. The internal consistency (α = 0.84) and the temporal stability (r = .75) of the four key symptom dimensions were good. The sensitivity of the scale was 90%, and its specificity, 82%. The additional subscales correlated closely with the four key symptom dimensions (r > .70), and predicted 81% and 57% of the cases with high symptom levels of separation anxiety. The results support the validity, reliability and clinical utility of the Spanish adaptation of the SAAS-P.

Assessment of the effect of parental presence in dental operatory on the behavior of children aged 4-7 years.

BACKGROUND: Child presents a unique challenge to accept a dental treatment, and such a challenge gets modified by the presence or the absence of a parent in the operatory. Many dentists have reportedly and controversially used parental separation anxiety as a tool to control behavior of an uncooperative child and also to deliver quality dental treatment in young children. But is the parental separation beneficial for dentist to gain child cooperation? AIMS AND OBJECTIVES: The objective is to evaluate the influence of parental presence or absence in the operating room on child's behavior during dental procedure on children of 4 years and above. MATERIALS AND METHODS: The study was carried out on 30 children of 4-7 years of age group, 16 (4-6 years) preschoolers, and 14 (6-7 years) early schoolers. Two consecutive restorative procedures were carried out. On a first visit, parents were present and on a second visit, separation of parents was done. Behavior rating was done by commonly used Frankel's Behavior Rating Scale. RESULTS: Chi-square test was performed for the statistical analysis. There was no significant difference found in the child's behavior by the presence or absence of parents in the perception of dental treatment in the dental operatory. In contrast to that there was a significant increase in cooperative behavior of some children due to other factors influencing the behavior of the child with a Chi-square value = 35.296, P < 0.001. CONCLUSION: Parents can be excluded from the dental operatory to eliminate many behavior-related problems during the course of treatment.

Identifying children with anxiety disorders using brief versions of the Spence Children's Anxiety Scale for children, parents, and teachers.

Anxiety disorders are among the most prevalent mental health disorders experienced by children and are associated with significant negative outcomes. Only a minority of affected children, however, access professional help, and a failure to identify children with anxiety disorders presents a key barrier to treatment access. Existing child anxiety questionnaire measures are long and time consuming to complete, limiting their potential for widespread use as identification tools in community settings. We developed a brief questionnaire for parents, children, and teachers using items from the Spence Children's Anxiety Scale (SCAS) and evaluated the new measure's psychometric properties, capacity to discriminate between a community (n = 361) and clinic-referred sample (n = 338) of children aged 7-11, and identified optimal cut-off scores for accurate identification of preadolescent children experiencing clinically significant levels of anxiety. The findings provided support for the reliability and validity of 8-item versions of the SCAS, with the brief questionnaire scores displaying comparable internal consistency, agreement among reporters, and convergent/divergent validity to the full-length SCAS scores. The brief SCAS scores also discriminated between the community and clinic-referred samples and identified children in the clinic-referred sample with a moderate-to-good level of accuracy and acceptable sensitivity and specificity. Combining reporters improved sensitivity, but at the expense of specificity, and findings suggested parent report should be prioritized. This new brief questionnaire has potential for use in community settings as a tool to improve identification of children who are experiencing clinically significant levels of anxiety and warrant further assessment and potential support. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Spanish Validation of the Separation Anxiety Assessment Scale.

The aim of this study was to investigate the factorial structure and psychometric properties of the Separation Anxiety Assessment Scale (SAAS) with Spanish schoolchildren. The participants in Study 1 were 1281 children aged 8-11. Exploratory factor analysis identified four factors: worry about calamitous events, fear of abandonment, fear of being alone, and fear of physical illness, which explained 47.77 % of the variance. The participants of Study 2 were 4628 schoolchildren aged 8-11. The four related factors model was validated by confirmatory factor analysis. The internal consistency (α = .84) and temporal stability (r = .77) were good. The convergent validity was evident from the pattern of correlations with the measures of separation anxiety, sensitivity to anxiety and school fears. The sensitivity of the scale was 83 %, and its specificity, 93 %. The complementary subscales predicted the diagnosis of separation anxiety disorder. The results support the reliability, validity and clinical utility of the SAAS.

Assessment of co-morbidity of adult separation anxiety in patients with bipolar disorder.

OBJECTIVE: The aim of this study was to assess the co-morbidity of adult separation anxiety in bipolar patients and evaluate its effects on the course of disorder and functionality. METHOD: A total of 70 patients who have been regularly followed in the Bipolar Disorder Unit were included in the study. The Structured Clinical Interview for DSM-IV - Axis I and Axis II disorders and demographic form were used. Separation anxiety was investigated by the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS) and the Hamilton Anxiety Rating Scale (HAM-A) was filled out by an interviewer. In addition, all patients completed the Bipolar Disorder Functioning Questionnaire (BDFQ), Separation Anxiety Symptom Inventory (SASI) and Adult Separation Anxiety Questionnaire (ASA). RESULTS: The prevalence rate of co-morbid adult separation anxiety disorder (A-SepAD) was 54% (n = 38) in our sample. Age of onset was in adulthood among 36% of patients with a diagnosis of A-SepAD and the others (64%) were childhood-onset. Co-morbidity of personality disorders was more common in bipolar patients with childhood-onset separation anxiety disorder (C-SepAD). The lifetime prevalence of co-morbidity of specific phobias and number of suicide attempts were significantly higher in the group with A-SepAD. Functionality loss due to feeling of stigmatization was higher, and total functionality as measured by the BDFQ was found to be lower in bipolar patients with A-SepAD. CONCLUSION: The results of this study have shown that 54% of bipolar patients had a diagnosis of A-SepAD. A-SepAD seems to increase the number of suicide attempts and have negative effects on functionality. A-SepAD should be assessed in regular interviews of patients with bipolar disorder.

Discussion of difficult assessment cases: psychodynamic perspectives.

I discuss the papers of Kleiger (this issue), Husain (this issue), and Bram (this issue), each of whom described their personality assessment of a very challenging case. Each case illustrates the way in which experienced personality assessors integrate psychoanalytic theory with clinical reasoning, multi-method assessment, and an understanding of the patient-examiner relationship when evaluating patients with serious psychiatric needs. The discussion elaborates particular aspects of each case and integrates the different estuaries through which personality assessors use psychoanalytic theory to develop diagnostic and treatment inferences.

Assessment of anxiety symptoms in school children: a cross-sex and ethnic examination.

We evaluated the cross-sex and -ethnic (Hispanic/Latino, non-Hispanic White) measurement invariance of anxiety symptoms based on the Spence Children's Anxiety Scale (SCAS) as well as SCAS anxiety symptoms' correspondence with scores on the 5-item Screen for Child Anxiety Related Emotional Disorders (SCARED) and teacher ratings of child anxiety. Based on data corresponding to 702 children (M age = 9.65, SD = 0.70; 51.9 % girls; 55 % Hispanic/Latino), findings showed some sex and ethnic variations in SCAS measured anxiety at the item and scale levels. Moreover, SCAS correspondence to the 5-item SCARED was found across ethnicity and sex. SCAS correspondence to teacher ratings was found for non-Hispanic White boys and non-Hispanic White girls, marginally in Hispanic/Latino boys, and poorly in Hispanic/Latino girls.

Developmental trajectories of anxiety and depression in early adolescence.

Adolescence is a period of heightened vulnerability for the onset of internalizing psychopathology. Characterizing developmental patterns of symptom stability, progression, and co-occurrence is important in order to identify adolescents most at risk for persistent problems. We use latent growth curve modeling to characterize developmental trajectories of depressive symptoms and four classes of anxiety symptoms (GAD, physical symptoms, separation anxiety, and social anxiety) across early adolescence, prospective associations of depression and anxiety trajectories with one another, and variation in trajectories by gender. A diverse sample of early adolescents (N = 1,065) was assessed at three time points across a one-year period. All classes of anxiety symptoms declined across the study period and depressive symptoms remained stable. In between-individual analysis, adolescents with high levels of depressive symptoms experienced less decline over time in symptoms of physical, social, and separation anxiety. Consistent associations were observed between depression and anxiety symptom trajectories within-individuals over time, such that adolescents who experienced a higher level of a specific symptom type than would be expected given their overall symptom trajectory were more likely to experience a later deflection from their average trajectory in other symptoms. Within-individual deflections in GAD, physical, and social symptoms predicted later deflections in depressive symptoms, and deflections in depressive symptoms predicted later deflections in GAD and separation anxiety symptoms. Females had higher levels of symptoms than males, but no evidence was found for variation in symptom trajectories or their associations with one another by gender or by age.

Structural vulnerability and problem drinking among Latino migrant day laborers in the San Francisco Bay Area.

Latino migrant day laborers (LMDLs) live under challenging conditions in the San Francisco Bay Area. This study explored day laborer alcohol use guided by a structural vulnerability framework, specifically problem vs. non-problem drinking as perceived by LMDLs and how they cope with or try to avoid problem drinking given their broader environment. The study utilized ethnographic methods including in-depth semi-structured qualitative interviews with 51 LMDLs. Findings revealed the considerable challenge of avoiding problem drinking given socio-environmental factors that influence drinking: impoverished living and working conditions, prolonged separation from home and family, lack of work authorization, consequent distress and negative mood states, and peer pressure to drink. While participants shared strategies to avoid problem drinking, the success of individual-level efforts is limited given the harsh structural environmental factors that define day laborers' daily lives. Discussed are implications for prevention and intervention strategies at the individual, community, national and international levels.

Are attachment dimensions associated with infertility-related stress in couples undergoing their first IVF treatment? A study on the individual and cross-partner effect.

STUDY QUESTION: Are attachment anxiety and avoidance dimensions in female and male partners in couples seeking infertility treatment associated with her and his infertility-related stress? SUMMARY ANSWER: Attachment dimensions are significantly associated with several aspects of infertility stress in couples undergoing IVF treatment. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Attachment dimensions of anxiety and avoidance (where highly anxious individuals fear rejection and are preoccupied with maintaining proximity to their partner and highly avoidant individuals are uncomfortable with intimacy and prefer to maintain distance from their partner) may influence the well being of individuals undergoing IVF/ICSI treatment. This study showed that one partner's attachment dimensions had a direct effect on the infertility-related stress of the other partner. DESIGN: Cross-sectional study of consecutive couples before starting their first IVF/ICSI treatment in 2009-2011 at the ANDROS clinic in Palermo, Italy. PARTICIPANTS AND SETTING: Three hundred and fifty-nine couples undergoing fertility treatments were invited to participate in the research. The final sample comprised 316 females and 316 males who filled out the psychological questionnaires (Experiences in Close Relationships; Fertility Problem Inventory; State scale of State-Trait Anxiety Inventory). The participants included patients who had a primary infertility diagnosis and were about to undergo their first IVF or ICSI treatment. DATA ANALYSIS METHOD: Paired t-tests were used to examine gender differences on the study variables (attachment anxiety, attachment avoidance, infertility stress, state anxiety, etc.). Associations between infertility-related stress and the study variables were explored using hierarchical stepwise multivariate linear regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE: Attachment anxiety and attachment avoidance were significantly associated with global infertility stress in both women (ß = 0.24, P < 0.01 and ß = 0.27, P < 0.01) and men (ß = 0.23, P < 0.01 and ß = 0.37, P < 0.01). Regarding the cross-partner effects, men's infertility stress and relationship concerns were associated with their partners' attachment avoidance (ß = 0.10 P < 0.05 and ß = 0.12, P < 0.05); and the infertility stress of women and the scores for need of parenthood were associated with their partners' attachment anxiety (ß = 0.14 P < 0.05 and ß = 0.16, P < 0.05). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION: The study data are cross sectional, and specifically focus on associations between adult attachment style and infertility stress. Treating the data from couples as independent observations may be a limitation of the analysis. Potential moderators of such relationships (e.g. coping strategies, stress appraisal) are not included in this study. STUDY FUNDING/COMPETING INTEREST(S): This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study.

Gender differences in response to deployment among military healthcare providers in Afghanistan and Iraq.

BACKGROUND: Despite their growing numbers in the United States military, little has been published on healthcare providers (HCP) or female service members from conflicts in Afghanistan and Iraq. The purpose of this secondary analysis of data from the 2005 Department of Defense (DoD) Survey of Health Related Behaviors Among Active Duty Military Personnel was to determine gender differences in reaction to the impact of operational stress in deployed military healthcare providers. METHODS: The unweighted study sample selected for this data analysis included results from female and male active duty military personnel over the age of 18 years (n=16,146) deployed at least once to Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) within the past 3 years (n=1,425), for a final sample consisting of either officer (healthcare officer) or enlisted (healthcare specialist) personnel (n=455) (weighted n=23,440). Indices of psychologic distress and social relations were explored and compared. RESULTS: Enlisted female HCPs were more likely to be African American (42.3%) and single (63.0%) and represented the greater percentage with significant psychologic difficulties, as shown by serious psychologic distress endorsement (11.3%) and positive screen results for depression (32.2%). More harmful drinking patterns (Alcohol Use Disorders Identifications Test [AUDIT] score 8-15) were found in more female HCPs (enlisted 61.8%, officers 76.4%) compared with males (enlisted 41.1%, officers 67.1%). CONCLUSIONS: Female HCPs serving in the current military conflicts are reporting significant psychologic distress that may adversely impact their performance within the military, in theaters of operations, and in their lives at home. Implications for clinical care of female service members and veterans of current wars are addressed.

A qualitative study of incarcerated mothers' perceptions of the impact of separation on their children.

Many incarcerated women are mothers, and their children exhibit various responses to the separation that incarceration commands. This exploratory qualitative study examines incarcerated women's perceptions of the consequences of their illegal activity, confinement, and separation from their children on their offspring. The results indicate that although mothers are concerned about their children, they are typically unable to recognize the negative consequences of their actions on their children and their relationship with their children until beginning intensive treatment. Effective treatment must focus on the woman's personal issues along with their parenting abilities and skills to repair these relationships and promote healthy family functioning.

Assessing separation anxiety in Italian youth: preliminary psychometric properties of the Separation Anxiety Assessment Scale.

This study examined the internal consistency and construct validity of the Separation Anxiety Assessment Scale for Children in a non-clinical Italian sample of 358 children ages 6 to 10 years. Statistically significant differences were examined by sex and age. Two exploratory factor analyses were carried out: (a) on the symptom sub-dimensions which led to three interpretable factors of Fear of Abandonment and of Physical Illness, Fear of Calamitous Events, Fear of Being Alone and (b) on all Separation Anxiety Assessment Scale for Children items, which led to three interpretable factors: Fear of Abandonment and Safety Signals, Fear of Calamitous Events, and Fear of Being Alone and Left Alone. Preliminary findings for validity were described with the Separation Anxiety Symptoms Inventory for Children and the Italian Fear Schedule for Children (convergent validity). Implications regarding the clinical utility of the Separation Anxiety Assessment Scale for Children are discussed.

Inter-generational social mobility following early life stress.

INTRODUCTION. Socio-economic position (SEP) is a powerful source of health inequality. Less is known of early life conditions that may determine the course of adult SEP. We tested if early life stress (ELS) due to a separation from the parents during World War II predicts adult SEP, trajectories of incomes across the entire working career, and inter-generational social mobility. MATERIALS AND METHODS. Participants (n = 10,702) were from the Helsinki Birth Cohort Study 1934-44. Compared to the non-separated, the separated individuals attained a lower SEP in adulthood. The separated whose fathers were manual workers were less likely to be upwardly mobile from paternal occupation category to higher categories of own occupation, education, and incomes. The separated whose fathers had junior and senior clerical occupations were more likely to be downwardly mobile. Comparison of trajectories of incomes across adulthood showed that the difference between the separated and the non-separated grew larger across time, such that among the separated the incomes decreased. CONCLUSIONS. This life-course study shows that severe ELS due to a separation from parents in childhood is associated with socio-economic disadvantage in adult life. Even high initial SEP in childhood may not protect from the negative effects of ELS.

Loneliness of left-behind children: a cross-sectional survey in a sample of rural China.

BACKGROUND: It is reported that about 28.3% of rural children estimated at 58 million were left behind in China when their parents migrated to cities to find work. These children may encounter critical situations of psychological well-being. We conducted a cross-sectional study to explore whether left-behind children are lonelier than the non-left-behind and to highlight subpopulations that are particular at risk. METHODS: We conducted a community-based cross-sectional study on a representative sample in rural China. Semi-structured questionnaires were applied to 324 left-behind and 282 non-left-behind children. Logistic regression analysis was used to find out risk factors associated with loneliness. RESULTS: We found that whether children were left behind or not influenced their likelihood of being lonely. Compared with non-left-behind children, the left-behind were 2.5 times (95% CI 1.7, 3.5) more likely to suffer from loneliness and 6.4 times (95% CI 4.2, 9.7) more likely to be very lonely. Left-behind children who were brought up by grandparents, or having poor economic status, bad relationship and low frequency of communication with parents were prone to encounter more as well as more severe loneliness. In particular, children who had a bad relationship with parents were at highest risk for severe loneliness (OR 14.5; 95% CI 2.1, 99.5). CONCLUSIONS: Left-behind children are at significant risk for loneliness. More specific investigations targeted towards the psychological well-being of these children are needed to identify the underlying preventable risk factors.

Maternal daily diary report in the assessment of childhood separation anxiety.

The current study evaluated the feasibility and validity of a parent-report measure of separation anxiety, the Separation Anxiety Daily Diary (SADD). Mother and child participants consisted of three groups: 96 children (aged 4-15 years) with separation anxiety disorder, 49 children with "other" anxiety disorders, and 43 healthy controls. The SADD assesses the frequency of anxiety-provoking and non-anxiety-provoking separations, along with associated parental anxiety, thoughts, child behaviors, and corresponding parental reactions. The SADD demonstrated acceptable compliance and convergent validity with hypothesized measures. Substantial improvement in the prediction of diagnostic group membership was shown when SADD items assessing child symptoms were added to information gathered from a separation anxiety symptom questionnaire.

Health-related quality of life of "left-behind children": a cross-sectional survey in rural China.

PURPOSE: To estimate the prevalence of children in rural China without constant parental guardians (i.e., "left-behind"), to examine whether left-behind children were associated with lower health-related quality of life (HRQOL) than their counterparts ("non-left-behind"). METHODS: A stratified two-stage cluster survey was conducted among 640 children aged between 8 and 14 in a county of Shandong province. HRQOL was assessed in 606 participants using the Pediatric Quality of Life Inventory (PedsQL). RESULTS: The estimated prevalence of left-behind children in the area was estimated at 53.5% (324/606). The mean PedsQL total scores were lower in the left-behind children than the non-left-behind (84.1 vs. 88.4; P < 0.01), as were psychosocial summary, emotional functioning, social functioning and school performance scores, while mean physical subscale scores did not differ significantly (85.4 vs. 86.2; P = 0.31). As age, education level and economic status increased, HRQOL of the children was significantly improved. CONCLUSIONS: Left-behind children report poorer HRQOL than non-left-behind children due to psychosocial dysfunction. An assessment of such problems is essential to estimate the need of rural children, for the identification of those at particular risk for lower quality of life, and for planning and implementation of appropriate health interventions.

The Picture Anxiety Test (PAT): a new pictorial assessment of anxiety symptoms in young children.

This study examines the psychometric properties of a newly developed pictorial anxiety assessment, the Picture Anxiety Test (PAT), designed for young children. A sample of 71 5-7-year-old children (clinically anxious and healthy controls) participated in an assessment comparing the PAT to other, established anxiety measures. Children's ratings were also compared to parent ratings of internalizing and externalizing problems. The PAT demonstrated favorable psychometric properties in this sample, including moderate to high internal consistency, high convergent validity with related constructs, and high discriminant validity between diagnostic groups and across pre- and post-treatment. Initial findings suggest that the PAT is a psychometrically sound instrument for assessing child anxiety and avoidance in young children and a valuable addition to existing diagnostic instruments for clinicians working with anxious children.

The Brief Child and Family Phone Interview (BCFPI): 1. Rationale, development, and description of a computerized children's mental health intake and outcome assessment tool.

BACKGROUND: This study describes the development of the Brief Child and Family Phone Interview (BCFPI) - a computer-assisted telephone interview which adapts the revised Ontario Child Health Study's (OCHS-R) parent, teacher, and youth self-report scales for administration as intake screening and treatment outcome measures in children's mental health services. It focuses on the factor structure of the BCFPI's hypothesized parent-reported child mental health scales describing attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and major depression (MDD). METHODS: Data for the analysis come from an OCHS-R measurement study that included two groups of children and adolescents selected from the same urban area: a general population sample (n = 1,712) and a clinic-referred sample (n = 1,512); and a third sample that was enlisted in a province-wide implementation study of clinic-referred 6- to 18-year-olds (n = 56,825). We used confirmatory factor analysis to assess the factor structure of the BCFPI scales in different populations and to test measurement equivalence across selected groups. RESULTS: Despite the strong constraints imposed on the measurement models, estimates of model fit across the three samples were comparable in magnitude and approached the cut-offs suggested for the GFI and CFI (>.9) and RMSEA (<.05). Measurement equivalence was demonstrated between the OCHS-R clinic and provincial implementation samples. Within the implementation sample, the factor structure of the BCFPI scales was equivalent for boys versus girls and for 6- to 12- versus 13- to 18-year-olds. A companion paper examines the test-retest reliability, sensitivity, specificity, and validity of these BCFPI scales when used for screening. CONCLUSION: This project supports the feasibility and acceptability of a computer-assisted telephone interview for assessing emotional-behavioral problems of children and adolescents referred to children's mental health services.