RESUMEN
BACKGROUND: The high rate of depression among children of depressed mothers is well known. Suggestions that improvement in maternal acute depression has a positive effect on the child have emerged. However, data on the mechanisms of change have been sparse. The aim was to understand how remission and relapse in the mother might explain the changes in the child's outcome. METHOD: Participants were 76 depressed mothers who entered into a medication clinical trial for depression and 135 of their eligible offspring ages 7-17 years. The mothers and children were assessed at baseline and periodically over 9 months by independent teams to understand the relationship between changes in children's symptoms and functioning and maternal remission or relapse. The main outcome measures were, for mothers, the Hamilton Depression Rating Scale (HAMD), the Social Adjustment Scale (SAS) and the Parental Bonding Instrument (PBI) and, for children, the Children's Depression Inventory (CDI), the Columbia Impairment Scale (CIS), the Multidimensional Anxiety Scale for Children (MASC) and the Children's Global Assessment Scale (CGAS). RESULTS: Maternal remission was associated with a decrease in the child's depressive symptoms. The mother's subsequent relapse was associated with an increase in the child's symptoms over 9 months. The effect of maternal remission on the child's improvement was partially explained by an improvement in the mother's parenting, particularly the change in the mother's ability to listen and talk to her child, but also reflected in her improvement in parental bonding. These findings could not be explained by the child's treatment. CONCLUSIONS: A depressed mother's remission is associated with her improvement in parenting and a decrease in her child's symptoms. Her relapse is associated with an increase in her child's symptoms.
Asunto(s)
Hijo de Padres Discapacitados/psicología , Depresión/psicología , Progresión de la Enfermedad , Relaciones Madre-Hijo/psicología , Responsabilidad Parental/psicología , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Madres , Recurrencia , Inducción de RemisiónRESUMEN
BACKGROUND: Lower and middle income countries (LMICs) are home to >80% of the global population, but mental health researchers and LMIC investigator led publications are concentrated in 10% of LMICs. Increasing research and research outputs, such as in the form of peer reviewed publications, require increased capacity building (CB) opportunities in LMICs. The National Institute of Mental Health (NIMH) initiative, Collaborative Hubs for International Research on Mental Health reaches across five regional 'hubs' established in LMICs, to provide training and support for emerging researchers through hub-specific CB activities. This paper describes the range of CB activities, the process of monitoring, and the early outcomes of CB activities conducted by the five research hubs. METHODS: The indicators used to describe the nature, the monitoring, and the early outcomes of CB activities were developed collectively by the members of an inter-hub CB workgroup representing all five hubs. These indicators included but were not limited to courses, publications, and grants. RESULTS: Results for all indicators demonstrate a wide range of feasible CB activities. The five hubs were successful in providing at least one and the majority several courses; 13 CB recipient-led articles were accepted for publication; and nine grant applications were successful. CONCLUSIONS: The hubs were successful in providing CB recipients with a wide range of CB activities. The challenge remains to ensure ongoing CB of mental health researchers in LMICs, and in particular, to sustain the CB efforts of the five hubs after the termination of NIMH funding.
RESUMEN
OBJECTIVE: The aim of this study was to investigate the association of panic attacks and suicide attempts in a community-based sample of 13-14-year-old adolescents. METHOD: The data are from a survey of 1,580 students in an urban public school system located in the mid-Atlantic region of the United States. Logistic regression methods were used to estimate associations between panic attacks and suicidal ideation and suicide attempts. RESULTS: Controlling for demographic factors, major depression, the use of alcohol, and the use of illicit drugs, the authors found that adolescents with panic attacks were three times more likely to have expressed suicidal ideation and approximately two times more likely to have made suicide attempts than were adolescents without panic attacks. CONCLUSIONS: This new epidemiologic research adds to the evidence of an association between panic attacks and suicide attempts during the middle years of adolescence.
Asunto(s)
Trastorno de Pánico/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adolescente , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Distribución de Chi-Cuadrado , Comorbilidad , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Modelos Logísticos , Masculino , Mid-Atlantic Region/epidemiología , Oportunidad Relativa , Trastorno de Pánico/psicología , Prevalencia , Factores Sexuales , Estudiantes/estadística & datos numéricos , Suicidio/psicología , Intento de Suicidio/psicologíaRESUMEN
OBJECTIVE: To inform child and adolescent psychiatrists about the almost 500,000 children now residing in the American foster care system. This overview surveys the pediatric, developmental, and psychiatric needs of these children. METHOD: Child and adolescent psychiatrists, pediatricians, a child welfare researcher, a social worker, and a psychologist developed a consensus paper from their experience with child welfare and a review of the literature in their respective fields. RESULTS: Being in foster care is a defining experience in these children's lives. They are at risk in myriad ways: for instance, being poor, having chronic health deficits, experiencing the trauma of abuse and neglect, and suffering from a gamut of emotional challenges. Evolutionary developments in foster care such as therapeutic foster homes, kinship care, and changes in Medicaid funding will continue to alter the system. CONCLUSIONS: Foster children are a huge reservoir of unmet pediatric and psychiatric needs; research on them is spotty at best. It is hoped that child and adolescent psychiatrists will meet the challenges these youngsters present and will advocate for them.
Asunto(s)
Servicios de Salud del Niño/organización & administración , Protección a la Infancia/tendencias , Cuidados en el Hogar de Adopción , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Servicios de Salud Mental/organización & administración , Adolescente , Niño , Psiquiatría Infantil/normas , Preescolar , Cuidados en el Hogar de Adopción/tendencias , Humanos , Estados UnidosRESUMEN
While it is known that injection drug users (IDUs) often have their children removed or place them voluntarily, little is known about factors associated with whether IDU parents live with their children. We identified a community sample of 391 IDU parents with at least one child under age 14 (index IDU parents). For these IDU parents, 62% did not have any of their children under age 14 living with them. We assessed whether certain health factors, risk related behaviors, social indicators, and active drug use were related to whether children of IDUs were living with the index IDU parent. IDU parents who were living with their children were overwhelmingly more likely to be female, more likely to have health insurance, and engage in no-risk or low-risk drug practices, as compared to moderate/high-risk practices. Additionally, HIV negative and HIV positive asymptomatic parents were about three times more likely to be living with their children than HIV positive parents with clinical symptoms commonly seen among those suffering from HIV-related illnesses. HIV-related clinical symptoms, rather than HIV status per se, seem to be associated with retention of children.
Asunto(s)
Hijo de Padres Discapacitados , Infecciones por VIH/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Niño , Preescolar , Estudios Transversales , Recolección de Datos , Femenino , Infecciones por VIH/psicología , Humanos , Seguro de Salud , Masculino , Oportunidad Relativa , Padres/psicología , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Abuso de Sustancias por Vía Intravenosa/psicologíaRESUMEN
This article describes the plight of HIV affected children, and the work of mental health professionals with HIV affected children and their families, and presents pertinent research findings on the topics. The concepts of prevention, resilience, and family and child development are applied to the organizing of mental health care for HIV affected children.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/psicología , Hijo de Padres Discapacitados/psicología , Infecciones por VIH/psicología , Rol del Enfermo , Adolescente , Adulto , Niño , Preescolar , Familia/psicología , Femenino , Humanos , Lactante , Recién Nacido , Responsabilidad Parental/psicología , Grupo de Atención al Paciente , Embarazo , Investigación , Ajuste SocialRESUMEN
The child welfare system is, for better or worse, an unavoidable associate of the child and adolescent psychiatrist. Although the child psychiatrist rarely plays an integral role in decision making about the children who are involved with the system, the authors point out that a large percentage of children maintained in and involved with the system have psychiatric and developmental disorders. When these children's difficulties are either minimized or unrecognized by child welfare workers, the interventions and treatment that the children receive may be inappropriate. Worse still, when the children's difficulties are improperly addressed, the vicissitudes of the system may further harm them. The authors propose several ways in which the child and adolescent psychiatrist can have an important reparative role and voice in child welfare systems.
Asunto(s)
Maltrato a los Niños/prevención & control , Protección a la Infancia , Servicios Comunitarios de Salud Mental/organización & administración , Cuidados en el Hogar de Adopción/organización & administración , Adolescente , Niño , Maltrato a los Niños/rehabilitación , Psiquiatría Infantil , Protección a la Infancia/historia , Preescolar , Servicios Comunitarios de Salud Mental/historia , Toma de Decisiones , Cuidados en el Hogar de Adopción/historia , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Estados UnidosRESUMEN
We conducted a randomised clinical trial to test the efficacy of an enhanced version of an intervention previously shown to reduce HIV sexual risk behaviours among men with severe mental illness. One-hundred-and-forty-nine subjects aged 18-59 years were randomly assigned to the experimental or control conditions. Sexual risk behaviours were assessed every three months for 12-months. The primary analysis compared experimental and control groups with respect to sexual risk behaviours with casual partners as measured by the Vaginal Episodes Equivalent (VEE) score. Additional analyses included comparison of VEE scores of those men sexually active in the three months prior to baseline and the proportion of condom-protected sexual acts with casual partners. There were no significant differences in sexual risk behaviours with casual partners between experimental and control subjects. Additional analyses demonstrated a trend toward sexual risk reduction at six months post-intervention (p=0.06) but not at 12 months. These results may reflect a lack of efficacy or a true reduction in risk that the trial was underpowered to detect at the 0.05-level. If there was a true reduction in risk, it was not maintained after the initial six months.
Asunto(s)
Infecciones por VIH/prevención & control , Trastornos Mentales/psicología , Sexo Inseguro/psicología , Adolescente , Adulto , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Humanos , Masculino , Trastornos Mentales/tratamiento farmacológico , Persona de Mediana Edad , Resultado del Tratamiento , Sexo Inseguro/estadística & datos numéricosRESUMEN
We explored the impact of substance dependence on the efficacy of an HIV sexual risk reduction intervention previously shown to be effective among men with severe mental illness by comparing rates of high-risk sexual behaviors among men with (n = 26) and without (n = 31) a lifetime history of substance dependence. We sub-divided subjects by alcohol and drug dependence status, comparing each intervention sub-group to the corresponding control sub-group. At each follow-up interval (six, 12 and 18 months), the intervention group as a whole and the non-substance dependent participants showed a significant reduction in risk; the substance-dependent men showed no difference from controls. These data suggest that among men with severe mental illness, substance dependence may be a further impediment to HIV risk reduction.
Asunto(s)
Infecciones por VIH/prevención & control , Trastornos Mentales/psicología , Trastornos Relacionados con Sustancias/psicología , Sexo Inseguro/prevención & control , Adulto , Estudios de Seguimiento , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Conducta de Reducción del Riesgo , Asunción de RiesgosRESUMEN
The purpose of this investigation was to ascertain the reasons given by mothers diagnosed with AIDS (acquired immunodeficiency syndrome) for disclosing or not disclosing their HIV (human immunodeficiency virus) status to their children, a dilemma faced by most HIV-infected parents and those who counsel them. We interviewed 29 mothers residing in one of two New York City facilities that provide housing and medical treatment for adults with AIDS. The majority of these mothers do not live with their children, but all had recent face-to-face contact with them. The two reasons most frequently considered important for disclosing to children were that disclosure was the "right thing to do" and the need to make arrangements for children's future in case of maternal death or incapacity. The reason most frequently considered important for not disclosing was maternal concern about discussing death and dying with children. These findings have significant implications for counseling of HIV-positive parents.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Madres/psicología , Relaciones Padres-Hijo , Revelación de la Verdad , Adolescente , Adulto , Niño , Protección a la Infancia , Preescolar , Femenino , Humanos , Entrevistas como Asunto , Madres/estadística & datos numéricos , Motivación , Ciudad de Nueva YorkRESUMEN
As the number of HIV-infected women and children in the USA has increased, clinicians and researchers have debated the benefits and risks of disclosure of parental HIV status to children. Disclosure is usually ascertained through interviews of unknown reliability. Given the need to advance knowledge regarding the benefits and risks of disclosure of parental HIV status to children, a reliable and comprehensive disclosure interview is needed. The Parent Disclosure Interview (PDI) was developed for this purpose. In order to study its reliability, 29 HIV-infected mothers were administered the PDI twice, on average one week apart, by two different female interviewers. Kappa statistics indicate that the PDI is highly reliable in most content areas. Researchers may use the interview for comparing the prevalence of disclosure among different groups of HIV-infected parents. Practitioners who assist parents in making decisions about disclosure of HIV status to children may use the interview to obtain a baseline assessment of the clients' disclosure history and attitudes towards disclosure.
Asunto(s)
Infecciones por VIH/prevención & control , Relaciones Madre-Hijo , Autorrevelación , Adulto , Actitud Frente a la Salud , Niño , Crianza del Niño , Femenino , Infecciones por VIH/psicología , Humanos , Persona de Mediana Edad , Ciudad de Nueva York , Reproducibilidad de los Resultados , Factores de RiesgoRESUMEN
The objective of this article is to examine the relationship between panic attacks, panic disorder, and suicidal ideation among primary care patients. A probability sample of 1,007 primary care attenders from a large urban university practice was assessed for current mental disorders and suicidal ideation (past 2 week prevalence) with the PRIME-MD Patient Health Questionnaire. Controlling for major depression, substance use disorders, and sociodemographic variables simultaneously, patients with either panic attacks or panic disorder had significantly increased risks of suicidal ideation. Suicidal ideation was highly associated with major depression and comorbid panic disorder (OR = 15.4) or panic attacks (OR = 7.9). There is need for detection and possible treatment of patients with panic attacks or disorder in primary care, especially among those with co-occurring major depression.
Asunto(s)
Trastorno de Pánico/psicología , Pánico , Intento de Suicidio/psicología , Adulto , Anciano , Comorbilidad , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno de Pánico/diagnóstico , Atención Primaria de Salud , Riesgo , MuestreoRESUMEN
We investigated the association between parental factors (including infection with human immunodeficiency virus [HIV], acquired immunodeficiency syndrome [AIDS] diagnosis, parental medical illness, and depression) and children's behavioral and emotional problems among children of injection drug users (IDUs). IDUs were recruited through community outreach. The sample included 73 parents of 73 children, aged 4 to 12 years. Parental depression (odds ratio [OR] = 4.61) and medical illness (OR = 4.70) were found to be significantly associated with internalizing (depressive and anxiety-related symptoms), but not with externalizing (aggressive and disruptive behaviors) symptoms in the children of IDUs. The clinical implications are that children of IDUs are known to be at high risk for psychiatric symptoms and disorders; these data suggest that children of depressed and/or medically ill IDU parents may be at even higher risk of internalizing symptoms (depression and anxiety symptoms) than children of IDUs who do not suffer from these conditions.