The interplay of maternal and paternal postpartum depressive symptoms with children's internalizing and externalizing symptoms from childhood to adolescence: does socioeconomic status matter? A longitudinal cohort study.

BACKGROUND: Maternal postpartum depression is an important risk factor for internalizing and externalizing problems in children. The role of concurrent paternal depression remains unclear, especially by socioeconomic status. This study examined independent and interactive associations of postpartum maternal and paternal depression with children's internalizing/externalizing symptoms throughout childhood and adolescence (ages 3.5-17 years). METHODS: We used data from the Québec Longitudinal Study of Child Development, a representative birth cohort (1997-1998) in Canada. Data included self-reported maternal and paternal depressive symptoms at 5 months' postpartum using the Center for Epidemiologic Studies Depression Scale. Internalizing and externalizing symptoms in children were reported by parents, teachers and children/adolescents using the Social Behaviour Questionnaire (ages 3.5-13 years) and the Mental Health and Social Inadaptation Assessment for Adolescents (ages 15-17 years). We used three-level mixed effects modelling to test associations after adjusting for confounding factors. RESULTS: With 168 single-parent families excluded, our sample consisted of 1,700 families with useable data. Of these, 275 (16.2%) families reported maternal depression (clinically elevated symptoms), 135 (7.9%) paternal depression and 39 (2.3%) both. In families with high socioeconomic status, maternal depression was associated with greater child internalizing (ß = .34; p < .001) and externalizing symptoms (ß = .22; p = .002), regardless of the presence/absence of paternal depression. In families with low socioeconomic status, associations with symptoms were stronger with concurrent paternal depression (internalizing, ß = .84, p < .001; externalizing, ß = .71, p = .003) than without (internalizing, ß = .30, p < .001; externalizing, ß = .24, p = .002). CONCLUSIONS: Maternal depression increases the risk for children's internalizing/externalizing problems in all socioeconomic contexts. In families with low socioeconomic status, risks were exacerbated by concurrent paternal depression. Postpartum depression, especially in low socioeconomic environments, should be a primary focus to optimize mental health across generations.

Rethinking how health care professionals cope with stress: A process model for COVID-19 and beyond.

ISSUE: Prior to the COVID-19 pandemic, there was evidence of challenges surrounding the psychological well-being of health care professionals (HCPs). HCPs already frayed psychological ability to cope risks being further compromised by COVID-19-related stresses. CRITICAL THEORETICAL ANALYSIS: Most research on stress, psychological distress, and coping among HCPs is done in a piecemeal manner without a theoretical model connecting these different but related phenomena. This critical advancement article aims to apply and extend Wheaton and Montazer's model of stressors, stress, and distress to the literature on HCPs, generally, and COVID-19, specifically, to summarize past and guide future research on HCPs' mental health, resilience, and coping. Our model describes how different sources of support buffer the effect of stressors on stress and how coping strategies moderate the effect of stress on psychological distress. ADVANCE: We extended the model by (a) distinguishing context from the support in HCPs' environment; (b) distinguishing adaptive from maladaptive coping strategies and their relationships with antecedents and outcomes; (c) describing the adverse impacts that psychological distress has on patients, HCPs, and health services; and (d) describing how such outcomes can become stressors, in turn, further contributing to HCPs' stress in a vicious cycle. PRACTICE IMPLICATIONS: Our model provides a broader perspective of HCPs' work-related mental health and helps guide the creation, implementation, and evaluation of different sources of support and promote adaptive coping strategies. This model helps HCPs, researchers, and health services managers better understand and respond to the well-being crisis HCPs are facing, especially during the pandemic.

Predictors of Participation in a Perinatal Text Message Screening Protocol for Maternal Depression and Anxiety: Prospective Cohort Study.

BACKGROUND: Universal screening for depression and anxiety in pregnancy has been recommended by several leading medical organizations, but the implementation of such screening protocols may overburden health care systems lacking relevant resources. Text message screening may provide a low-cost, accessible alternative to in-person screening assessments. However, it is critical to understand who is likely to participate in text message-based screening protocols before such approaches can be implemented at the population level. OBJECTIVE: This study aimed to examine sources of selection bias in a texting-based screening protocol that assessed symptoms of depression and anxiety across pregnancy and into the postpartum period. METHODS: Participants from the Montreal Antenatal Well-Being Study (n=1130) provided detailed sociodemographic information and completed questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (State component of the State-Trait Anxiety Inventory [STAI-S]) at baseline between 8 and 20 weeks of gestation (mean 14.5, SD 3.8 weeks of gestation). Brief screening questionnaires, more suitable for delivery via text message, assessing depression (Whooley Questions) and anxiety symptoms (Generalized Anxiety Disorder 2-Item questionnaire) were also collected at baseline and then via text message at 14-day intervals. Two-tailed t tests and Fisher tests were used to identify maternal characteristics that differed between participants who responded to the text message screening questions and those who did not. Hurdle regression models were used to test if individuals with a greater burden of depression and anxiety at baseline responded to fewer text messages across the study period. RESULTS: Participants who responded to the text messages (n=933) were more likely than nonrespondents (n=114) to self-identify as White (587/907, 64.7% vs 39/96, 40.6%; P<.001), report higher educational attainment (postgraduate: 268/909, 29.5% vs 15/94, 16%; P=.005), and report higher income levels (CAD $150,000 [a currency exchange rate of CAD $1=US $0.76 is applicable] or more: 176/832, 21.2% vs 10/84, 11.9%; P<.001). There were no significant differences in symptoms of depression and anxiety between the 2 groups at baseline or postpartum. However, baseline depression (EPDS) or anxiety (STAI-S) symptoms did predict the total number of text message time points answered by participants, corresponding to a decrease of 1% (eß=0.99; P<.001) and 0.3% (eß=0.997; P<.001) in the number of text message time points answered per point increase in EPDS or STAI-S score, respectively. CONCLUSIONS: Findings from this study highlight the feasibility of text message-based screening protocols with high participation rates. However, our findings also highlight how screening and service delivery via digital technology could exacerbate disparities in mental health between certain patient groups.

Longitudinal associations between paternal mental health and child behavior and cognition in middle childhood.

Introduction: Paternal mental health has been associated with adverse consequences on offspring psychosocial development, and family environmental factors may partly explain those associations. To clarify this, we need comprehensive prospective studies, particularly in middle-childhood when the child enters school and is expected to make use of behavioral and cognitive skills as part of their interactions and learning. Method: Using data from a sub-sample of the prospective 3D birth cohort study comprised of mother-father-child triads, and a follow-up of the parents and the children at 6-8 years of age (n = 61; 36 boys, 25 girls), we examined whether paternal anxious and depressive symptoms measured during the pregnancy period (i.e., prenatally) or concurrently when the child was assessed at 6-8 years old were associated with children's cognition/behavior. Results: In contrast to our hypotheses, we found that greater prenatal paternal depressive symptoms predicted fewer child behavioral difficulties; and that greater concurrent childhood paternal depression or anxiety symptoms were associated with higher child full-scale IQ, controlling for the equivalent maternal mental health assessment and parental education. Father parenting perception did not mediate these associations, nor were they moderated by maternal mental health at the concurrent assessment, or paternal ratings of marital relationship quality. Discussion: These findings suggest that higher symptoms of paternal mental health symptoms are associated with fewer child behavioral difficulties and higher cognitive performance in middle childhood. Potential clinical implications and future research directions are discussed.

Prenatal paternal anxiety symptoms predict child DHEA levels and internalizing symptoms during adrenarche.

Introduction: This study examined (1) whether measures of paternal anxious and depressive symptoms collected prenatally and during a follow-up assessment when the child was in middle childhood, predict child neuroendocrine outcomes, and (2) whether neuroendocrine outcomes are intermediate factors between paternal mental health and child cognitive/behavioral outcomes. Middle childhood coincides with increased autonomy as the child transitions into grade school, and with adrenarche, as the maturing adrenal gland increases secretion of dehydroepiandrosterone (DHEA) and its sulfated metabolite (DHEA-S), hormones that are implicated in corticolimbic development which regulate emotions and cognition. Methods: Participants were recruited from a subsample of a large prospective birth cohort study (3D study). We conducted a follow-up study when children were 6-8 years old (N = 61 families, 36 boys, 25 girls). Parental symptoms of anxiety, stress and depression were assessed via validated self-report questionnaires: prenatally using an in-house anxiety questionnaire, the Perceived Stress Scale (PSS) and the Center for Epidemiologic Studies Depression (CES-D), and at the follow up, using the Beck Anxiety and Beck Depression Inventories. Children provided salivary hormone samples, and their pituitary gland volume was measured from structural Magnetic Resonance Imaging (MRI) scans. Child behaviors were measured using the Strengths and Difficulties Questionnaire and cognitive outcomes using the WISC-V. Multiple regression analyses were used to test whether paternal mental health symptoms assessed prenatally and during childhood are associated with child neuroendocrine outcomes, adjusting for maternal mental health and child sex. Indirect-effect models assessed whether neuroendocrine factors are important intermediates that link paternal mental health and cognitive/behavioral outcomes. Results: (1) Fathers' prenatal anxiety symptoms predicted lower DHEA levels in the children, but not pituitary volume. (2) Higher prenatal paternal anxiety symptoms predicted higher child internalizing symptoms via an indirect pathway of lower child DHEA. No associations were detected between paternal anxiety symptoms measured in childhood, and neuroendocrine outcomes. No child sex differences were detected on any measure. Conclusion: These results highlight the often-overlooked role of paternal factors during pregnancy on child development, suggesting that paternal prenatal anxiety symptoms are associated with child neuroendocrine function and in turn internalizing symptoms that manifest at least up to middle childhood.

Case manager- and patient-rated alliance as a predictor of medication adherence in first-episode psychosis.

OBJECTIVE: The objective of this study was to evaluate the association between adherence to antipsychotic medication and working alliance (WA) ratings as reported separately by case manager (CM) and patient in first-episode psychosis (FEP) and to identify whether other factors previously related to adherence influence this relationship. METHODS: Adherence was evaluated every month in 81 participants who met criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, psychotic disorder (affective or nonaffective) and were treated in a specialized early intervention program. Adherence was measured, taking into account information from patient and clinician reports and pill counting. The WA, as assessed by both CM and patient, was assessed using the Working Alliance Inventory. RESULTS: The WA was stable during the course of the study as rated by both patient and CM. The "task" domain of WA was the subdomain most significantly correlated to adherence in cross-sectional analysis. The WA as measured by CM at study baseline was a significant predictor of the number of subsequent months with "good" adherence independently of other variables, including adherence at treatment onset (ß = 0.011; P = 0.020; 95% confidence interval, 0.002-0.020). However, the WA as measured by patients was not similarly predictive of subsequent adherence (ß = 0.003; P = 0.31; 95% confidence interval, -0.003 to 0.010). CONCLUSIONS: The CM-rated WA is a significant predictor of future medication adherence in FEP, suggesting that good alliance can improve adherence in this population.

The role of maternal child maltreatment history and unsupportive emotion socialization in the intergenerational transmission of emotion regulation difficulties.

BACKGROUND: Maternal mental health problems and poor parenting are thought to account for the intergenerational transmission of poor outcomes to offspring of mothers who have experienced child maltreatment. OBJECTIVE: Given that emotion regulation (ER) difficulties have been linked to adult psychopathology and maladaptive parenting, the goal of the present study was to examine the mechanisms through which a maternal history of child maltreatment, and subsequent difficulties with ER, might contribute to unsupportive emotion socialization and the intergenerational transmission of ER difficulties. PARTICIPANTS AND SETTING: Mothers and their young adult children (aged 18-25) were recruited from across Canada to participate in an online study (N = 185 dyads). METHODS: Mothers responded to questionnaires assessing their child maltreatment histories and ER difficulties. Young adults retrospectively reported on their mothers' emotion socialization behaviours in adolescence as well as their own difficulties with ER. RESULTS: A moderated mediation analysis revealed that mothers who endorsed more types of child maltreatment were described as using more unsupportive contingencies, but only in the context of high levels of maternal ER difficulties. The indirect effect of maternal child maltreatment on young adults' ER difficulties was only significant for mothers with high levels of ER difficulties. More specifically, maternal difficulties with impulse control and emotional clarity contributed to more unsupportive contingencies. CONCLUSIONS: Mothers who have experienced multiple forms of child maltreatment may be more likely to struggle with ER and engage in unsupportive emotion socialization behaviours, which may increase the risk of emotional difficulties in their children. Survivors of child maltreatment should have access to interventions that promote ER skills to improve their own well-being and to prevent the transmission of ER difficulties to future generations.

The Late Positive Potential as a Reliable Neural Marker of Cognitive Reappraisal in Children and Youth: A Brief Review of the Research Literature.

The mental health of young people is a growing public health concern. With socio-emotional difficulties in youth often resulting in psychiatric disorders later in life and most with mental health conditions rather stabilizing in time, it is essential to support healthy socio-emotional development. With a comprehensive definition of mental health, since emotion regulation (ER) plays a critical role in prevention, it becomes imperative to better understand how children effectively manage their emotions from an early age. Determining effective use of ER skills relies on adequate measurements. Typical methods of data collection in children present consistent shortcomings. This review addresses research findings considering the suitability of the late positive potential measured through electroencephalogram as a neural indicator of ER in children and youth. There is growing evidence, as reported in this review, that indicates that the late positive potential may be a reliable neural indicator of children's cognitive reappraisal abilities more specifically. Results generally suggest that the late positive potential amplitudes are sensitive to directed reappraisal in children. However, given the scant research, questions remain regarding developmental trends, methodology, interindividual variability, reappraisal of various stimuli, and how the late positive potential may relate to more traditional measures of ER. Directions for future research are provided, which are expected to address unanswered research questions and fill literature gaps. Taken together, the findings reviewed indicate that the late positive potential is generally sensitive to directed cognitive reappraisal in children and that there is promise of establishing this neural marker as an indicator of ER.

Emotion regulation interacts with gambling motives to predict problem gambling among emerging adults.

BACKGROUND: It is presently estimated that as much as 10% of emerging adults are at risk for a gambling disorder. The consequences stemming from problematic gambling engagement include increased substance use, mental health disorders, suicidality, financial strain and legal issues. The present study explores whether deficits in specific dimensions of emotion regulation coupled with the motivation to escape negative emotions (i.e., coping motives) increases the likelihood of problem gambling severity, while controlling for variables such as gambling frequency, age, and sex. METHODS: A sample of 919 emerging adult gamblers (Mage = 21.16 years-old, SD = 2.90, 48.1% female) completed an online survey including an assessment of problematic engagement in gambling over the past year, gambling motivations, and difficulties in emotion regulation. In total, 15.2% and 8.1% of this sample were at moderate or high risk for gambling disorder. RESULTS: A series of six moderation analyses revealed that the total models accounted for approximately 37-38% of the variance in problem gambling and that coping motives interacted with less difficulties engaging in goal-directed behavior, increased lack of emotional clarity, and increased lack of emotional awareness to create a toxic mixture for problem gambling. CONCLUSIONS: These findings reveal the importance of considering both psychological factors such as emotion regulation and motivational factors in understanding who is at greatest risk for gambling problems.

Emotion regulation in emerging adult gamblers and its mediating role with depressive symptomology.

BACKGROUND: It is presently estimated that as much as 10% of emerging adults are at risk for a gambling disorder. The consequences stemming from problematic gambling engagement include increased substance use, mental health disorders, suicidality, financial strain and legal issues. The present study explores whether deficits in emotion regulation explain the association between problem gambling severity and depression. METHODS: A sample of 820 emerging adult gamblers (Mage = 21.14 years-old, SD = 2.90, 50.9% female) completed an online survey including an assessment of problematic engagement in gambling over the past year, levels of anxious/depressive symptomology, and difficulties in emotion regulation. In total, 15.6% and 8.2% of this sample were at moderate or high risk for gambling disorder. RESULTS: Results from a linear regression model revealed that difficulties with impulse control positively contributed to problem gambling scores and engagement in goal-directed behavior positively contributed to problem gambling scores, even after accounting for symptoms of depression. Moreover, results from a mediation model revealed that the association between problem gambling and depression was explained by participants' deficits in non-acceptance, goals, strategies, and clarity. LIMITATIONS: Limitations include the use of self-report and cross-sectional data making it difficult to infer causality. CONCLUSIONS: These findings add to our understanding of the mechanisms that appear to explain for the first time the affective consequences of problem gambling. Enhancing specific dimensions of emotion regulation will allow for tailored interventions among gamblers with depression, ultimately achieving better mental health outcomes.

Attribution bias and social anxiety in schizophrenia.

Studies on attribution biases in schizophrenia have produced mixed results, whereas such biases have been more consistently reported in people with anxiety disorders. Anxiety comorbidities are frequent in schizophrenia, in particular social anxiety disorder, which could influence their patterns of attribution biases. The objective of the present study was thus to determine if individuals with schizophrenia and a comorbid social anxiety disorder (SZ+) show distinct attribution biases as compared with individuals with schizophrenia without social anxiety (SZ-) and healthy controls. Attribution biases were assessed with the Internal, Personal, and Situational Attributions Questionnaire in 41 individual with schizophrenia and 41 healthy controls. Results revealed the lack of the normal externalizing bias in SZ+, whereas SZ- did not significantly differ from healthy controls on this dimension. The personalizing bias was not influenced by social anxiety but was in contrast linked with delusions, with a greater personalizing bias in individuals with current delusions. Future studies on attribution biases in schizophrenia should carefully document symptom presentation, including social anxiety.

Manualized Group Cognitive-Behavioral Therapy for Social Anxiety in At-Risk Mental State and First Episode Psychosis: A Pilot Study of Feasibility and Outcomes.

Social anxiety has received scant attention in studies of schizophrenia and related psychoses. However, some data suggest it may be an obstacle to vocational and functional outcome. This pilot study investigated the feasibility of a group-based cognitive behavioral therapy (CBGT) to reduce social anxiety in those at risk for developing psychosis or in the early phase. Twenty-nine patients with first-episode psychosis (FEP) or at ultra high risk for developing psychosis or often referred to as at-risk mental state (ARMS) with comorbid social anxiety attended a CBGT intervention weekly for 14 weeks in 90-minute sessions. Baseline, post-treatment, and follow-up ratings of social anxiety were measured using the Social Interaction Anxiety Scale, the Social Phobia Inventory, and the Brief Social Phobia Scale. Psychotic symptoms and general psychopathology were also measured before and after the intervention. Results suggest that the proposed CBGT is feasible and beneficial for socially anxious patients at risk, or with experience of, psychosis. Participants significantly improved on three outcome measures of social anxiety after completing this intervention (all p's < .002). Participants who completed treatment also showed a significant reduction on measures of depression and negative symptoms. Future research should examine the relative efficacy of this brief manualized CBGT intervention for the treatment of social anxiety and psychotic symptoms in a larger randomized controlled trial.

Anxiety symptoms severity and short-term clinical outcome in first-episode psychosis.

AIM: In psychotic disorders, a limited number of studies have documented the presence of symptoms of anxiety, especially in first-episode psychosis (FEP). There is a growing interest in better understanding how these symptoms may affect the severity of psychotic symptoms and clinical outcome. This study examined the association between symptoms of anxiety, as measured by the Hamilton Anxiety Rating Scale (HARS) and the Positive and Negative Syndrome Scale (PANSS), and short-term clinical outcome. We first examined the potential association between anxiety symptom severity among FEP patients and remission. A secondary objective explored the relation between the PANSS single item subscale 'anxiety' item and the total score value of the HARS. METHOD: Data were collected on 201 FEP patients divided into remitted and unremitted groups based on clinical data at 6 months. Anxiety ratings were compared between 67 remitted and 99 unremitted patients with the HARS, and for 72 remitted and 103 unremitted patients with the (G2) PANSS. RESULTS: A significant interaction Time × Group was observed on the HARS and on the PANSS G2 item. Looking at the two time points specifically, groups did not significantly differ at baseline on either the HARS or the PANSS. At 6 months, these two groups were significantly different on both anxiety rating scores - HARS [t(170) = 3.48, P = 0.001)] and PANSS G2 [t(173) = 2.51, P = 0.013)]. CONCLUSION: Anxiety severity is marked in FEP, and appears to be linked to poor short-term clinical outcome. The PANSS single item (G2) seems to represent a good indicator of anxiety as it significantly correlates with a more systematic measure of anxiety, namely the HARS score. Anxiety severity appears to vary across diagnosis type.