Specialist care of children with complex needs: Insights from comparison of child development and child mental health clinics.

AIM: Paediatricians and child psychiatrists review children with complex comorbidity, noting similarities between tertiary Child Development Service (CDS) and Child and Youth Mental Health Service (CYMHS) cohorts. Mental health comorbidity is common in developmental services. Developmental comorbidity in mental health cohorts is uncharacterised. The study aimed to describe CDS and CYMHS cohorts using measures of child development, mental health, physical health and psychosocial risk. METHODS: A questionnaire was completed by parents of CDS and CYMHS new clients aged 4-11. It included measures of mental health symptoms, child development, physical health, stressful life events, family functioning, parent mental health and socio-economic variables. Sample rates were compared to population norms. CDS and CYMHS cohorts were compared. RESULTS: The study population had elevated rates of psychosocial risk, family dysfunction, physical illness, developmental risk and mental health symptoms. CDS had higher levels of developmental risk and family dysfunction. Most CDS clients (81%) had mental health difficulties. CYMHS clients were older, and had more mental health symptoms, stressful life events and child safety contact; 81% of CYMHS clients demonstrated developmental risk. CDS and CYMHS had similar socio-demographic profiles and parent mental health difficulties, and similarly high rates of physical health problems. CONCLUSIONS: Consideration should be given to mental health screening and support in CDS, and to developmental screening in CYMHS. Both services support at-risk children with complex developmental, mental health and physical co-morbidity necessitating shared approaches to clinical and population health, including care integration, and collaborative cross-disciplinary models of service provision and training, and advocacy.

Does the millennial generation of women experience more mental illness than their mothers?

BACKGROUND: There is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age. METHODS: Pregnant women were recruited during 1981-1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008-11). Offspring were administered the CIDI at the 30-year follow-up (2010-2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes. RESULTS: When comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD. CONCLUSIONS: In the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.

Evaluation of a collaborative group intervention for mothers with moderate to severe perinatal mental illness and their infants in Australia.

Perinatal mental illness is a known risk to maternal-infant attachment and healthy infant development. Mothers experiencing complex mental health issues in the first year following birth are less likely to become involved in parenting programs or day stay interventions because of their mental health difficulties and perceived stigma. Currently, most perinatal day or group treatment programs only include the mother and not their infant. This paper describes "Together in Mind," a perinatal and infant mental health day program developed by the Queensland Centre for Perinatal and Infant Mental Health, targeting mothers with moderate to severe mental illness and their infants under 12 months. The service model was a 6-week, 1 day per week psychoeducation intervention. Psychoeducational material and support were provided across each day session by an adult perinatal mental health clinician, an infant mental health clinician, and a child health nurse working in collaboration. The program was trialed across seven Hospital and Health Service sites in Queensland, Australia, during 2016-18. In total, 24 group day programs were delivered with 84 mothers and their infants. Pre and post intervention quantitative measures and a post-program qualitative survey about participant satisfaction were collected. Statistically significant improvements in all quantitative measures showed a large to medium effect size on the: Health of the Nation Outcome Scale (HoNOS) (d = 0.82; p < .000); Depression, Anxiety and Stress Scale (DASS-21) (d = 0.5; p < .000); Karitane Parenting Confidence Scale (KPCS) (d = 0.63; p < .000); Maternal Postnatal Attachment Scale (MPAS) (d = 0.49; p < .000), Ages and Stages Questionnaire: Social-Emotional (6 months) (d = 0.83; p < .000). The results indicate collaboration and early intervention contributes to strengthening the emerging development of the maternal-infant relationship within the context of complex maternal mental health issues.

Con frecuencia se excluye a las madres perinatales con asuntos de salud mental severos y complejos de programas de apoyo a la crianza, lo cual presenta un riesgo para la relación materno-infantil y el desarrollo saludable del infante. El Centro de Queensland para la Salud Perinatal y la Salud Mental del Infante puso a prueba 'Juntos en la Mente,' un programa perinatal y de salud mental infantil de un día con énfasis en madres con salud mental entre moderada y severa e infantes de menos de 12 meses. La colaborativa intervención la llevaron a cabo 3 servicios públicos de salud mental y de salud infantil a lo largo de 7 lugares de Servicio de Hospital y Salud en Queensland, Australia, durante 2016-18. En el período de 2 años, se trabajó con 24 grupos de 6 semanas de duración y con 84 madres que completaron las medidas cuantitativas de pre- y post- intervención, así como encuestas posteriores al programa para reportar la experiencia de las participantes. Se dieron mejorías estadísticamente significativas en todas las medidas cuantitativas, lo cual muestra un efecto de tamaño entre grande y mediano: La Escala de Resultados de Salud de la Nación (HoNOS) (d = 0.82; p <.001); Escala de Depresión, Ansiedad y Estrés (DASS-21) (d = 0.5; p <.001); Escala Karitane de Confianza en la Crianza (KPCS) (d = 0.63; p <.001); Escala de Afectividad Materna Postnatal (MPAS) (d = 0.49; p<.001), Cuestionario de Edades y Estados: Socio-Emocional (6 meses) (d = 0.83; p <.001). Los resultados sindican intervenciones tempranas colaborativas refuerzan el naciente desarrollo de la relación materno-infantil dentro del contexto de los complejos asuntos de salud maternos.

Les mères périnatales avec des problèmes graves et complexes de santé mentale sont fréquemment exlues de programmes de soutien au parentage posant ainsi un risque à la relation maternelle-nourrisson et au développement sain de l'enfant. Le Centre de Queensland (en Australie) pour la Santé Mentale du Nourrisson a mis en place un programme 'Together in Mind', un programme de santé mentale périnatale et du nourrisson de jour ciblant les mères ayant des maladies mentales modérées à sévères avec des nourrissons de moins de 12 mois. L'intervention collaborative a été offerte par trois services publics de santé et de santé mentale de l'enfant au travers de 7 hôpitaux et sites de service de santé à Queensland en Australie entre 2016 et 2018. Durant cette période de deux ans 24 groupes de durée de 6 mois ont été formés avec 84 mères remplissant des mesures qualitatives pré-intervention et post-intervention et des questionnaires à la fin du programme, relatant l'expérience de la participante. Nous avons trouvé des améliorations statistiquement importantes dans toutes les mesures quantitatives, montrant une taille d'effet de grande à moyenne: Echelle de Résultat de Santé de la Nation (HoNOS) (d = 0,82; p <,001); Echelle de Dépression, Anxiété et Stress (DASS-21) (d = 0,5; p <,001); Echelle Karitane de Confiance de Parentage (KPCS) (d = 0,63; p <,001); Echelle d'Attachement Maternel Postnatal (MPAS) (d = 0,49; p <,001), le Questionnaire Âges et Étapes Socio-Émotionnel (6 mois) (d = 0,83; p <,001). Les résultats indiquent que l'intervention précoce collaborative renforce le développement qui pointe de la relation maternelle-nourrisson dans le contexte de problèmes de santé mentale complexe.

Age at first tobacco use and risk of subsequent psychosis-related outcomes: A birth cohort study.

OBJECTIVE: Compared to the substantial body of research examining links between cannabis use and psychosis, there has been relatively little attention to the role of tobacco as a potential risk factor for psychosis. This study explored the association between age at first tobacco use and psychosis-related outcomes in a birth cohort. METHOD: This study is based on a large birth cohort (the Mater-University Study of Pregnancy). At approximately 21 years of age, cohort members (N = 3752) were assessed for three psychosis-related outcomes (International Classification of Diseases non-affective psychosis, the presence of any hallucination and total count of delusional-like experiences) with the Composite International Diagnostic Interview and the Peters Delusional Inventory. Associations between age at first tobacco use and psychosis-related outcomes were examined using logistic regression in a model (a) adjusted for sex and age and (b) in a second model excluding all respondents who had a history of past problematic and current cannabis use. RESULTS: When adjusted for age and sex, those who commenced tobacco at 15 years of age or younger were significantly more likely to (a) have non-affective psychosis, (b) be in the highest quartile of total score of the Peters Delusional Inventory and (c) report hallucinations. After excluding all those with a history of a cannabis use disorder, or who were current (last month) cannabis users, a significant association between age at first tobacco use and the presence of hallucinations persisted. CONCLUSION: There is an association between age at first tobacco use and subsequent psychosis-related outcomes in young adults. While the findings cannot be used to deduce causality, it adds weight to the hypothesis that early tobacco use may contribute to the risk of developing psychosis-related outcomes.

Are child and adolescent mental health problems increasing in the 21st century? A systematic review.

OBJECTIVE: Up to one in five children experience mental health problems. Social and cultural factors may influence emergence of mental health problems. The 21st century has led to changes in many of these factors, but it is unclear whether rates of internalizing and externalizing problems have also changed in recent cohorts of young people. METHODS: A comprehensive literature search was undertaken to locate cohort or population studies that examined changes in mental health of children over time, where participants were aged 18 years and under, and the time frame for change was at least 10 years, with data for at least one time point in the 21st century being statistically compared to at least one time point in the 20th century. Studies were reviewed for quality and outcome. RESULTS: Nineteen studies met criteria for review. These included studies of toddlers, children, and adolescents. Seventeen studies examined internalizing problems, and 11 studies examined externalizing problems. For both children and toddlers, recent cohorts did not exhibit worsening of mental health symptoms. In adolescents, the burden of externalizing problems appear to be stable. However, the majority of studies report an increase in internalizing problems in adolescent girls. The findings for internalizing problems in boys were mixed. CONCLUSIONS: These findings suggest that recent cohorts of adolescent girls are experiencing increases in internalizing symptoms compared to previous cohorts. Approaches for prevention and early intervention should be explored.

Improving collaboration: a qualitative assessment of inter-agency collaboration between a pilot Multisystemic Therapy Child Abuse and Neglect (MST-CAN) program and a child protection team.

OBJECTIVE: Child protection inter-agency collaboration is characterized by strengths and problems. Some literature notes positive attitudes and high trust between teams. However, difficulties with communication, confidentiality, roles, boundaries and divergent paradigms reconciling child protection and parent mental health needs have been documented. This study investigated whether a pilot model of intensive family intervention for maltreated children and associated intensive inter-agency cooperation delivered an effective collaboration. METHOD: At the completion of the pilot program, a child protection team was interviewed. A qualitative assessment by semi-structured group interview format of inter-agency collaboration was undertaken and evaluated by a thematic analysis. RESULTS: The analysis identified: strong endorsement of the collaborative model; no changes in perception of referred patients; changes in treatment approaches. No perceived conflict between child protection and parent mental health needs were noted. CONCLUSIONS: The changes noted may be due to the unique structure and functioning of the pilot Multisystemic Therapy Child Abuse and Neglect program, which encouraged high levels of team communication, strong client engagement, availability and intensive treatment of child and parent mental health problems. The implications for future collaborations are discussed as well as limitations of the study.

The association between adult attachment style and delusional-like experiences in a community sample of women.

Community-based surveys have found that many otherwise well individuals endorse delusional-like experiences (DLEs). There is extensive literature that describes the demographic and psychosocial correlates of DLE; however, we know little about the association between DLE and attachment style. The association between DLEs (assessed by the Peters Delusional Inventory [PDI]) and interpersonal relationship style (as assessed by the Adult Attachment Questionnaire and the Dyadic Adjustment Scale) was examined in 3360 women. When adjusted for the presence of depressive and anxiety symptoms, high scores on the PDI (lowest versus highest quartiles) were associated with a) difficulties in adult attachment style particularly in the discomfort with closeness and preoccupation with relationships subscales and b) conflictual dyadic adjustment (adjusted odds ratios and 95% confidence intervals, 2.43 and 1.94-3.04, 2.50 and 1.99-3.14, and 2.90 and 1.38-6.06, respectively). The association between adult attachment style and DLE provides new clues into the causal pathway underpinning these common experiences.

Family structure, marital discord and offspring's psychopathology in early adulthood: a prospective study.

With marital breakdown and discord relatively common, we examined whether family structure and the quality of marital relationship have a long-term impact on offspring's psychopathology in early adulthood. This study aimed to examine the association of family structure and marital discord in the family with a wide range of offspring's mental health and problem behaviours at 21 years. Data were from the Mater-University of Queensland Study of Pregnancy, a population based birth cohort study, which commenced in Brisbane, Australia in 1981. Mothers and children were followed up at birth, 6 months and 5, 14 and 21 years after the initial interview. Marital status and marital quality were assessed at the 14 year follow-up. Young Adult Self-Report sub-scales of mental health and problem behaviours were measured at the 21-year follow-up. Type of family structure and the quality of marital relationship (at the 14-year follow-up) predicted offspring's psychopathology at 21 years. When a selected group of confounding factors were included in the multivariate analyses, children who lived with a step-father, un-partnered mother, or in families where parents had conflict in marital relationship reported higher symptoms of psychopathology at 21 years. The association between marital problems and young adult psychopathology does not appear to be confounded by a wide range of confounding variables. Further research is needed to explore the mechanism of these associations to develop preventive programmes.

Can a multi-disciplinary assessment approach improve outcomes for children with attention deficit hyperactivity disorder?

OBJECTIVE: Public, consumer and professional views about attention deficit hyperactivity disorder, its assessment and treatment - especially with medication - remain a highly contested domain. Parents in particular express disquiet with services. One response to this tension is a multidisciplinary evaluation. Parental and education perceptions of this process have not been evaluated previously. A community multidisciplinary approach was assessed in terms of diagnostic outcomes and client satisfaction. METHOD: A comprehensive multidisciplinary structured assessment of the first 50 referred children with severe attentional problems was documented. Demographic and symptom/behavioural profiles, developmental history and indicated multi-disciplinary evaluation were recorded. A team consensus process arrived at diagnostic classification. Post-assessment satisfaction of parents and school staff was surveyed. RESULTS: Thirteen children (26%) were diagnosed with attention deficit hyperactivity disorder and three commenced stimulants. The majority of parents and educators were satisfied with the service. CONCLUSIONS: A multidisciplinary assessment clinic for children presenting with attention problems resulted in minimal prescribing. Overall, education staff and parents were satisfied with the service. The model may be a suitable response to the multiple concerns in the community.

Therapy implications of child abuse in multi-risk families.

OBJECTIVES: Our aim is to critique Australian child maltreatment policy, outline abuse trends and provide data on family risk factors. METHOD: We identified policy gaps and reviewed family profiles within selective child maltreatment databases. Data sources included international and Australian literature, Queensland Department of Child Safety reports and a research clinical database. RESULTS: Data reviewed suggest that a pattern of co-occurring complex multiple system family problems characterize substantiated abuse cases. CONCLUSIONS: The presence of multiple family problems suggests the need for a new treatment paradigm. Multisystemic Therapy for child physical abuse and neglect is an evidence-based intervention that matches the therapeutic needs of such families.

Understanding the Perspective of Youths on Undergoing Metabolic Monitoring While on Second-Generation Antipsychotics: Challenges, Insight, and Implications.

Introduction: Prescription of second-generation antipsychotics (SGAs) in youths is rapidly increasing globally, despite the potential for significant adverse effects and long-term health consequences. A known adverse reaction resulting from SGAs is metabolic syndrome (MS). Youths exposed to antipsychotics are at higher risk than adults for adverse drug reactions, including adverse events such as MS (with weight gain as the most significant adverse outcome) and other long-term endocrinological abnormalities. This study aimed to explore the experiences of young patients on factors impacting barriers to metabolic monitoring of SGAs and the strategies to address those barriers thereby providing further guidance on policy and service delivery. Methods: Semi-structured interviews were conducted with patients (youths who were prescribed SGAs) who attended Child and Youth Mental Health Services. The interviews focused on barriers to monitoring and strategies to enhance rates of monitoring that could be customized across study sites. Results: Young patients revealed that none of them had any concerns or objections to receiving anthropometric metabolic measurements. However, they seemed concerned to undergo blood tests as part of the metabolic monitoring process. Specifically, youths cited their fear of the needles as barrier to undergo the required blood tests. Youths have also reported that their dislike to healthy foods and exercise being the most common challenge they face while trying to engage in a healthy lifestyle to manage the SGAs resulted weight gain. Conclusion: Prescribers are recommended to actively engage young patients about the expected SGAs-induced adverse effects, the importance of conducting metabolic monitoring, and how to prevent and minimize the expected adverse effects from the start of initiating SGAs. This could be a vital step toward a successful treatment as the insight of youths into the details of the chosen treatment can play a significant role into treatment adherence and recovery.

The impact of COVID-19 on children and adolescents attending Child and Youth Mental Health Services in Queensland, Australia.

OBJECTIVE: This explorative study aims to provide insight into impacts of the COVID-19 pandemic and associated restrictions, on mental health of children and adolescents treated at Child and Youth Mental Health Services, and their parents. METHOD: The COVID-19 Mental Health Survey was disseminated to parents of children and adolescents under treatment at community Child and Youth Mental Health Services (Brisbane, Australia) between July-November 2020 throughout different stages of COVID-19 related restrictions. Parents of 110 children participated. RESULTS: Most reported child's symptoms were sadness (46%), anxiety (60%), lack of focus (61%), lack of joy in their usual activities (38%) and reduction in sleep (42%). Parental emotions were significantly correlated with their child's emotions. Parent's lack of enjoyment of usual activities had the overall strongest average correlation (0.27) but this was no longer significant once other variables were controlled for. Children who attended school remotely for some of the days had a significantly (p < .05) higher risk of having more reported symptoms. Interestingly, in later stages of the lockdown with further easing of restrictions, symptoms also tended to be more severe. CONCLUSION: Cross-sectional data on children and adolescents in Queensland, Australia with pre-existing mental health issues suggests mental health continued to deteriorate through the pandemic even as restrictions eased. Changes in schooling seem to be an especially important risk factor.

Sleepless nights: the effect of socioeconomic status, physical activity, and lifestyle factors on sleep quality in a large cohort of Australian women.

The aims of this study were to examine: (1) the association between sociodemographic and lifestyle factors and sleep quality in a population-based cohort of Australian women and (2) possible influence of reproductive status and mental and physical health factors on these associations. Data on 3,655 women (mean age = 46.6 years, range 34.3-67.4) were obtained from the Mater Hospital University of Queensland Study of Pregnancy for this cross-sectional study. Self-rated sleep quality was assessed using the Pittsburgh Sleep Quality Index. For the purpose of this study, two cutoff points (scores 5 and 10) were used to divide women into three categories: normal (65.2%), moderately poor (26.4%), and very poor sleep quality (8.5%). Other covariates were measured at 21-year follow-up as well. After adjusting for reproductive status, mental and physical health, there were significant associations between moderately poor sleep quality and education and between very poor sleep quality and unemployment, both measures of socioeconomic status. In addition, work-related exertion was associated with increased rates of moderately poor sleep quality, whereas those women undertaking moderate exercise were less likely to experience very poor sleep quality. Independent associations between sociodemographic factors and exercise with moderately poor and very poor sleep quality were identified. These findings demonstrate the dynamic nature of the association between exercise/exertion, socioeconomic status, and sleep quality and highlight the importance of taking these into consideration when dealing with issues of poor sleep quality in women.

Practitioners' Perspective on Metabolic Monitoring of Second-Generation Antipsychotics: Existing Gaps in Knowledge, Barriers to Monitoring, and Strategies.

Introduction: Prescription of second-generation antipsychotics (SGAs) in youth is rapidly increasing globally and in Australia. Lack of timely metabolic monitoring for potential adverse effects puts youth at greater risk for lifelong adverse health impact. Metabolic monitoring is recommended as best practice to prevent and/or manage SGA-induced weight gain/metabolic syndrome. The adherence to clinical guidelines remains suboptimal. It is crucial to gauge insight to challenges and strategies from the perspective of prescribers and to recommend strategies in promoting quality use of SGAs and adherence to pharmacovigilance standards. Methods: Psychiatrists participated through semistructured interviews within the community mental health clinics in the Queensland State of Australia. The interviews focused on barriers to monitoring and strategies to enhance rate of monitoring with key focus on practical strategies for future implications in community setting. Results: Ten participants completed the interviews. Barriers were specified such as lack of adequate resources to conduct monitoring, carers' disengagement in their youth's treatments, and patients' refusal to undergo blood tests. Strategies to enhance metabolic monitoring heavily relied on organizational support, provision of training, and education opportunities. Conclusions: Clinical recommendations require mental health providers to facilitate conduction of metabolic monitoring among youth prescribed SGA/s. However, they are not provided with enough support and there are challenges that prevent such care. It is crucial to understand the challenges in managing a complex and vulnerable patient cohort. This research has thrown light on these key aspects of existing gap between best practice standards and clinical practice in youth prescribed SGAs.

Transition to Parenthood: Antenatal Education Promotes Perinatal Mental Health When Collaboratively Delivered by Midwives, Mental Health Peer Workers and Perinatal and Infant Mental Health Professionals.

Transition to Parenthood is a two-session (antenatal and postnatal) module for inclusion in a birth and parenting education course, designed to proactively support perinatal and infant mental health. In this pilot study, 299 mothers and 241 fathers/partners participated in the whole module, with 35 mothers completing pre- and post-program measures of depression, anxiety, stress, and parenting confidence. Statistically significant improvements were found on all four measures with high effect sizes. Participant ratings of learning and satisfaction were high and persisted over time. These results provide support for the usefulness of group-based birth and parenting education that focuses on perinatal and infant mental health, with mental health peer workers co-delivering the program.

Characteristics and treatment outcomes of children and adolescents accessing treatment in Child and Youth Mental Health Services.

AIM: To provide insight into the characteristics and treatment outcomes of children and adolescents accessing outpatient Child and Youth Mental Health Services (CYMHS), and to explore whether outcomes differ by age, sex, and ancestry background. This information can guide how to optimize the treatment delivered at these services. METHODS: An observational retrospective study was performed based on data from 3098 children and adolescents between age 5 and 18 who received treatment at Brisbane, Australia, community CYMHS between 2013-2018. Patient characteristics, service use, and clinician and parent rated Routine Outcome Measures (ROM) were extracted from electronic health records. RESULTS: Anxiety and mood disorders were the most common mental disorders (37% and 19%). In 1315 children and adolescents (42%), two or more disorders were diagnosed, and the far majority (88%) had experienced at least one psychosocial stressor. The ROM scores improved between start and end of treatment with Cohen's d effect sizes of around 0.9. However, ~50% of the children still scored in the clinical range at the end of treatment. Outcomes did not differ over gender and Indigenous status. CONCLUSIONS: Children and adolescents accessing CYMHS have severe and complex mental disorders as reflected by high rates of comorbidity, exposure to adverse circumstances and high symptom scores at the start of treatment. Despite the clinically relevant and substantial improvement, end ROM scores indicated the presence of residual symptoms. As this increases the risk for relapse, services should explore ways to improve treatment to further reduce mental health symptoms.

A longitudinal study of child mental health and problem behaviours at 14 years of age following unplanned pregnancy.

A substantial minority of children are born as a consequence of an unplanned pregnancy. Yet little is known about the impact of unplanned/unwanted pregnancy (UP) on long-term health outcomes for children. This study aimed to examine the association between UP and child mental health and behavioural problems at 14 years, and whether this association is confounded or mediated by other variables. Data were from a pre-birth prospective study that included 4765 mothers and their children (48.4% female and 51.6% male) followed up from pregnancy to 14 years of the child's age in Brisbane, Australia. Child anxiety/depression, aggression, delinquency, attention problems, withdrawal problems, somatic complaints, social problems, thought problems, internalizing, externalizing and total problems were measured using the Achenbach's Youth Self Report at 14 years. Child smoking and alcohol consumption were self-reported at 14 years. UP was prospectively assessed at the first antenatal visit of pregnancy. UP as reported by mothers at first antenatal visit predicted elevated levels of problem behaviours and increased substance use in children at 14 years. The impact of UP on child mental health and problem behaviours is partly due to the confounding effect of other variables, such as maternal socio-demographic status, mental health and substance use during pregnancy. Further research is needed to investigate the mechanism of association between UP and child aggression and early alcohol consumption at 14 years.

Longitudinal analysis of maternal risk factors for childhood sexual abuse: early attitudes and behaviours, socioeconomic status, and mental health.

OBJECTIVE: The objective of this study was to examine whether maternal factors such as socioeconomic status (SES), attitudes towards the baby, and mental health at 6 months or earlier, are associated with non-penetrative and penetrative childhood sexual abuse (CSA) in her offspring. METHODS: This was a prospective birth cohort study followed up to 21 years. Set in one of two obstetric hospitals in Brisbane, Australia, the Mater-University of Queensland Study of Pregnancy (MUSP) involves a prospective birth cohort from a population based sample of 7223 singletons whose mothers were enrolled between 1981 and 1984 at the first antenatal visit. The present cohort consisted of 2664 participants who provided CSA data, and whose mothers had responded to all relevant questions. RESULTS: About 16% of young adults reported non-penetrative sexual abuse before the age of sixteen and 9% reported penetrative abuse. After adjusting for all variables in the model, an increased risk for non-penetrative CSA was associated with the child being female, unwanted pregnancy, mother being a heavy smoker, and maternal anxiety. Increased risk for penetrative CSA was associated with the child being female, the mother having failed to complete a high school level education, living in an alternative arrangement other than marriage, and being either a moderate or heavy smoker. We found no associations between maternal age and CSA after correcting for other predictors. CONCLUSION: CSA was not uncommon in this cohort with one in four reporting some form of sexual abuse before 16. The results suggest that several early factors may predict later CSA and that the associations are different according to type of CSA.

Predicting depressive and anxiety disorders with the YASR internalising scales (empirical and DSM-oriented).

BACKGROUND: The Achenbach problem behaviour scales (CBCL/YSR) are widely used. The DSM-oriented anxiety and depression scales have been created to improve concordance between Achenbach's internalising scales and DSM-IV depression and anxiety. To date no study has examined the concurrent utility of the young adult (YASR) internalising scales, either the empirical or newly developed DSM-oriented depressive or anxiety scales. METHODS: A sample of 2,551 young adults, aged 18-23 years, from an Australian cohort study. The association between the empirical and DSM-oriented anxiety and depression scales were individually assessed against DSM-IV depression and anxiety diagnoses derived from structured interview. Odds ratios, ROC analyses and diagnostic efficiency tests (sensitivity, specificity, positive and negative predictive values) were used to report findings. RESULTS: YASR empirical internalising scale predicted DSM-IV mood disorders (depression OR = 6.9, 95% CI 5.0-9.5; anxiety OR = 5.1, 95% CI 3.8-6.7) in the previous 12 months. DSM-oriented depressive or anxiety scales did not appear to improve the concordance with DSM-IV diagnosed depression or anxiety. The internalising scales were much more effective at identifying those with comorbid depression and anxiety, with ORs between 10.1 and 21.7 depending on the internalising scale used. CONCLUSION: DSM-oriented scales perform no better than the standard internalising in identifying young adults with DSM-IV mood or anxiety disorder.