Longitudinal Study of Early Adversity and Disturbing Dream Frequency: Moderating Role of Early Negative Emotionality.

Although disturbing dreams are prevalent in youth and are associated with psychopathology, little is known about their developmental course and risk factors. We aimed to examine the association between early social environment and subsequent disturbing dream frequency across adolescence as moderated by early negative emotionality. Measures of children's early social environment and negative emotionality were collected from the mothers of 410 children (5-42 months old) and measures of disturbing dream frequency directly from the children (13-18 years old). Preliminary steps identified subgroups of families with distinct profiles of social environment using latent variable mixture modeling, and captured changes in disturbing dream frequency using latent growth modeling. Regression and moderation analyses were conducted to test the study objectives. Results showed that the diverse family patterns were best captured by two profiles reflecting adverse and positive social environments and that overall disturbing dream frequency decreased during adolescence. Moderation analyses showed that when early negative emotionality was higher, DD frequency was not only more elevated in an adverse environment, but lower in a positive environment. These results indicate that the development of disturbing dreams is most strongly associated with a combination of individual and environment factors. Our study adds to the literature by refining our conception of individual traits and disturbing dream development and has implications for the prevention of bad dreams, nightmares, and associated psychopathologies.

Phenotypic Environmental Sensitivity and Mental Health During Pregnancy and Post Partum: Protocol for the Experiences of Pregnancy Longitudinal Cohort Study.

BACKGROUND: Mental health problems during pregnancy and post partum are common and associated with negative short- and long-term impacts on pregnant individuals, obstetric outcomes, and child socioemotional development. Socio-environmental factors are important predictors of perinatal mental health, but the effects of the environment on mental health are heterogeneous. The differential susceptibility theory and the environmental sensitivity framework suggest that individuals differ in their degree of sensitivity to positive and negative environments, which can be captured by individual phenotypes such as temperament and personality. While there is strong evidence for these models in childhood, few studies examined them in adults, and they were not examined in pregnancy. OBJECTIVE: The primary objective of the Experiences of Pregnancy study is to explore whether childhood and current environments are associated with mental health and well-being in pregnancy and whether these effects depend on individual sensitivity phenotypes (personality). This study also aims to gather important psychosocial and health data for potential secondary data analyses and integrative data analyses. METHODS: We will conduct a longitudinal cohort study. The study was not registered elsewhere, other than this protocol. Participants will be recruited through social media advertisements linking to the study website, followed by an eligibility call on Zoom (Zoom Video Communications). Participants must be aged 18 years or older, currently residing in the United States as citizens or permanent residents, and currently planning to continue the pregnancy. A minimum of 512 participants will be recruited based on power analyses for the main objectives. Since the data will also be a resource for secondary analyses, up to 1000 participants will be recruited based on the available budget. Participants will be in their first trimester of pregnancy, and they will be followed at each trimester and once post partum. Data will be obtained through self-reported questionnaires assessing demographic factors; pregnancy-related factors; delivery, labor, and birth outcomes; early infant feeding; individual personality factors; childhood and current environments; mental health and well-being; attachment; and infant temperament. A series of measures were taken to safeguard the study from web robots and fraudulent participants, as well as to reduce legal and social risks for participants following Dobbs v. Jackson. RESULTS: The study received ethics approval in April 2023 from the University of Oklahoma-Norman Campus Institutional Review Board. Recruitment occurred from May to August 2023, with 3 follow-ups occurring over 10 months. CONCLUSIONS: The Experiences of Pregnancy study will extend theories of environmental sensitivity, mainly applied in children to the perinatal period. This will help better understand individual sensitivity factors associated with risk, resilience, plasticity, and receptivity to negative and positive environmental influences during pregnancy for pregnant individuals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/49243.

The Building Emotional Awareness and Mental health (BEAM) program developed with a community partner for mothers of infants: protocol for a feasibility randomized controlled trial.

BACKGROUND: Drastic increases in the rates of maternal depression and anxiety have been reported since the COVID-19 pandemic began. Most programs aim to improve maternal mental health or parenting skills separately, despite it being more effective to target both concurrently. The Building Emotional Awareness and Mental health (BEAM) program was developed to address this gap. BEAM is a mobile health program aiming to mitigate the impacts of pandemic stress on family well-being. Since many family agencies lack infrastructure and personnel to adequately treat maternal mental health concerns, a partnership will occur with Family Dynamics (a local family agency) to address this unmet need. The study's objective is to examine the feasibility of the BEAM program when delivered with a community partner to inform a larger randomized controlled trial (RCT). METHODS: A pilot RCT will be conducted with mothers who have depression and/or anxiety with a child 6-18 months old living in Manitoba, Canada. Mothers will be randomized to the 10 weeks of the BEAM program or a standard of care (i.e., MoodMission). Back-end App data (collected via Google Analytics and Firebase) will be used to examine feasibility, engagement, and accessibility of the BEAM program; cost-effectiveness will also be examined. Implementation elements (e.g., maternal depression [Patient Health Questionnaire-9] and anxiety [Generalized Anxiety Disorder-7]) will be piloted to estimate the effect size and variance for future sample size calculations. DISCUSSION: In partnership with a local family agency, BEAM holds the potential to promote maternal-child health via a cost-effective and an easily accessible program designed to scale. Results will provide insight into the feasibility of the BEAM program and will inform future RCTs. TRIAL REGISTRATION {2A}: This trial was retrospectively registered with ClinicalTrial.gov ( NCT05398107 ) on May 31st, 2022.

Building Emotional Awareness and Mental Health (BEAM): an open-pilot and feasibility study of a digital mental health and parenting intervention for mothers of infants.

BACKGROUND: Maternal mental health concerns and parenting stress in the first few years following childbirth are common and pose significant risks to maternal and child well-being. The COVID-19 pandemic has led to increases in maternal depression and anxiety and has presented unique parenting stressors. Although early intervention is crucial, there are significant barriers to accessing care. METHODS: To inform a larger randomized controlled trial, the current open-pilot trial investigated initial evidence for the feasibility, acceptability, and efficacy of a newly developed online group therapy and app-based mental health and parenting program (BEAM) for mothers of infants. Forty-six mothers 18 years or older with clinically elevated depression scores, with an infant aged 6-17 months old, and who lived in Manitoba or Alberta were enrolled in the 10-week program (starting in July 2021) and completed self-report surveys. RESULTS: The majority of participants engaged in each of the program components at least once and participants indicated relatively high levels of app satisfaction, ease of use, and usefulness. However, there was a high level of attrition (46%). Paired-sample t-tests indicated significant pre- to post-intervention change in maternal depression, anxiety, and parenting stress, and in child internalizing, but not externalizing symptoms. Effect sizes were in the medium to high range, with the largest effect size observed for depressive symptoms (Cohen's d = .93). DISCUSSION: This study shows moderate levels of feasibility and strong preliminary efficacy of the BEAM program. Limitations to program design and delivery are being addressed for testing in adequately powered follow-up trials of the BEAM program for mothers of infants. TRIAL REGISTRATION: NCT04772677 . Registered on February 26 2021.

Building Emotional Awareness and Mental Health (BEAM): study protocol for a phase III randomized controlled trial of the BEAM app-based program for mothers of children 18-36 months.

BACKGROUND: The prevalence of maternal depression and anxiety has increased during the COVID-19 pandemic, and pregnant individuals are experiencing concerningly elevated levels of mental health symptoms worldwide. Many individuals may now be at heightened risk of postpartum mental health disorders. There are significant concerns that a cohort of children may be at-risk for impaired self-regulation and mental illness due to elevated exposure to perinatal mental illness. With both an increased prevalence of depression and limited availability of services due to the pandemic, there is an urgent need for accessible eHealth interventions for mothers of young children. The aims of this trial are to evaluate the efficacy of the Building Emotion Awareness and Mental Health (BEAM) app-based program for reducing maternal depression symptoms (primary outcome) and improve anxiety symptoms, parenting stress, family relationships, and mother and child functioning (secondary outcomes) compared to treatment as usual (TAU). METHODS: A two-arm randomized controlled trial (RCT) with repeated measures will be used to evaluate the efficacy of the BEAM intervention compared to TAU among a sample of 140 mothers with children aged 18 to 36 months, who self-report moderate-to-severe symptoms of depression and/or anxiety. Individuals will be recruited online, and those randomized to the treatment group will participate in 10 weeks of psychoeducation modules, an online social support forum, and weekly group teletherapy sessions. Assessments will occur at 18-36 months postpartum (pre-test, T1), immediately after the last week of the BEAM intervention (post-test, T2), and at 3 months after the intervention (follow-up, T3). DISCUSSION: eHealth interventions have the potential to address elevated maternal mental health symptoms, parenting stress, and child functioning concerns during and after the COVID-19 pandemic and to provide accessible programming to mothers who are in need of support. This RCT will build on an open pilot trial of the BEAM program and provide further evaluation of this evidence-based intervention. Findings will increase our understanding of depression in mothers with young children and reveal the potential for long-term improvements in maternal and child health and family well-being. TRIAL REGISTRATION: ClinicalTrials.gov NCT05306626 . Registered on April 1, 2022.

Building Emotional Awareness and Mental Health (BEAM): A Pilot Randomized Controlled Trial of an App-Based Program for Mothers of Toddlers.

Background: Families have faced unprecedented challenges during the COVID-19 pandemic, leading to increased maternal mental health problems and barriers to accessing care. Innovative programs are needed to support both maternal mental health and parenting, and to buffer the long-term impacts of stress on young children. Using a patient-oriented approach, our research team aimed to co-develop and pilot test an App-based psychoeducation and social-connection platform: Building Emotional Awareness and Mental Health (BEAM). Methods: The co-development process involved a parent advisory board from conceptualization and design, through to direct participation in the program delivery. The BEAM program includes weekly videos and activities based on Unified Protocol therapy modules and emotion-focused parenting strategies, a weekly telehealth group review session, and access to a private online forum for support from other mothers and clinical coaches. A parallel randomized control trial was conducted across two provinces in Canada. Mothers of preschool children (aged 18-36 months old), with moderate-to-severe depression (Patient Health Questionaire-9 ≥ 10), were recruited online and randomized to either the 10-week BEAM intervention or treatment as usual (TAU) control group. Online surveys (ensuring researcher blinding) included questions about feasibility and acceptability of the program and pre/post self-report measures of mental health, parenting, positive coping and child behavior outcomes. The primary outcome measures were symptoms of depression and parenting stress. Data were analyzed using mixed models and an intention-to-treat approach. Results: 65 participants were randomized, by an online allocation tool, to the BEAM (n = 33) and TAU (n = 32) groups. Engagement was relatively high at the beginning of the program, with 78.8% starting the BEAM App and 70.6% attending ≥1 telehealth session. Most respondents felt socially supported, satisfied with the App, and found it easy to use. Pre-post results indicated interaction effects with greater reductions in overall mental health problems, and specifically anxiety and sleep symptoms, among BEAM vs. control participants. There were also time effects with reductions in depression symptoms across both groups. No significant treatment effects emerged for the other mental health symptoms, parenting problems, positive coping, or child behavior outcomes. Descriptive data are included to highlight possible areas of promise for future large efficacy trials. Technological difficulties and other challenges that may have led to attrition and impacted outcomes are discussed. There were no adverse events related to study participation. Conclusions: The BEAM program has promise as a novel, feasible and acceptable intervention for improving mental health among mothers of young children. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04772677].

Sleep and mental health in pregnancy during COVID-19: A parallel process growth model.

OBJECTIVES: Pregnancy is associated with elevated risk for poor sleep quality, which increases the risk for poor obstetrical outcomes and parent mental health problems. The COVID-19 pandemic has seen increased reports of disturbed sleep worldwide; however, the degree this extends to pregnancy or influences pregnancy mental health outcomes has not been examined. The goal of this study was to examine changes in pregnant individuals' sleep, anxiety, and depression during the pandemic, and to understand how sleep was associated with symptoms of anxiety and depression over time. METHODS: The Pregnancy During the COVID-19 Pandemic (PdP) study is a prospective longitudinal cohort of pregnant individuals (at enrollment) with repeated follow-ups during pregnancy and the postpartum period. About 3747 pregnant individuals participated between April and July 2020. The present analysis was restricted to participants who completed at least 2 assessments, yielding a final sample of 1842 pregnant individuals. RESULTS: Depression symptoms were elevated at baseline, compared to prepandemic estimates of prevalence, but declined gradually over time. Shorter sleep duration, higher sleep disturbance, and more sleep-related impairments at baseline predicted a slower decline in depression symptoms over time. More sleep disturbances at baseline also predicted slower decline in anxiety symptoms over time. In contrast, rates of depression and anxiety symptoms at baseline were not predictive of changes in any of the 3 sleep variables over time. CONCLUSIONS: These findings highlight the importance of early intervention for sleep problems in pregnancy, in order to optimize mental health throughout pregnancy and mitigate long-term negative outcomes.

Sex and gender terminology: a glossary for gender-inclusive epidemiology.

There is increased interest in inclusion, diversity and representativeness in epidemiological and community health research. Despite this progress, misunderstanding and conflation of sex and gender have precluded both the accurate description of sex and gender as sample demographics and their inclusion in scientific enquiry aiming to distinguish health disparities due to biological systems, gendered experiences or their social and environmental interactions. The present glossary aims to define and improve understanding of current sex-related and gender-related terminology as an important step to gender-inclusive epidemiological research. Effectively, a proper understanding of sex, gender and their subtleties as well as acknowledgement and inclusion of diverse gender identities and modalities can make epidemiology not only more equitable, but also more scientifically accurate and representative. In turn, this can improve public health efforts aimed at promoting the well-being of all communities and reducing health inequities.

Gender-inclusive writing for epidemiological research on pregnancy.

People who have a uterus but are not cisgender women may carry pregnancies. Unfortunately, to date, academic language surrounding pregnancy remains largely (cis) woman-centric. The exclusion of gender-diverse people in the language of pregnancy research in English is pervasive. In reviewing a random sample of 500 recent articles on pregnancy or pregnant populations across health research fields, we found that only 1.2% of articles used gender-inclusive language (none of them in epidemiology), while the remaining 98.8% used (cis) woman-centric language. First and foremost, recent recommendations highlight the need to include trans, non-binary and gender-diverse people in study design. Meanwhile, there remains a lack of awareness that all research on pregnancy can contribute to inclusiveness, including in dissemination and retroactive description. We explain how the ubiquitous use of (cis) woman-centric language in pregnancy-related research contributes to (1) the erasure of gender diversity; (2) inaccurate scientific communication and (3) negative societal impacts, such as perpetuating the use of exclusionary language by students, practitioners, clinicians, policy-makers and the media. We follow with recommendations for gender-inclusive language in every section (ie, introductions, methods, results, discussions) of epidemiological articles on pregnant populations. The erasure of gender-diverse people in the rhetoric of research about pregnant people can be addressed immediately, including in the dissemination of results from ongoing studies that did not take gender diversity into consideration. This makes gender-inclusive language a crucial first step towards the inclusion of gender-diverse people in epidemiological research on pregnant people and other health research more globally.

eHealth Interventions to Treat Substance Use in Pregnancy: A Systematic Review and Meta-Analysis.

Substance use during pregnancy is associated with adverse pregnancy and neonatal outcomes; eHealth interventions offer a potential accessible treatment option. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of eHealth interventions for the treatment of substance use during pregnancy. A comprehensive search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from May 2020 to April 2021. The protocol for this study was registered with Prospero (CRD42020205186) through the University of York Centre for Reviews and Dissemination. Two independent reviewers completed screening, data extraction, and quality assessment. RCTs were included if they reported: (a) administration of an eHealth intervention for (b) substance use outcomes, among (c) pregnant individuals. Comprehensive Meta-Analysis Software (CMA) was used to calculate pooled effect sizes (Odds Ratio) to determine the effect of eHealth interventions on substance use outcomes. Six studies were identified with substance use outcomes that included: smoking (n = 3), alcohol (n = 2), and other (n = 1). eHealth interventions were delivered through the internet (n = 1), computer (n = 3), telephone (n = 1), and text (n = 1). Results suggested that eHealth interventions significantly reduced substance use in pregnant individuals compared to controls (OR = 1.33, 95% CI = 1.06 to 1.65, p = 0.013). eHealth interventions offer a promising and accessible treatment option to reduce substance use during pregnancy. This work was supported by the generous donors of the Alberta Children's Hospital Foundation, the Canadian Child Health Clinician Scientist Program (CCHCSP), the Canadian Institute of Health Research and the Fonds de Recherche du Québec-Santé.

Substance use disorders and suicidality in youth: A systematic review and meta-analysis with a focus on the direction of the association.

BACKGROUND: Reviews and meta-analyses suggest that substance use and suicidality (i.e., suicidal ideations and attempts) are associated in youth, but the direction of this association remains unclear. Theoretically, the secondary psychiatric disorder hypothesis (SPDH) posits that substance use leads to suicidality, while the secondary substance use disorder hypothesis (SSUDH) posits that suicidality leads to substance use. To clarify these associations, this meta-analysis systematically reviewed studies that examined the prospective associations between SUDs and suicidality in youth (age 25 and younger) and compared results according to the direction of the association. METHODS: Web of Science, Embase, PsycINFO, PubMed, Medline and ProQuest Dissertations & Theses Global were searched from inception to March 8, 2020, and 55 effect sizes from 23 samples were included and analyzed using a three-level meta-analysis. RESULTS: SUDs significantly predicted subsequent suicidality (OR = 2.16, 95%CI 1.57-2.97), suicidality significantly predicted subsequent SUDs (OR = 2.16, 95%CI 1.53-3.04), and these effect sizes did not differ (p = 0.49). CONCLUSIONS: Considering that 65% of reviewed studies only examined the SPDH, this review highlights that more attention should be given to the SSUDH, and that studies should examine bidirectional associations between SUDs and suicidality across time. Clinically, because SUDs and suicidality were found to influence each other, results suggest that mental health and SUDs should ideally be detected and treated early, and that co-occurring disorders should be assessed and treated concomitantly.

Longitudinal associations of cannabis, depression, and anxiety in heterosexual and LGB adolescents.

Cannabis use is linked to symptoms of depression and anxiety, particularly among sexual minorities. This study examines the relationships between cannabis, and depression and anxiety symptoms at 13, 15, and 17 years using cross-lagged models in a predominantly White (n = 1,430; 92%) subsample of 1,548 participants from the Quebec Longitudinal study of Child Development. Multigroup analyses were conducted to examine the models according to sexual orientation. Demographic covariates were included as control variables, as well as alcohol, cigarette, and other drug use to examine cannabis specificity. The full sample revealed small bidirectional associations, which remained significant once control variables were included in the model: cannabis at 13 and 15 years predicted anxiety symptoms at 15 and 17 years respectively, and depression symptoms at 15 years predicted cannabis at 17 years. The initial association between cannabis at 13 years and depression symptoms at 15 years was accounted for by other drug use at 13 years. Substantial differences were found between heterosexual participants and sexual minorities: LGB participants presented a substantially larger positive association between depression symptoms at 15 years and cannabis at 17 years, as well as a negative association between anxiety symptoms at 15 years and cannabis at 17 years. Both of these relationships remained significant when accounting for control variables. These results suggest that the relationships between cannabis, and depression and anxiety symptoms are bidirectional across adolescence, albeit small. Sexual minorities present particularly large associations that may represent self-medication efforts for depressive symptoms between 15 and 17 years. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The 3D-Transition Study: Objectives, Methods, and Implementation of an Innovative Planned Missing-Data Design.

The prevalence of mental health problems represents a significant burden on school and community health resources as early as preschool. Reducing this burden requires a better understanding of the developmental mechanisms linking children's early vulnerabilities with mental health after the transition to formal schooling. The 3D-Transition Study (2017-2021) follows 939 participants from a pregnancy cohort in the province of Québec, Canada, as they transition to kindergarten and first grade to examine these mechanisms. Biannual assessments include completed questionnaires from 2 parents as well as teachers, parent-child observations, anthropometric measurements, and age-sensitive cognitive assessments. Saliva is also collected on 11 days over a 16-month period in a subsample of 384 participants to examine possible changes in child salivary cortisol levels across the school transition and their role in difficulties observed during the transition. A combination of planned missing-data designs is being implemented to reduce participant burden, where incomplete data are collected without introducing bias after the use of multiple imputation. The 3D-Transition Study will contribute to an evidence-based developmental framework of child mental health from pregnancy to school age. In turn, this framework can help inform prevention programs delivered in health-care settings during pregnancy and in child-care centers, preschools, and schools.

Reflection on modern methods: planned missing data designs for epidemiological research.

Taking advantage of the ability of modern missing data treatments in epidemiological research (e.g. multiple imputation) to recover power while avoiding bias in the presence of data that is missing completely at random, planned missing data designs allow researchers to deliberately incorporate missing data into a research design. A planned missing data design may be done by randomly assigning participants to have missing items in a questionnaire (multiform design) or missing occasions of measurement in a longitudinal study (wave-missing design), or by administering an expensive gold-standard measure to a random subset of participants while the whole sample is administered a cheaper measure (two-method design). Although not common in epidemiology, these designs have been recommended for decades by methodologists for their benefits-notably that data collection costs are minimized and participant burden is reduced, which can increase validity. This paper describes the multiform, wave-missing and two-method designs, including their benefits, their impact on bias and power, and other factors that must be taken into consideration when implementing them in an epidemiological study design.

Moderation of parenting by inhibitory control in the prediction of the common and unique variance of hyperactivity-impulsivity and inattention.

This study examined whether the interaction between parenting and inhibitory control predicts hyperactivity-impulsivity and inattention in 195 children. Observation data of positive parenting were collected at 4 years, and mother reports of coercive parenting at 5 years, inhibitory control at 6 years, and hyperactivity-impulsivity/inattention at 7 years were obtained. The common and unique variance of hyperactivity-impulsivity and inattention symptoms were examined as outcomes using a bifactor model. Results indicated that positive parenting practices predicted lower levels of hyperactivity-impulsivity/inattention behaviors at age 7 only when children's inhibitory control was high. These results support the vantage sensitivity model, which posits that some individuals show an increased sensitivity to positive experiences exclusively, and support the appropriateness of a targeted prevention approach in early childhood.