[Preventing emotional disorders in the elderly with programs based on cognitive-behavioral therapies]. / Prévenir les troubles émotionnels des personnes âgées avec des programmes fondés sur les thérapies cognitivo-comportementales.

The cognitive-behavioral approach is particularly well-suited to older people who are looking for a short-term therapeutic solution to many emotional problems, without necessarily resorting to psychotropic drugs. One of the major advantages of this type of psychological treatment is that it helps seniors develop coping skills that can be beneficial in both the short and long term. However, some adjustments are sometimes necessary to achieve this goal.

Technologies Applied to the Mental Health Care of Pregnant Women: A Systematic Literature Review / Tecnologias aplicadas aos cuidados em saúde mental de grávidas: revisão sistemática da literatura

Abstract Objective: This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices. Methods: This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish. Results: The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content. Conclusion: There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age.

Resumo Objetivo: Este artigo objetiva revisar a literatura quanto ao uso das tecnologias como promotoras de saúde mental de gestantes. Desta forma, compreender quais são as estratégias utilizadas no cuidado da saúde mental dessas mulheres, assim como verificar se há evidências científicas que justifiquem a implementação dessas práticas. Métodos: Este estudo segue o protocolo PRISMA para revisões sistemáticas de 27 estudos publicados em 2012-2019, incluindo publicações em português, inglês e espanhol. Resultados: Os resultados revelaram diferentes possibilidades de utilização da tecnologia, sendo o uso de mensagens de texto e de aplicativos em smartphones mais os utilizados (22,5%). No que se refere às ferramentas utilizadas, estratégias cognitivo-comportamentais, tais como verificação do humor, exercícios de relaxamento e psicoeducação compreenderam 44,12% do conteúdo. Conclusão: Verifica-se a necessidade de mais investimentos nessa área para que se possa compreender as possibilidades de intervenção em saúde mental na era digital.

Lycium barbarum polysaccharide attenuates emotional injury of offspring elicited by prenatal chronic stress in rats via regulation of gut microbiota.

Stress during pregnancy is not only detrimental to a woman's own physical and mental health, but can also cause changes in the intrauterine environment and even have an impact on later growth and development, this study was designed to understand the changes of gut microbiota in the maternal and offspring caused by prenatal chronic stress, and to explore the regulatory effect of LBP on gut microbiota, and then to improve the emotional damage caused by prenatal chronic stress in the offspring. A rat model of prenatal chronic stress was made and used LBP to intervene by gavage. Fresh feces of offspring were collected, the concentration of microbial metabolites were tested by ELISA. Illumina MiSeqPE300 sequencing technology was used to determine the sequence of 16S rRNA V3-V4 of microorganisms. On the PND 42, the emotional function of offspring were tested by open-field test (OFT), sucrose preference test (SPT) and tail of suspend test (TST). Results indicated that stress factors increased the plasma corticosterone level of rats during pregnancy and they appeared depressive behaviors. The body weight of offspring during prenatal chronic stress was lower than the control group, and the plasma corticosterone level was increased. Prenatal chronic stress had a significant impact on emotional performance of the offspring on OFT, SPT and TST. Alpha diversity of gut microbiota and microbiota composition in offspring of prenatal chronic stress was attenuated and some relationships existed between these parameters. LBP treatment reduced offspring's plasma corticosterone level and improved their body weight, changed the emotional function, increased the diversity of gut microbiota. Collectively, these findings disclose that prenatal chronic stress not only causes emotional injury on the offspring, but also changes the gut microbiota of the mother and offspring; LBP may regulate the intestinal flora of the mother, then reducing the influence of stress factors on the emotional injury of offspring.

Parents and peer attachment and their relationship with emotional problems in adolescence: is stress mediating? / Apego a padres e iguales y problemas emocionales en adolescentes: ¿es el estrés un mediador?

Adolescence is a vital stage susceptible to the development of stress and emotional problems that reduce well-being. The aim of this work was to study the relationship between attachment to mother, father, and peers, considering the mediating role of stress, and controlling the influence of gender and age. We also studied the relationship between stress and emotional problems with scholar and familiar variables. 700 Spanish students (54.1% girls) between 12 and 15 years participated (M = 13.59; SD = 1.07). Academic performance, family structure, parents and peer attachment (IPPA), emotional problems (SDQ) and stress (PSS-4) were assessed. Data were collected cross-sectional and analysed using SPSS 24.0 and PROCESS (model 4). Descriptive analyses, t-tests, bivariate correlations, and three mediation models were performed. Results suggest that girls suffer more stress (t = 4.51; p = .000) and more emotional problems (t = 7.31; p = .000) than boys. Age correlates positively with stress (r = .12; p = .000). Lastly, stress is a mediating variable between attachment (to both parents and peers) and emotional problems. The importance of addressing stress and emotional symptoms management in adolescence is discussed, particularly in adolescents with poorer quality relationships with their parents and peers. (AU)

La adolescencia es una etapa vital susceptiblede desarrollar estrés y problemas emocionales que reducen el bienestar. El objetivo de este trabajo fue estudiar la relación entre el apego a la madre, al padre y a los iguales, considerando el papel mediador del estrés, y controlando la influencia del género y la edad. También se estudió la relación entre el estrés y los problemas emocionales con variables escolares y familiares. Participaron 700 estudiantes españoles (54,1% chicas) entre 12 y 15 años (M = 13,59; DT = 1.07). Se evaluaron el rendimiento académico, la estructura familiar, el apego a los padres y a los compañeros (IPPA), los problemas emocionales (SDQ) y el estrés (PSS-4). Los datos se recogieron de forma transversal y se analizaron con SPSS 24.0 y PROCESS (modelo 4). Se realizaron análisis descriptivos, pruebas t, correlaciones bivariadas y tres modelos de mediación. Los resultados sugieren que las chicas sufren más estrés (t = 4.51; p = .000) y más problemas emocionales (t = 7.31; p = .000) que los chicos. La edad de los adolescentes correlaciona positivamente con el estrés (r = .12; p = .000). Por último, el estrés es una variable mediadora entre el apego (tanto a los padres como a los compañeros) y los problemas emocionales. Se discute la importancia de abordar el manejo del estrés y de los síntomas emocionales en laadolescencia, particularmente en los adolescentes con relaciones de peor calidad con sus padres y compañeros. (AU)

Systemic Elevation of n-3 Polyunsaturated Fatty Acids (n-3-PUFA) Is Associated with Protection against Visual, Motor, and Emotional Deficits in Mice following Closed-Head Mild Traumatic Brain Injury.

Traumatic brain injury (TBI) causes neuroinflammation and neurodegeneration leading to various pathological complications such as motor and sensory (visual) deficits, cognitive impairment, and depression. N-3 polyunsaturated fatty acid (n-3 PUFA) containing lipids are known to be anti-inflammatory, whereas the sphingolipid, ceramide (Cer), is an inducer of neuroinflammation and degeneration. Using Fat1+-transgenic mice that contain elevated levels of systemic n-3 PUFA, we tested whether they are resistant to mild TBI-mediated sensory-motor and emotional deficits by subjecting Fat1-transgenic mice and their WT littermates to focal cranial air blast (50 psi) or sham blast (0 psi, control). We observed that visual function in WT mice was reduced significantly following TBI but not in Fat1+-blast animals. We also found Fat1+-blast mice were resistant to the decline in motor functions, depression, and fear-producing effects of blast, as well as the reduction in the area of oculomotor nucleus and increase in activated microglia in the optic tract in brain sections seen following blast in WT mice. Lipid and gene expression analyses confirmed an elevated level of the n-3 PUFA eicosapentaenoic acid (EPA) in the plasma and brain, blocking of TBI-mediated increase of Cer in the brain, and decrease in TBI-mediated induction of Cer biosynthetic and inflammatory gene expression in the brain of the Fat1+ mice. Our results demonstrate that suppression of ceramide biosynthesis and inflammatory factors in Fat1+-transgenic mice is associated with significant protection against the visual, motor, and emotional deficits caused by mild TBI. This study suggests that n-3 PUFA (especially, EPA) has a promising therapeutic role in preventing neurodegeneration after TBI.

Chronic unpredictable stress during adolescence protects against adult traumatic brain injury-induced affective and cognitive deficits.

Pre-clinical early-life stress paradigms model early adverse events in humans. However, the long-term behavioral consequences of early-life adversities after traumatic brain injury (TBI) in adults have not been examined. In addition, endocannabinoids may protect against TBI neuropathology. Hence, the current study assessed the effects of adverse stress during adolescence on emotional and cognitive performance in rats sustaining a TBI as adults, and how cannabinoid receptor 1 (CB1) activation impacts the outcome. On postnatal days (PND) 30-60, adolescent male rats were exposed to four weeks of chronic unpredictable stress (CUS), followed by four weeks of no stress (PND 60-90), or no stress at any time (Control), and then anesthetized and provided a cortical impact of moderate severity (2.8 mm tissue deformation at 4 m/s) or sham injury. TBI and Sham rats (CUS and Control) were administered either arachidonyl-2'-chloroethylamide (ACEA; 1 mg/kg, i.p.), a CB1 receptor agonist, or vehicle (VEH; 1 mL/kg, i.p.) immediately after surgery and once daily for 7 days. Anxiety-like behavior was assessed in an open field test (OFT) and learning and memory in novel object recognition (NOR) and Morris water maze (MWM) tasks. No differences were revealed among the Sham groups in any behavioral assessment and thus the groups were pooled. In the ACEA and VEH-treated TBI groups, CUS increased exploration in the OFT, enhanced NOR focus, and decreased the time to reach the escape platform in the MWM, suggesting decreased anxiety and enhanced learning and memory relative to the Control group receiving VEH (p < 0.05). ACEA also enhanced NOR and MWM performance in the Control + TBI group (p < 0.05). These data suggest that 4 weeks of CUS provided during adolescence may provide protection against TBI acquired during adulthood and/or induce adaptive behavioral responses. Moreover, CB1 receptor agonism produces benefits after TBI independent of CUS protection.

Is Physical Activity Associated with Mental Health among Chinese Adolescents during Isolation in COVID-19 Pandemic?

BACKGROUND: Restricted outdoor activities and online learning during COVID-19 pandemic may pose threats on the physical and mental health of Chinese adolescents in middle schools. The study was to explore the relationship of Physical Activity (PA) and Sedentary Time (SED) with mood states among Chinese adolescents during the pandemic. METHODS: A total of 4898 adolescents (16.3 ± 1.3 years old) from 49 middle schools in 13 urban and rural areas in Yan'an, China volunteered to participate in this study and completed online questionnaires. International Physical Activity Questionnaire (IPAQ) were used to measure PA and SED, and Profile of Mood States were used to evaluate mood states. We used Mann-Whitney U-test and Kruskal-Wallis test to assess differences in PA and SED in different sex and grade group, respectively. Mixed linear regression was used to analyze the relationship between PA/SED and mood states. RESULTS: Participants in our study accumulated 23.4 ± 52.5 min of moderate-to-vigorous PA and 363.6 ± 148.4 min of SED per day. The mood states of boys were better than that of girls (p < 0.01). The mood states of the students in Senior High School Grade 3 were at the highest level of mood disturbance. Higher levels of PA were significantly associated with lower levels of total mood disturbance in this population (High PA group according to IPAQ: B = -3.22, SE = 0.40, p < 0.001; Moderate: B = -1.47, SE = 0.37, p < 0.001, compared to Low PA group). CONCLUSION: Chinese adolescents maintained a sedentary lifestyle during the COVID-19 pandemic. Girls and students in Grade 3 Senior High School had higher level of mood disturbance. More PA was associate with improving mood state among adolescents in the pandemic. The present study may assist policymakers and healthcare professionals understand PA and mood states of Chinese adolescents during the epidemic and take targeted actions in case of emergencies in future.

Short- and Long-term Effects of Support Visibility on Support Providers' Negative Affect.

OBJECTIVES: Seminal research with spouses of chronic pain patients indicates that providing patients with instrumental support can be either costly or beneficial for spouses' well-being. Drawing from the invisible support literature, this study evaluated the extent to which patients' recognition of spouses' support moderated daily and long-term associations between spouses' support provision and negative affect. METHOD: Data came from a sample of spouses (N = 145) of knee osteoarthritis (OA) patients, and the patients themselves. Participants completed a baseline interview, 22 days of daily diaries, and two follow-up interviews 6 and 18 months after baseline. Multilevel models were estimated to test study hypotheses. RESULTS: As expected, support visibility moderated daily and long-term associations between spouses' instrumental support provision and negative affect. Spouses reported elevated levels of negative affect in response to providing patients with extra care and attention, but only when their support was not recognized (i.e., reported) by patients. DISCUSSION: Findings from the current study pinpoint support visibility as a protective factor that may mitigate negative short- and long-term effects of spousal instrumental support provision on spouses' negative affect. Promoting patients' awareness of their spouses' support may offset negative emotional consequences of caregiving in the context of chronic health stressors.

Impacto de los factores socio-ambientales en la ludopatía y su relación con la necesidad de la prevención a través de normativas del juego. Consideraciones sobre el Anteproyecto de la Ley del Juego d / Impact of socio-environmental factors on compulsive gambling and the need for prevention through gambling regulations. Considerations of the Draft Law on Gambling by the Regional Valencian Government (Spain)

Desde que el juego se legalizara en España en 1977, bingos, casinos y máquinas tragaperras irrumpen con fuerza en nuestras ciudades y, en poco tiempo, aparecen los primeros casos de ludopatía en España. Lejos de tomar medidas para frenar esta situación, la fácil accesibilidad al mundo del juego, la proliferación de locales para jugar y aparición de nuevos juegos con el potencial adictivo más elevado (p. ej. juego online y apuestas deportivas) han contribuido, entre otros factores, a que la ludopatía se haya convertido en un grave problema en la sociedad, de la que no están exentos los menores de edad. En este artículo se exponen factores predisponen-tes en la ludopatía, siendo de especial relevancia, la necesidad de llevar a cabo por parte de las Administraciones medidas legales para proteger al ciudadano de la ludopatía y generar políticas de juego responsable. En este contexto se analiza el Anteproyecto de Ley que el Consell de la Generalitat Valenciana aprobó el pasado 25 de octubre de 2019 en relación a la Ley del Juego en la Comunidad Valenciana (España) y se detallan algunas consideraciones a tener en cuenta en la reglamentación del juego tanto por parte de las Cortes Valencianas como por parte de otras instituciones autonómicas o de ámbito estatal

Since gambling was legalized in Spain in 1977, bingos, casinos and slot machines underwent an enormous boom in our cities and, in a short time, the first cases of compulsive gambling in Spain appeared. Far from taking measures to curb this situation, easy accessibility to the gambling world, the proliferation of places to gamble and the appearance of new, more addic-tive gambling (pj, online gambling and sports betting) have contributed, among other factors, to gambling having become a serious problem in society, from which minors are not exempt. In this article, predisposing factors in compulsive gambling are described, with the need for the Administration to implement legal measures protect citizens from gambling and generate responsible gambling policies have become particularly relevant. In this context, the Draft Law that the Regional Valencian Government approved on October 25, 2019 in relation to the Gambling Law in the Region of Valencia (Spain) is analyzed and some considerations to be taken into account in the regulation of gambling are detailed by the Valencian Courts and also by other regional or state-level institutions

Alexithymia in Young people's academic career: The mediating role of anxiety and resilience.

Alexithymia prevents people from understanding and adopting verbal language to describe and regulate one's emotions. Recent studies have found that alexithymia symptoms also impact on young people's academic achievement. Nevertheless, it is worth investigating risk and protective roles played by students' academic anxiety and resilience, respectively. The authors expected that students' anxiety and resilience mediated the effect of alexithymia symptoms on students' academic burnout and performance. A sample of 257 university students answered self-report questionnaires about alexithymia, academic anxiety and resilience, and academic burnout and performance. Mediation analyses were performed by the structural equation model. Anxiety acted as a mediator between alexithymia and academic burnout and performance. Furthermore, resilience mediated the effect of alexithymia on burnout, but not on academic performance. The study provides support for preventing alexithymia consequences on young people's academic career by reducing their anxiety and promoting academic resilience. Implications of intervention programs were discussed.

The impact of Balint work on alexithymia, perceived stress, perceived social support and burnout among physicians working in palliative care: a longitudinal study.

OBJECTIVES: Physicians working with palliative patients have a substantial risk of emotional exhaustion because of their daily confrontation with suffering and death. Common concerns include alexithymia, high stress, low perceived social support and a greater burnout risk. This longitudinal study aimed to evaluate the effectiveness of Balint training in preventing the development of these symptoms in these medical professionals. MATERIAL AND METHODS: The design of the study was longitudinal. A group of 69 physicians working with palliative patients from 5 county hospitals in Romania (33 men, 36 women) participated in the study. Out of them, 31 joined and systematically attended a local Balint group whereas the others did not participate in such a group, either during the study or previously. They were given, both at the beginning (2015) and at the end of the study (2017), 4 psychometric instruments assessing alexithymia (Bagby's Toronto Alexithymia Scale), perceived stress (Cohen and Williamson's Perceived Stress Scale), social support (Duke-UNC Functional Social Support Questionnaire) and burnout (Maslach Burnout Inventory). A split-plot ANOVA analysis was used for evaluating the significance of Balint groups participation, with gender and age considered as auxiliary variables. RESULTS: In the study group, Balint training significantly improved the scores of global burnout (F(1, 64) = 25.104, p < 0.0001), 2 of its components (emotional exhaustion (F(1, 64) = 18.390, p < 0.0001) and depersonalization (F(1, 64) = 10.957, p < 0.002), alexithymia (F(1, 64) = 3.461, p < 0.0001) and perceived social support (F(1, 64) = 57.883, p < 0.0001), but not the scores of perceived stress and low personal accomplishment. Gender had an additional contribution in decreasing alexithymia (F(1, 64) = 7.436, p < 0.009) and increasing perceived social support (F(1, 64) = 15.426, p < 0.0001), with higher effects in men. CONCLUSIONS: This study points to the potential usefulness of Balint training in addressing alexithymia and burnout, and in improving perceived social support among physicians working with palliative patients. As the Balint method is easily understood and does not require special investments, it could represent a cost-effective instrument of addressing job-related psychological risks. Int J Occup Med Environ Health. 2019;32(1):53-63.

Changes in irrational beliefs are responsible for the efficacy of the REThink therapeutic game in preventing emotional disorders in children and adolescents: mechanisms of change analysis of a randomized clinical trial.

The mechanisms of change are rarely investigated in the field of gamified interventions for preventing emotional disorders in children and adolescents despite the wide recognition for the advantages they offer as prevention tool. Therefore, the aim of the present study was to investigate the mechanisms of change of a therapeutic game (REThink), specifically mediators and moderators of its efficacy. We conducted a randomized controlled trial, involving 165 children (age range 10-16 years), who were randomly distributed across three groups: the REThink group (N = 54), the Rational Emotive Behavior Education group (N = 55) and the Waitlist condition (N = 56). Results indicated that changes in irrational beliefs were significant mediators for the REThink intervention on depressive mood and overall negative emotions. Age did not moderate the effect of REThink, which indicates that the program was equally effective for children and adolescents.Trial Registration ClinicalTrials.gov NCT03308981.

Online cognitive-behavioral based group interventions for adolescents with chronic illness and parents: study protocol of two multicenter randomized controlled trials.

BACKGROUND: Adolescents with chronic illness (CI) and parents of a child with CI are at risk for psychosocial problems. Psychosocial group interventions may prevent these problems. With the use of cognitive-behavioral therapy, active coping strategies can be learned. Offering an intervention online eliminates logistic barriers (travel time and distance) and improves accessibility for participants. Aim of this study is to examine the effectiveness of two cognitive-behavioral based online group interventions, one for adolescents and one for parents: Op Koers Online. The approach is generic, which makes it easier for patients with rare illnesses to participate. METHODS/DESIGN: This study conducts two separate multicenter randomized controlled trials. Participants are adolescents (12 to 18 years of age) with CI and parents of children (0 to 18 years of age) with CI. Participants are randomly allocated to the intervention group or the waitlist control group. Outcomes are measured with standardized questionnaires at baseline, after 8 (adolescents) or 6 (parents) weeks of treatment, and at 6- and 12-month follow-up period. Primary outcomes are psychosocial functioning (emotional and behavioral problems) and disease-related coping skills. Secondary outcomes for adolescents are self-esteem and quality of life. Secondary outcomes for parents are impact of the illness on family functioning, parental distress, social involvement and illness cognitions. The analyses will be performed according to the intention-to-treat principle. Primary and secondary outcomes will be assessed with linear mixed model analyses using SPSS. DISCUSSION: These randomized controlled trials evaluate the effectiveness of two online group interventions improving psychosocial functioning in adolescents with CI and parents of children with CI. If proven effective, the intervention will be optimized and implemented in clinical practice. TRIAL REGISTRATION: ISRCTN ISRCTN83623452 . Registered 30 November 2017. Retrospectively registered.

[Psychosocial Risk Factors and Negative Emotionality in Early Childhood: Mothers' Perspective]. / Psychosoziale Belastungsfaktoren und negative Emotionalität in der frühen Kindheit: die Perspektive der Mütter.

Psychosocial Risk Factors and Negative Emotionality in Early Childhood: Mothers' Perspective Based on a nationally representative study of parents, this study examines risk factors for mothers' perceptions of young children's negative emotionality, focusing the role of mothers' educational resources and related psychosocial risk factors. Participants were 7,311 mothers with children below age 48 month. Mothers' perception of child emotionality was assessed through two factors, irritability and defiance. Findings from regression analyses showed a stable negative relationship between maternal education and perceived defiance of the child. Although this effect was partly mediated by further psychosocial risk factors, lower education was consistently related with higher perceived defiance. Perceived irritability, in contrast, was not affected by mother's education. Further analyses showed age-specific effects (stronger effects for younger children) as well as a predictive value of mothers' perceptions regarding the occurrence of child abuse or neglect. The results are discussed in the context of early prevention programs in Germany, emphasizing the relevance of identifying risk-groups and offering early and multidimensional prevention.

[Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders]. / Elterliche Mentalisierungsfähigkeit und der Zusammenhang mit elterlicher Belastung bei frühkindlichen Regulationsstörungen.

Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders Parents' capacity to reflect on their child as a mental agent, is defined as an important competence for the early parent-infant relationship. One way to operationalize this is parental reflective functioning (PRF) that distinguishes between mentalizing and non-mentalizing modes of reflection. Until today PRF has not been investigated in samples of infants/toddlers with early regulatory disorders. Goal of the present study is to investigate PRF by comparing a clinical group with parents of infants/toddlers with early regulatory disorders (N = 98) with a healthy control group (N = 27) and testing if PRF is related to parenting stress, past mental illness of the mother, and stress factors related to pregnancy and birth. A semi-structured clinical interview, the Parenting Stress Index, the Symptom-Check-List-90R-S, the Parental Reflective Functioning Questionnaire, and an anamnestic questionnaire were used. Compared to the control group, mothers of infants/toddlers with early regulatory disorders reported significant more prementalizing. Prementalizing in the total sample was significantly predicted by parenting stress, accounting for 16.3 % of the variance. None of the other independent variables significantly predicted prementalizing. Results are discussed in relation to early regulatory disorders and implications for clinical practice.

Population-Based System of Parenting Support to Reduce the Prevalence of Child Social, Emotional, and Behavioural Problems: Difference-In-Differences Study.

The quality of parenting is recognised as an important determinant of children's mental health. Parenting interventions typically target high-risk families rather than adopting a universal approach. This study examined the population impact of the Triple P Positive Parenting Programme on the prevalence of children's social, emotional, and behavioural problems. A propensity score matching difference-in-differences method was used to compare intervention and comparison regions matched on socio-demographic characteristics in midlands Ireland. The pre-intervention sample included 1501 and 1495 parents of children aged 4-8 years in the intervention and comparison regions respectively. The post-intervention sample included 1521 and 1544 parents respectively. The primary outcome measure was parental reports on the Strengths and Difficulties Questionnaire. There were some significant reductions in the prevalence rates of social, emotional, and behavioural problems in the intervention regions compared to the comparison regions. Children in the intervention sample experienced lower total difficulties, emotional symptoms, and conduct problems than children in the comparison sample, and they were less at risk of scoring within the borderline/abnormal range for total difficulties, conduct problems, and hyperactivity. The programme reduced the proportion of children scoring within the borderline/abnormal range by 4.7% for total difficulties, 4.4% for conduct problems, and 4.5% for hyperactivity in the total population. This study demonstrated that a universal parenting programme implemented at multiple levels using a partnership approach may be an effective population health approach to targeting child mental health.

Experiences of parenting and clinical intervention for mothers affected by personality disorder: a pilot qualitative study combining parent and clinician perspectives.

BACKGROUND: Evidence-based parenting programmes are recommended for the treatment of child mental health difficulties. Families with complex psychosocial needs show poorer retention and outcomes when participating in standard parenting programmes. The Helping Families Programme (HFP) is a 16-week community-based parenting intervention designed to meet the needs of these families, including families with parental personality disorder. This study aimed to explore the help seeking and participatory experiences of parents with a diagnosis of personality disorder. It further aimed to examine the acceptability of referral and intervention processes for the HFP from the perspectives of (i) clinicians referring into the programme; and (ii) referred parents. METHOD: Semi-structured interviews were conducted with parents recruited to receive HFP (n = 5) as part of a research case series and the referring NHS child and adolescent mental health service (CAMHS) clinicians (n = 5). Transcripts were analysed using Interpretive Phenomenological Analysis. RESULTS: Four themes were identified for parents: (i) the experience of parenthood, (ii) being a parent affected by personality disorder, (iii) experience of the intervention, and (iv) qualities of helping. Three themes emerged for clinicians: (i) challenges of addressing parental need, (ii) experience of engaging parents with personality disorders and (iii) limited involvement during HFP. Comparison of parent and clinician themes led to the identification of two key interlinked themes: (i) concerns prior to receiving the intervention, and (ii) the challenges of working together without a mutual understanding. CONCLUSIONS: This pilot study identifies potentially significant challenges of working with parents affected by personality disorder and engaging them in HFP and other similar interventions. Results have important wider clinical implications by highlighting potential barriers to engagement and participation and providing insights on how these barriers might be overcome. Findings have been used to inform the referral and intervention processes of a pilot RCT and further intervention development.

Antenatal consultations for preterm labour: how are future mothers reassured?

OBJECTIVE: To evaluate whether the antenatal consultation for preterm labour worries or reassures women, and to identify factors contributing to these feelings. DESIGN: This is a prospective survey study from April 2012 to September 2013. This mixed-methodology tool was co-constructed with patients and first tested in a single-centre pilot study. SETTING: Three university-affiliated, tertiary care, high-risk obstetrics inpatient units in Quebec, Canada. PARTICIPANTS: Women hospitalised with threatened preterm labour between 26 and 32 weeks' gestational age completed the survey within 72 hours of an antenatal consultation by neonatology. 341 women were invited to participate and 226 mothers completed the survey (72% response rate), at a median gestational age of 30 weeks. MAIN OUTCOME MEASURES: Participant worry, reassurance and change in perception after the antenatal consultation were the main outcome measures. Multivariable logistic regression was used to identify factors associated with these outcomes. RESULTS: 23% of participants were worried by the consultation, and 87% were reassured by it. Lower gestational age and higher maternal education were associated with feeling worried (adjusted OR=0.83, 95% CI 0.70 to 0.99; and adjusted OR=2.15, 95% CI 1.04 to 4.44, respectively). Longer consultations were associated with reassurance (adjusted OR=8.21, 95% CI 2.67 to 25.26). Women were reassured by (1) feeling well informed about prematurity with optimistic outlooks, and (2) a trusting and reassuring expert neonatology team. High-quality interactions with neonatologists were associated with reassurance, while poorer communications were associated with feelings of worry. CONCLUSIONS: To be reassuring, neonatologists should strive to establish a trusting relationship with mothers, in which realistic and clear, but optimistic, information is offered.