Parenting behaviors, parenting styles, and non-suicidal self-injury in young people: a systematic review.

Non-suicidal self-injury (NSSI) is a worrying phenomenon that is prevalent among young people. Prior theorizing and empirical evidence suggest that parenting may play a role in the etiology of NSSI. Thus, we conducted a systematic review to examine the association between parenting behaviors and parenting styles with NSSI in young people. METHODS: The following databases were searched for relevant articles in July 2020: PubMed, EMBASE, CINAHL Plus, and PsycINFO. Studies were included if they sampled young persons aged 10-25 years old with a history of NSSI, assessed parenting behavior or style, and tested associations between parenting and NSSI outcomes. RESULTS: A total of 26 studies were included in this review. Among parenting behaviors, low parental support, high psychological control, and high reactive control were more consistently associated with NSSI. Conversely, the evidence for behavioral control is equivocal. There is some evidence that invalidating parenting is also associated with NSSI. CONCLUSION: Consistent with the wider adolescent psychopathology literature, parenting that is perceived to be supportive, less psychologically controlling and reactive/punitive were less likely to be associated with NSSI. However, these results were largely based on child reports of parenting. Limitations and directions for future research are discussed.

Comparing Emotional Adjustment of Living-donor and Deceased-donor Kidney Transplant Patients.

Kidney transplantation is regarded as the best treatment option for patients with end-stage renal disease. However, living-donor recipients (LDRs) and deceased-donor recipients (DDRs) still face challenges in transplant-specific emotional adjustment post-transplantation. Research distinguishing emotional adjustment between transplant groups has been limited to Western settings, with little attention given to Asian populations. As such, documenting and comparing the emotional adjustment of LDRs and DDRs in an ethnically diverse Asian setting in Singapore and identifying factors associated with emotional adjustment are of interest. METHODS: One hundred eighty-two kidney transplant patients (106 LDRs and 76 DDRs) completed measures of generic distress (Depression, Anxiety, Stress Scale-21) and transplantation-specific emotional and behavioral outcomes (Transplant Effects Questionnaire). RESULTS: LDRs were significantly younger (P = 0.019) and had higher education levels (P = 0.007), higher personal income (P < 0.001), shorter dialysis vintage (P < .001), and higher estimated glomerular filtration rates (eGFRs) (P = 0.002) compared with DDRs. Generic symptoms of depression and stress were very low; however, 29.2% of LDRs and 19.7% of DDRs experienced moderate to severe symptoms of anxiety. Similarly, 83.0% of LDRs and 72.4% of DDRs reported high levels of transplant-specific worry. Multivariate models showed younger patients expressing greater generic distress, and transplant-specific worry (P < 0.01), despite higher eGFRs (P < 0.05). ANCOVA controlling for casemix differences showed that LDRs experienced higher feelings of guilt (P = 0.004) and greater willingness to disclosure (P = 0.041). CONCLUSIONS: Clinicians should be vigilant of younger kidney transplant patients who have greater risk of poorer emotional adjustment. Future interventions should target alleviating anxiety and transplant-specific worry.

Unintentional and intentional non-adherence to immunosuppressive medications in renal transplant recipients.

Background Non-adherence to immunosuppressive medications following renal transplantation is a risk factor for rejection and graft loss. Despite the dire consequences, adherence lapses, both unintentional and intentional, are common and poorly understood. Objective The present study sets to compare the rates and determinants of unintentional, intentional and overall self-reported non-adherence. Setting Outpatient clinic at the National University Centre for Organ Transplantation, Singapore. Method This was a cross-sectional survey administered to N = 152 renal transplant recipients. Main outcome measure They completed the Transplant Effects Questionnaire, Beliefs about Medications Questionnaire, Multidimensional Scale of Perceived Social Support, the Depression, Anxiety and Stress Scale, and the Medication Adherence Report Scale. Clinical and laboratory information were also assessed. Results The prevalence rates for overall, unintentional, and intentional self-reported non-adherence were 19.7, 47.4, and 15.1% respectively. Unintentional non-adherence was predicted by engagement in formal work, a primary diagnosis of autoimmune nephritis, and being a recipient of a living-donor renal transplant (i.e. stable characteristics). In contrast, intentional non-adherence was predicted by co-morbid burden and patients' evaluation of the side effects of their medications. Overall non-adherence was predicted by a deliberate decision-making process involving the weighing of the costs of using immunosuppressive drugs against their perceived benefits. Conclusion The survey highlighted the importance of making a distinction between unintentional and intentional non-adherence in renal transplant recipients, and suggested that modifiable factors may be targeted in different ways in interventions to increase adherence.