A bibliometric analysis of the quantitative schema therapy literature.

BACKGROUND: The evidence base for schema therapy has evolved significantly since it was first developed by Jeffrey Young in the 1990s. The aim of this bibliometric analysis was to summarize the trends and characteristics of the quantitative literature on schema therapy. METHOD: PsycINFO, PubMed and CINAHL Complete databases were last searched on 1 June 2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement to identify peer-reviewed journal articles written in English that reported on original quantitative research on schema therapy or schema therapy constructs. NVivo was used to complete a descriptive analysis of the bibliographic, sample and study characteristics, and a coding framework was applied to capture the aspect of the schema therapy model that was the focus of each study, as well as the study context (e.g., the population or outcomes under investigation). SciVal was used to complete citations and authorship analyses. VOSviewer was used to examine co-authorship networks. RESULTS: A total of 704 quantitative studies on schema therapy were published by 483 unique first authors between 1994 and mid-2023. Studies predominantly used correlational designs with small samples (Mdn N = 153) of mostly females aged 18 years or older. The articles tended to focus on early maladaptive schemas, rather than schema domains or schema modes. Schema therapy and its concepts were most frequently studied in the context of depression and personality disorders. SciVal analyses indicated that, on average, articles were cited 27 times, with a Field Weighted Citation Impact of 1.02. CONCLUSIONS: Schema therapy research output appears to have slowed in recent years and several critical research gaps were evident. Areas of high priority for future research include schema modes and coping responses, and the use of developmental and longitudinal designs to evaluate several key causal assumptions in the theory underpinning schema therapy.

Early maladaptive schemas, emotion regulation difficulties and alexithymia: A systematic review and meta-analysis.

BACKGROUND: Emotion regulation is an integral part of the schema therapy model. The aim of this systematic review and meta-analysis was to synthesize the evidence on the associations between early maladaptive schemas (EMSs), difficulties with emotion regulation and alexithymia. METHOD: PsycINFO, PubMed and CINAHL Complete databases were searched on 28 May 2022 and 3 February 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Included studies were in English, in peer-reviewed journals and reported on the association between one or more of the 18 EMSs or five schema domains and emotion regulation difficulties or alexithymia. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses were conducted to examine difficulties with emotion regulation and alexithymia as correlates of each EMS and domain. RESULTS: A total of 19 studies published between 2008 and 2022 were included (Pooled N = 5957). Difficulties with emotion regulation were positively correlated with all 18 EMSs (range: entitlement r(7) = .28, 95% CI [.13, .42] to negativity pessimism r(5) = .53, 95% CI [.23, .74]) and schema domains (range: impaired limits r(5) = .34, 95% CI [.08, .56] to disconnection rejection r(5) = .44, 95% CI [.33, .73]). Alexithymia was positively correlated with the other-directedness domain (r(2) = .40, 95% CI [.09, .64]) and 16 of the 18 EMSs (range: unrelenting standards r(5) = .21, 95% CI [.12, .28] to emotional inhibition r(5) = .50, 95% CI [.34, .63]). CONCLUSIONS: The findings suggested that almost all 18 EMSs are implicated in emotion regulation difficulties and alexithymia, particularly those relating to unmet needs for attachment and autonomy.

Early maladaptive schemas and obsessive-compulsive disorder: A systematic review and meta-analysis.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a condition with poor treatment outcomes. Improved understanding of the aetiology can inform prevention and treatment approaches; hence several studies have assessed early maladaptive schemas (EMSs) in OCD. This systematic review and meta-analysis aimed to synthesise the evidence on relationships between the 18 EMSs and OCD. METHODS: The study was conducted according to PRISMA guidelines and registered on PROSPERO (CRD42022329337). A systematic search of PubMed, PsycINFO, and CINAHL Complete was conducted on 4 June 2022. Studies in peer-reviewed journal articles were included if they assessed EMSs and OCD (diagnosis or symptom severity) in adults with a mean age of 18 years or older. Studies were excluded if they were not in English, did not include original quantitative data, or reported on case studies. Study details were tabulated and the meta-analysis findings were presented using forest plots. Methodological quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS). RESULTS: Based on 22 studies (pooled N = 3699), all 18 EMSs were positively correlated with OCD. The largest associations were with the dependence/incompetence (r = 0.40 95 % CI [0.32, 0.47]), vulnerability to harm or illness (r = 0.40 95 % CI [0.32, 0.48]), and negativity/pessimism schemas (r = 0.42 95 % CI [0.22, 0.58]). LIMITATIONS: Several meta-analyses showed considerable heterogeneity and publication bias. CONCLUSIONS: The findings suggest all EMSs, particularly those relating to disproportionate negative expectations and a perceived inability to cope, are implicated in OCD. Psychological prevention and treatment for OCD may benefit from targeting these schemas.

Overprotective parenting experiences and early maladaptive schemas in adolescence and adulthood: A systematic review and meta-analysis.

Young's schema model identifies overprotection as a type of childhood experience associated with early maladaptive schemas. This review evaluated the evidence base examining overprotective parenting as a predictor of schema endorsement in adolescence and adulthood. A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, and registered on PROSPERO (CRD42021258990). PsycINFO, CINAHL and PubMed databases were searched on 5 June 2021 for eligible studies reporting original data on unadjusted association(s) between overprotective parenting and schema endorsement in samples with a mean age of 12 years or older. Studies were excluded if they were not in English or peer reviewed or participants were exposed to an intervention. Meta-analyses using Meta-Essentials software examined the relationship between maternal and paternal overprotective parenting with Young's 18 schemas. An adapted version of the Appraisal tool for Cross-Sectional Studies (AXIS) was used to assess methodological quality. A total of 16 articles were included. Based on 36 meta-analyses (Pooled N = 1,496 to 3,218), several schemas demonstrated positive small correlations with maternal overprotective parenting (range: r = 0.15, 95% CI = 0.10, 0.19 [Entitlement] to r = 0.29, 95% CI = 0.13, 0.43 [Enmeshment]) and paternal overprotective parenting (range: r = 0.15, 95% CI = 0.10, 0.20 [Abandonment] to r = 0.24, 95% CI = 0.10, .36 [Enmeshment]). Considerable heterogeneity was detected, but subgroup analyses were not significant. Overall, recollections of overprotective parenting experiences were primarily associated with schemas relating to disconnection and rejection, and impaired autonomy and performance. However, the literature has thus far relied on retrospective measures of parenting, and longitudinal research is needed to establish causality.

Identifying the research priorities for schema therapy: A Delphi consensus study.

Despite the popularity of schema therapy, there exist several important gaps in research on the schema therapy model and its effectiveness. The number of gaps makes it difficult to determine the research areas of the highest strategic priority to advance schema therapy. The objective of this study was to establish consensus among schema therapy clinicians and researchers on the priority areas for future schema therapy research. A panel of experts in schema therapy (43 clinicians and 13 researchers) participated in a Delphi consensus study. The research areas rated were developed by interviewing the founder of schema therapy, Jeffrey Young, conducting a focus group with the executive board of the International Society for Schema Therapy and screening recent reviews on schema therapy for recommendations for future research. The panel rated 81 research areas in terms of priority across three rounds. Nineteen research areas were rated by 75% of the panel as 'Very high priority' or 'High priority'. These priorities reflected four broad themes: (1) schema therapy constructs and measures, (2) the theoretical assumptions underlying schema therapy, (3) schema therapy and theory in relation to different contexts and outcomes and (4) schema therapy effectiveness and mechanisms of change. The findings are important for establishing a clear research agenda for the future of schema therapy.

Schema therapists' perceptions of the influence of their early maladaptive schemas on therapy.

OBJECTIVE: This qualitative survey aimed to explore schema therapists' perceptions of how their early maladaptive schemas are activated in their therapeutic work, and how they manage their reactions. METHOD: An online qualitative survey was conducted with 22 schema therapists. Following brief demographic questions, participants were asked three open-ended questions about their schema activation and associated reactions. An inductive-deductive hybrid thematic analysis of the qualitative responses identified four superordinate themes and 12 subthemes. RESULTS: Participants described several negative impacts on their therapeutic work, including avoiding limit setting, becoming argumentative or aggressive, detaching or avoiding, and over-functioning. An array of strategies for managing schema and countertransference reactions were identified, including refocusing on the client's vulnerability, caring for one's own vulnerability and connecting with one's healthy adult self, and engaging in supervision, training, personal therapy, and self-care. Notably, several participants described how their internal reactions can be used advantageously to conceptualize and support clients, and to facilitate therapists' personal development. CONCLUSION: The findings highlighted that although schema and associated countertransference experiences can be challenging, awareness and effective management of therapists' reactions can benefit treatment and promote personal growth.

Adolescent maladaptive schemas and childhood abuse and neglect: A systematic review and meta-analysis.

This study aimed to review evidence on the associations between childhood emotional, physical and sexual abuse; neglect and bullying and early maladaptive schemas, as measured in adolescence. PubMed, PsycInfo and CINAHL were searched to identify peer-reviewed studies reporting original quantitative data on the association between early maladaptive schemas or schema domains (e.g., Disconnection and Rejection) and childhood emotional, physical and sexual abuse; neglect and bullying, measured in individuals aged up to 18 years. Meta-analyses were conducted to estimate the magnitude of the associations between schemas and childhood experiences. Twelve studies were included: Seven explored schemas, and five examined schema domains. Most studies had somewhat representative samples that were adequate in size, and all used validated measures of schemas or schema domains. Three studies explored emotional neglect, two each for emotional abuse, physical abuse and peer problems, one explored family violence and one adolescent stressors. Meta-analyses indicated small to medium pooled associations between emotional abuse and Emotional Deprivation, r = .33 (95% CI [.19, .46]) and Subjugation, r = .32 (95% CI [.14,.47]) and emotional neglect and Mistrust Abuse, r = .41 (95% CI [.32, .49]), Abandonment, r = .25 (95% CI [.22, .28]), Social Isolation r = .23 (95% CI [.10, .35]) and Failure, r = .35 (95% CI [.26, .44]). Associations between childhood abuse and neglect experiences and schemas were evident in adolescents. There were limited data on some adverse experiences including sexual abuse and neglect. The evidence thus far suggests that maladaptive schemas are related to experiences of childhood emotional abuse and neglect and are evident before adulthood.

Early maladaptive schemas and depression in adulthood: A systematic review and meta-analysis.

BACKGROUND: Improved understanding of the specific cognitive risk factors associated with depression is needed to inform prevention and treatment approaches. Recent research has examined the relationship between early maladaptive schemas (EMSs) and depression, but the findings were yet to be integrated using meta-analytic methods. The aim of this review was to synthesize the evidence on the relationship between depression and EMS. METHOD: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, by searching the PsycINFO, PubMed and CINAHL databases. Included studies were peer-reviewed journal articles that examined the relationship between one or more EMS and depression in adulthood in participants aged 18 years or older. RESULTS: A total of 51 studies were included (k = 743; pooled N = 17,830). All 18 EMSs were positively correlated with depression, with effect sizes ranging from small (r = .23 [.17, .29]; Entitlement) to large (r = .53 [.46, .60]; Social Isolation; r = .50, 95% CI [.45, .54]; Defectiveness/Shame). CONCLUSION: The evidence suggests that individuals who feel like they do not belong, or that they are flawed, bad or unlovable, report higher levels of depression. However, most studies used cross-sectional designs, and further longitudinal research is needed to establish the direction of the relationship between EMS and depression. These findings can guide preventative and treatment approaches. Focusing treatment on the Social Isolation and Defectiveness/Shame EMS may aid in relieving depressive symptoms.

Parental separation or divorce and adulthood attachment: The mediating role of the Abandonment schema.

This study investigated whether the Abandonment schema mediates the relationship between a history of parental separation or divorce and attachment styles in adulthood. Participants (N = 426; Mage = 30.78 years) completed online measures, using Qualtrics. Results demonstrated that a history of parental separation or divorce was positively associated with anxious and avoidant attachment styles in adulthood. Mediation analyses revealed that the Abandonment schema mediated these relationships (p < 0.001). This suggests that adults with a history of parental divorce or separation are more likely to report anxious and avoidant attachment styles, and this is partially accounted for by an expectation that they will be abandoned by others. These findings have implications for case formulation and can be used to inform treatment. Schema therapy focused on healing the Abandonment schema could promote attachment security in individuals with a history of parental separation or divorce. For example, limited reparenting (i.e., the therapist seeking to meet the client's unmet emotional needs, within the professional boundaries of the relationship), could be tailored to address the individual's underlying unmet need for security and stability. Further research is needed to advance our understanding of the implications of these findings for treatment.

Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta-analysis.

Autism spectrum disorder (ASD) and borderline personality Disorder (BPD) share features, including social and emotion regulation difficulties. The evidence for the overlap in prevalence and clinical characteristics was systematically reviewed. Ovid Medline, PsycInfo, and PubMed were searched until November 30, 2020 using keywords relating to BPD and ASD. Studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort, or case-controlled design were included. Of 1633 screened studies, 19 were included, of which 12 reported data suitable for meta-analysis. Most samples were of small, clinically ascertained groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across clinical areas. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was within population prevalence estimates of each disorder. Based on this data we were not able to assess whether there is misdiagnosis of one in favor of the other. Neurocognitive differences may underlie similar behavioral symptoms, but further research using larger, well-validated samples is needed. LAY SUMMARY: Autism spectrum disorder (ASD) and borderline personality disorder (BPD) have overlaps in their symptoms. The overlap in how frequently they co-occur and their presentation was systematically reviewed. We searched the key databases and including all studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort or case-controlled design. Of 1633 studies, 19 were included, of which 12 reported data suitable for pooling. Most samples were of small, clinical groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across studies comparing ASD and BPD related symptoms and problems. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was similar to the population prevalence of each disorder. Further research using larger, well-validated samples is needed.

Mothers' Worries During Pregnancy: A Content Analysis of Reddit Posts.

Qualitative investigations into maternal worries during pregnancy are limited. The aim of this study was to identify the content of women's pregnancy-related worries by completing a content analysis of posts on Reddit. A total of 217 posts by 196 unique users were analyzed. Most worries related to infant factors (32.6%), individual factors (27.1%), and antenatal care factors, such as medical procedures (25.2%). The remaining worries related to situational factors (10.9%) and the partner relationship (4.3%). Although most fears related to fetal well-being, other concerns included problems with family members, women's own mental health, and not being a "good mother." These findings support calls for antenatal education to more adequately address women's psychosocial concerns.

Early maladaptive schemas and intimate partner violence victimization and perpetration: A systematic review and meta-analysis.

Young's early maladaptive schemas represent a possible pathway between childhood adversity and Intimate Partner Violence (IPV). The aim of this review was to synthesize the evidence on early maladaptive schemas and IPV. PubMed, PsycInfo, and CINAHL databases were searched, in compliance with PRISMA, to identify peer reviewed studies that reported on the relationship between schema or schema domain scores and IPV victimization or perpetration. Based on nine included studies, meta-analyses indicated that IPV victimization showed a moderate association with the Disconnection and Rejection and Impaired Autonomy domains, and a small association with Other-Directedness. The Mistrust Abuse and Vulnerability to Harm schemas were moderately correlated with victimization. Mistrust Abuse was also implicated in perpetration but insufficient data were available for meta-analysis. The evidence suggests that being a victim of IPV is associated with an expectation that one's needs for love and safety will not be met and doubt regarding one's capacity to handle responsibilities or succeed in life.

Adverse childhood experiences and early maladaptive schemas in adulthood: A systematic review and meta-analysis.

BACKGROUND: Schema Therapy is based on the theory that trauma and neglect in childhood lead to early maladaptive schemas and psychopathology in adulthood. The aim of this review was to evaluate support for this theory by synthesizing the literature on childhood adversity and schemas. METHODS: A systematic review and meta-analysis were completed in compliance with PRISMA. PsycInfo, CINAHL and PubMed were searched to identify eligible studies that reported unadjusted association(s) between adverse childhood events and schema scores when participants were 18 years or older. Meta-analyses were conducted to estimate the pooled effect size of associations between schemas and experiences of childhood adversity. RESULTS: A total of 33 studies met inclusion criteria and provided sufficient data for meta-analyses on childhood experiences relating to toxic frustration of needs (emotional neglect and physical neglect) and trauma and victimization (emotional abuse, physical abuse and sexual abuse). Of the 124 meta-analyses, 65 indicated that schemas show small to large correlations with emotional neglect (range: r = .16 [Failure] to r = .51 [Emotional Deprivation]); small to moderate correlations with emotional abuse (range: r = .20 [Vulnerability to Harm] to r = .44 [Emotional Deprivation]); and small correlations with physical neglect, physical abuse and sexual abuse (range: r = .16 [Vulnerability to Harm] to .26 [Emotional Deprivation and Social Isolation]). CONCLUSIONS: Of the 33 included studies, only one used a longitudinal design. However, based on the correlational studies available, early maladaptive schemas in adulthood are associated with a history of childhood abuse and neglect.

Midwives' perceptions and experiences of engaging fathers in perinatal services.

BACKGROUND: The active engagement of fathers in maternity care is associated with long-term benefits for the father, their partner, and their child. Midwives are ideally placed to engage fathers, but few studies have explored midwives' experiences of working with men. Therefore, the aim of this study was to describe midwives' perceptions and experiences of engaging fathers in perinatal services. METHOD: A multi-method approach was utilised. Registered midwives (N=106) providing perinatal services to families in Australia participated in an online survey. Of these, 13 also participated in semi-structured telephone interviews. Descriptive analyses summarised the online survey data. The interview data were coded using semantic thematic analysis. RESULTS: Survey results indicated that midwives unanimously agreed that engaging fathers is part of their role and acknowledged the importance of receiving education to develop knowledge and skills about fathers. Analysis of the telephone interviews led to the identification of a range of strategies, facilitators and barriers to engaging fathers in midwifery services. Some of these were related to characteristics of midwives, factors related specifically to fathers, and several external factors relating to organisational policies. CONCLUSIONS: Findings from this study could inform maternity health care policies, as well the development of resources, education and ongoing professional training for midwives to promote father-inclusive practice.

Fathers' Worries During Pregnancy: A Qualitative Content Analysis of Reddit.

Qualitative investigations into the emotional needs of expectant fathers have been limited by difficulties with recruitment. This study aimed to unobtrusively obtain insights into fathers' worries during pregnancy by analyzing the content of posts on the Internet forum Reddit. The majority of worries related to infant well-being (50.8%), particularly the potential for perinatal loss (23.0%). Concerns relating to partner well-being and the couple relationship were also common, comprising 17.0% of posts. Several posts related to individual factors, such as apprehension about the father role (16.3%). Finally, situational factors such as work-family conflict accounted for 15.9% of posts. These findings contribute to the growing literature on fathers' experiences of pregnancy and can inform the development of father-inclusive perinatal education.

A SYSTEMATIC REVIEW OF INTERVENTIONS TARGETING PATERNAL MENTAL HEALTH IN THE PERINATAL PERIOD.

Interventions targeting parents' mental health in the perinatal period are critical due to potential consequences of perinatal mental illness for the parent, the infant, and their family. To date, most programs have targeted mothers. This systematic review explores the current status and evidence for intervention programs aiming to prevent or treat paternal mental illness in the perinatal period. Electronic databases were systematically searched to identify peer-reviewed studies that described an intervention targeting fathers' mental health in the perinatal period. Mental health outcomes included depression, anxiety, and stress as well as more general measures of psychological functioning. Eleven studies were identified. Three of five psychosocial interventions and three massage-technique interventions reported significant effects. None of the couple-based interventions reported significant effects. A number of methodological limitations were identified, including inadequate reporting of study designs, and issues with the timing of interventions. The variability in outcomes measures across the studies made it difficult to evaluate the overall effectiveness of the interventions. Father-focused interventions aimed at preventing perinatal mood problems will be improved if future studies utilize more rigorous research strategies.

Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis.

BACKGROUND: Perinatal distress is a significant public health problem that adversely impacts the individual and their family. The primary objective of this systematic review and meta-analysis was to identify factors that partners can modify to protect each other from developing perinatal depression and anxiety. METHOD: In accordance with the PRISMA statement, we reviewed the risk and protective factors associated with perinatal depression and anxiety symptoms that partners can potentially modify without professional assistance (PROSPERO reference CRD42014007524). Participants were new or expectant parents aged 16 years or older. The partner factors were sub-grouped into themes (e.g., instrumental support) based on a content analysis of the scale items and measure descriptions. A series of meta-analyses were conducted to estimate the pooled effect sizes of associations. RESULTS: We included 120 publications, reporting 245 associations with depression and 44 with anxiety. Partner factors with sound evidence that they protect against both perinatal depression and anxiety are: emotional closeness and global support. Partner factors with a sound evidence base for depression only are communication, conflict, emotional and instrumental support, and relationship satisfaction. LIMITATIONS: This review is limited by the lack of generalizability to single parents and the inability to systematically review moderators and mediators, or control for baseline symptoms. CONCLUSION: The findings suggest that future prevention programs targeting perinatal depression and anxiety should aim to enhance relationship satisfaction, communication, and emotional closeness, facilitate instrumental and emotional support, and minimize conflict between partners.

Use of Twitter to monitor attitudes toward depression and schizophrenia: an exploratory study.

Introduction. The paper reports on an exploratory study of the usefulness of Twitter for unobtrusive assessment of stigmatizing attitudes in the community. Materials and Methods. Tweets with the hashtags #depression or #schizophrenia posted on Twitter during a 7-day period were collected. Tweets were categorised based on their content and user information and also on the extent to which they indicated a stigmatising attitude towards depression or schizophrenia (stigmatising, personal experience of stigma, supportive, neutral, or anti-stigma). Tweets that indicated stigmatising attitudes or personal experiences of stigma were further grouped into the following subthemes: social distance, dangerousness, snap out of it, personal weakness, inaccurate beliefs, mocking or trivializing, and self-stigma. Results and Discussion. Tweets on depression mostly related to resources for consumers (34%), or advertised services or products for individuals with depression (20%). The majority of schizophrenia tweets aimed to increase awareness of schizophrenia (29%) or reported on research findings (22%). Tweets on depression were largely supportive (65%) or neutral (27%). A number of tweets were specifically anti-stigma (7%). Less than 1% of tweets reflected stigmatising attitudes (0.7%) or personal experience of stigma (0.1%). More than one third of the tweets which reflected stigmatising attitudes were mocking or trivialising towards individuals with depression (37%). The attitude that individuals with depression should "snap out of it" was evident in 30% of the stigmatising tweets. The majority of tweets relating to schizophrenia were categorised as supportive (42%) or neutral (43%). Almost 10% of tweets were explicitly anti-stigma. The percentage of tweets showing stigmatising attitudes was 5%, while less than 1% of tweets described personal experiences of stigmatising attitudes towards individuals with schizophrenia. Of the tweets that indicated stigmatising attitudes, most reflected inaccurate beliefs about schizophrenia being multiple personality disorder (52%) or mocked or trivialised individuals with schizophrenia (33%). Conclusions. The study supports the use of analysis of Twitter content to unobtrusively measure attitudes towards mental illness, both supportive and stigmatising. The results of the study may be useful in assisting mental health promotion and advocacy organisations to provide information about resources and support, raise awareness and counter common stigmatising attitudes.

Parenting strategies for reducing the risk of adolescent depression and anxiety disorders: a Delphi consensus study.

BACKGROUND: The family setting, particularly parents, is a strategic target for preventive interventions for youth depression and anxiety disorders. However, more effective translation of relevant research evidence is required. METHOD: This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing adolescent depression or anxiety disorders. A literature search identified 402 recommendations for parents. These were presented to a panel of 27 international experts over three survey rounds, who rated their preventive importance. RESULTS: One-hundred and ninety parenting strategies were endorsed as important or essential in reducing adolescents' risk of developing depression or anxiety disorders by ≥90% of the panel. These strategies were written into a document suitable for parents, categorised under 11 sub-headings: You can reduce your child's risk of depression and anxiety problems, Establish and maintain a good relationship with your teenager, Be involved and support increasing autonomy, Establish family rules and consequences, Minimise conflict in the home, Encourage supportive relationships, Help your teenager deal with problems, Encourage good health habits, Help your teenager to deal with anxiety, Encourage professional help seeking when needed, and Don׳t blame yourself. LIMITATIONS: This study utilised an international panel of experts from Western countries, hence the strategies identified may not be relevant for families from other cultural groups. CONCLUSIONS: This study produced a set of parenting strategies that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their adolescents from depression and anxiety disorders.

The Australian public's beliefs about the causes of depression: associated factors and changes over 16 years.

BACKGROUND: Biological conceptualisations of depression are increasingly prevalent. The current study aimed to investigate the current prevalence of causal beliefs about depression in the Australian public, the factors associated with these beliefs, and changes over time. METHOD: A nationally representative sample of Australian adults was surveyed as part of the 2011 National Mental Health Literacy and Stigma Survey. Beliefs about the causes of depression were assessed based on responses to vignettes depicting a person with either depression (n=893) or depression with suicidal thoughts (n=903). Socio-demographic characteristics, personal and professional experience with depression, and correct recognition of depression were investigated as predictors of causal beliefs about depression using binary logistic regression. Comparisons were made between the Australian public's current causal beliefs and data obtained in national surveys conducted in 1995 and 2003/4. RESULTS: Over 80% of the Australian public attributed depression to day to day problems, death of a close friend or relative, a recent traumatic event, childhood problems, and a chemical imbalance in the brain. People who correctly labelled the disorder in the vignettes were more likely to attribute depression to psychosocial reasons and less likely to attribute it to an allergic reaction, a virus, or an infection. Belief in psychosocial and genetic causes has increased over time, whereas belief in infection, allergy and weakness of character has decreased. LIMITATIONS: Comparisons between the 1995, 2003/4 and 2011 surveys were limited by the differences in the survey methodology at each time point, and by low response rates to the 2003/4 and 2011 surveys. The survey design prevented insight into the reasoning underlying individuals' responses, and lacked sufficient power to explore the beliefs of Australians from cultural minorities. CONCLUSIONS: The majority of the Australian public believe that both psychosocial and biological factors cause depression.