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1.
PLoS One ; 15(11): e0242437, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33211766

RESUMEN

INTRODUCTION: Adverse childhood experiences (ACE) have been recognized as an important risk factor for suicidal behaviour among adults, but evidence from low and middle-income countries is lacking. This study explored associations between ACE and hospital admission due to non-fatal self-poisoning in Sri Lanka. METHODS: This was a case-control study. Adults admitted to a tertiary care hospital for medical management of self-poisoning were included as cases, and age and sex matched controls were recruited from the outpatient department. ACE were measured using the World Health Organization's Childhood Adversity Scale. Logistic regression models adjusting for age, sex, ethnicity, and religion were used to quantify the association between ACE and self-poisoning. RESULTS: The study included 235 cases and 451 controls. Cases were 2.5 times (95% CI 1.8, 3.6) more likely to report an ACE than controls and had higher ACE scores. Childhood physical abuse (OR 4.7, 95% CI 1.2, 19.0) and emotional abuse or neglect (OR 3.7, 95% CI 1.3, 10.1, and 3.7, 95% CI 2.3, 6.0 respectively), increased the risk of self-poisoning in adulthood, as did witnessing household violence (OR 2.2, 95% CI 1.4, 3.4), growing up in a household with a mentally ill or suicidal household member (OR 2.1, 95% CI 1.2, 3.4), and experiencing parental death/separation/divorce (OR 3.1, 95% CI 2.0, 4.9) as a child. CONCLUSIONS: Reducing exposures to ACEs should be a priority for prevention of suicide and self-harm in Sri Lanka. Innovative methods to increase support for children facing adversity should be explored.

2.
J Affect Disord ; 2020 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-33250203

RESUMEN

BACKGROUND: Biological markers of suicide risk have the potential to inform prevention and treatment efforts. It has recently been hypothesised that inflammation may influence mood and in turn suicide risk. We investigated the association between indicators of systemic inflammation and suicide in a large cohort of Taiwanese adults. METHODS: White blood cell (WBC) count and levels of C-reactive protein (CRP) were measured in 462,747 and 359,849 adults in the Taiwan MJ cohort, respectively. The associations between WBC, CRP and suicide risk were investigated using Cox proportional hazards models adjusting for a range of potential confounding factors. RESULTS: During a mean 15.1 and 15.8 years of follow-up, 687 and 605 suicides were identified in participants who had information on WBC and CRP respectively. There was an association of suicide with WBC count (adjusted hazard ratio [aHR] = 1.13 per 1 standard deviation increase of log-transformed WBC, 95% confidence interval [CI] 1.05, 1.22). The association was driven by the highest quintile of WBC count (aHR = 1.39, 95% CI 1.09, 1.77; reference: the lowest quintile). No association between CRP and suicide was found. LIMITATIONS: Our cohort was from a privately-run health check-up programme and had a lower suicide rate than that in the general population. CONCLUSIONS: Individuals with the highest WBC counts may have increased risk of suicide. Peripheral markers of inflammation are potential biomarkers of suicide risk; however, this seems to vary by population and the marker investigated and could be influenced by a range of confounding factors.

3.
Brain Behav Immun ; 89: 43-50, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32473944

RESUMEN

BACKGROUND: The causal role of inflammatory markers on self-harm and suicidal risk has been studied using observational data, with conflicting results. Confounding and reverse causation can lead to bias, so we appraised question from a genetic perspective to protect against these biases. We measured associations between genetic liability for high levels of inflammatory markers Interleukin-6 (IL-6) and C-reactive protein (CRP) on self-harm, and conducted a secondary analysis restricted to self-harm with suicidal intent. METHODS: We conducted two sample and multivariable Mendelian randomisation (MR) to assess the effects of IL-6 and CRP on self-harm utilising existing data and conducting new genome wide association studies to instrument IL-6 and CRP, and for the outcome of self-harm. RESULTS: No single nucleotide polymorphisms (SNPs) reached genome-wide significance for self-harm, however 193 SNPs met suggestive significance levels (p < 5 × 10-6). We found no evidence of an association between our instruments for IL-6 and self-harm in the two-sample MR, however we found an inverse association between instruments for CRP and self-harm, indicating that higher levels of circulating CRP may protect against self-harm (inverse variance weighted OR 0.92, 95%CI 0.84, 1.01, p = 0.08; MR Egger OR 0.86, 95% CI 0.74, 1.00, p = 0.05). The direct effect estimate for IL-6 was slightly smaller in the multivariable MR than in the two sample MR, while the CRP effect estimates were consistent with the two sample MR (OR 0.92, SE 1.05, p = 0.09). CONCLUSIONS: Our findings are conflicting and indicate that IL-6 and CRP are not robust etiological markers of increased self-harm or suicide risk.

4.
Br J Educ Psychol ; 90(2): 330-348, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-30980389

RESUMEN

BACKGROUND: Teaching is a stressful occupation with poor retention. The Incredible Years® Teacher Classroom Management (TCM) programme is a training programme that research has demonstrated may be an effective intervention for improving children's mental health, but little research has explored any impacts there may be on the teachers' own professional confidence and mental health. AIMS: In this paper, we evaluate whether TCM may lead to changes in teachers' well-being, namely a reduction in burnout and an improvement in self-efficacy and mental health. SAMPLE: Eighty schools across the South West of England were recruited between September 2012 and September 2014. Headteachers were asked to nominate one class teacher to take part. METHODS: Eighty teachers were randomized to either attend a TCM course (intervention) or not (control). TCM was delivered to groups of up to 12 teachers in six whole-day workshops that were evenly spread between October and April. At baseline and 9-month follow-up, we measured teachers' mental health using the Everyday Feelings Questionnaire (EFQ), burnout using the Maslach Burnout Inventory-General Survey (MBI-GS), and self-efficacy using the Teachers' Sense of Efficacy Scale-Short (TSES-Short). RESULTS: Using linear regression models, there was little evidence of differences at follow-up between the intervention and control teachers on the outcomes (the smallest p-value was .09). CONCLUSIONS: Our findings did not replicate previous research that TCM improved teachers' sense of efficacy. However, there were limitations with this study including low sample size.

5.
Child Adolesc Ment Health ; 24(3): 230-238, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31588199

RESUMEN

Background: Adolescent self-harm is a major public health concern. To date there is a limited evidence-base for prevention or intervention, particularly within the school setting. To develop effective approaches, it is important to first understand the school context, including existing provision, barriers to implementation, and the acceptability of different approaches. Methods: A convenience sample of 222 secondary schools in England and Wales were invited to participate in a survey, with a 68.9% (n = 153) response rate. One member of staff completed the survey on behalf of each school. Participants responded to questions on the existing provision of adolescent self-harm prevention and intervention, barriers to delivery, and future needs. Results: Adolescent self-harm is an important concern for senior management and teachers. However, emotional health and well-being is the primary health priority for schools. Health services, such as Child and Adolescent Mental Health Services, and on-site counselling are the main approaches schools currently use to address adolescent self-harm, with counselling cited as the most useful provision. Fifty-two per cent of schools have received some staff training on adolescent self-harm, although only 22% rated the adequacy of this training as high. Where schools do not have existing provision, respondents stated that they would like staff training, specialist student training, external speakers, posters and assemblies, although the latter four options were infrequently ranked as the most useful approaches. Key barriers to addressing adolescent self-harm were: lack of time in the curriculum; lack of resources; lack of staff training and time; and fear of encouraging self-harm amongst adolescents. Conclusions: Adolescent self-harm is a priority for schools. Intervention might focus on increasing the availability of training to teaching staff.

6.
J Child Psychol Psychiatry ; 60(10): 1094-1103, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31486089

RESUMEN

BACKGROUND: Adverse childhood experiences (ACEs) such as physical and emotional abuse are strongly associated with self-harm, but mechanisms underlying this relationship are unclear. Inflammation has been linked to both the experience of ACEs and self-harm or suicide in prior research. This is the first study to examine whether inflammatory markers mediate the association between exposure to ACEs and self-harm. METHODS: Participants were 4,308 young people from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in the United Kingdom. A structural equation modelling approach was used to fit a mediation model with the number of ACEs experienced between ages 0 and 9 years old (yo), levels of the inflammatory markers interleukin-6 and C-reactive protein measured at 9.5 yo, and self-harm reported at 16 yo. RESULTS: The mean number of ACEs young people experienced was 1.41 (SE 0.03). Higher ACE scores were associated with an increased risk of self-harm at 16 yo (direct effect relative risk (RR) per additional ACE 1.11, 95% CI 1.05, 1.18, p < 0.001). We did not find evidence of an indirect effect of ACEs on self-harm via inflammation (RR 1.00, 95% CI 1.00, 1.01, p = 0.38). CONCLUSIONS: Young people who have been exposed to ACEs are a group at high risk of self-harm. The association between ACEs and self-harm does not appear to be mediated by an inflammatory process in childhood, as indexed by peripheral levels of circulating inflammatory markers measured in childhood. Further research is needed to identify alternative psychological and biological mechanisms underlying this relationship.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Inflamación/epidemiología , Conducta Autodestructiva/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Inflamación/sangre , Estudios Longitudinales , Masculino , Reino Unido/epidemiología
7.
Br J Dev Psychol ; 36(4): 557-572, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29498073

RESUMEN

Although attachment plays a key role in children's socio-emotional development, little attention has been paid to the role of children's attachment to their father. This study examined whether insecure attachment to each parent was associated with reduced emotion understanding in children and whether children showed consistent attachments to their mother and father. We measured children's attachment to each parent using the Manchester Child Attachment Story Task and child emotion understanding using the Test of Emotion Comprehension (children's Mage  = 5.64 years, SD = 0.84). The results indicated that insecure father-child attachment and insecure mother-child attachment were each associated with lower emotion understanding in children after controlling for parent's depressive symptoms and children's age. There was significant concordance of child attachment to mother and father. The findings provide support for convergence of children's attachment across parents and suggest that father-child attachment is an important factor to consider when examining children's emotion understanding. Statement of contribution What is already known on this subject Secure mother-child attachment is positively associated with children's emotional competence. Children form similar representations of attachment to their mother and father. What the present study adds Both mother-child and father-child attachment are associated with children's emotion understanding. The study's findings highlight the importance of father-child attachment in their children's emotion understanding. The study provides support for concordance of children's attachment across parents.


Asunto(s)
Conducta Infantil/fisiología , Comprensión/fisiología , Emociones/fisiología , Relaciones Padre-Hijo , Relaciones Madre-Hijo , Apego a Objetos , Adulto , Preescolar , Femenino , Humanos , Masculino
8.
Soc Psychiatry Psychiatr Epidemiol ; 53(1): 33-44, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29124294

RESUMEN

PURPOSE: Attention deficit/hyperactivity disorder (ADHD) is associated with socioeconomic status (SES), in that children who grow up in low SES families are at an increased risk of ADHD symptoms and diagnosis. The current study explores whether different levels of ADHD symptoms are associated with prior changes in the SES facet of financial difficulty. METHODS: Using the Avon Longitudinal Study of Parents and Children (ALSPAC), we examined symptoms of ADHD measured by the Strengths and Difficulties Questionnaire (SDQ) hyperactivity subscale in relation to parent-reported changes in financial difficulty, grouped into four repeated measures at four time points across childhood; (n = 6416). A multilevel mixed-effects linear regression model with an unstructured covariance matrix was used to test whether different patterns of financial difficulty were associated with subsequent changes in ADHD symptoms. RESULTS: Families who had no financial difficulty had children with a lower average ADHD symptom score than groups who experienced financial difficulty. Children whose families stayed in financial difficulty had higher mean ADHD symptom scores than all other groups (No difficulty mean SDQ hyperactivity 3.14, 95% CI 3.07, 3.21, In difficulty mean SDQ hyperactivity 3.39, 95% CI 3.28, 3.45, p < 0.001). Increasing or decreasing financial difficulty predicted mean symptom scores lower than those of the in difficulty group and higher than the no difficulty group. CONCLUSIONS: Our findings contribute to the building evidence that SES may influence the severity and/or impairment associated with the symptoms of ADHD, however the effects of SES are small and have limited clinical significance.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Pobreza/psicología , Adolescente , Niño , Femenino , Humanos , Renta , Estudios Longitudinales , Masculino , Padres , Clase Social , Evaluación de Síntomas
9.
Br J Clin Psychol ; 56(4): 431-442, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28805254

RESUMEN

OBJECTIVES: Although rumination can have a negative influence on the family environment and the quality of parent-child interactions, there is little research on the role of parental rumination in predicting adverse child outcomes over time. This longitudinal study examined whether mothers' and fathers' brooding rumination would each uniquely predict emotional symptoms in preschool children. METHODS: The initial sample consisted of 160 families (including 50 mothers with past depression, 33 fathers with past depression, and 7 fathers with current depression according to the Structural Clinical Interview for DSM-IV). Families were seen at two times separated by 16 months. Children's mean age at the entry into the study was 3.9 years (SD = 0.8). Each parent independently completed the Ruminative Response Scale, the Child Behavior Checklist, the Patient Health Questionnaire, and the Dyadic Adjustment Scale. RESULTS: Fathers' brooding rumination significantly predicted children's emotional symptoms over 16 months when controlling for child emotional symptoms, couple adjustment, parents' depressive symptoms, mothers' brooding and reflective rumination, and fathers' reflective rumination at baseline. Unexpectedly, mothers' brooding rumination did not significantly predict child emotional symptoms over time. Correlational analyses showed significant associations between parents' rumination and lower levels of couple adjustment. CONCLUSIONS: Findings suggest that fathers' brooding rumination may play a unique role in their children's emotional outcomes. If these findings are replicated, studies should examine the processes by which these links occur and their implications for clinical interventions. PRACTITIONER POINTS: Rumination is prevalent among individuals with depression, but to date no studies have examined the possible role of mothers' and fathers' brooding rumination in predicting children's emotional symptoms. Fathers' brooding rumination was positively associated with children's emotional symptoms over time when controlling for mothers' rumination and other important characteristics. Parental rumination might be a promising target for both prevention and intervention strategies for parents with depression and their children. The findings of this study could inform parenting interventions (e.g., educate parents about the possible effects of rumination on family interactions and children's outcomes, help parents notice when they ruminate, teach them to replace rumination with more adaptive strategies). The findings should be interpreted with caution. The study relied on self-reports, and therefore, the data are subject to shared method variance which may have artificially inflated associations between parent and child outcomes. The sample consisted of well-educated parents, and therefore, the findings should be generalized to other populations with caution.


Asunto(s)
Depresión/complicaciones , Depresión/psicología , Emociones , Padre/psicología , Madres/psicología , Relaciones Padres-Hijo , Adulto , Preescolar , Femenino , Humanos , Estudios Longitudinales , Masculino
10.
Child Psychiatry Hum Dev ; 47(3): 440-58, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-26266467

RESUMEN

This systematic review examines associations between parental socioeconomic disadvantage and childhood attention deficit/hyperactivity disorder (ADHD). Socioeconomic status (SES) was measured by parental income, education, occupation and marital status. Results were mixed by measure of SES with no one aspect being differentially related to ADHD. 42 studies were included in the review, of which 35 found a significant univariate association between socioeconomic disadvantage and ADHD. Meta-analyses of dimensions of SES and their association with ADHD indicate that children in families of low SES are on average 1.85-2.21 more likely to have ADHD than their peers in high SES families. In spite of substantial between-study heterogeneity, there is evidence for an association between socioeconomic disadvantage and risk of ADHD measured in different ways. This is likely mediated by factors linked to low SES such as parental mental health and maternal smoking during pregnancy.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Niño , Humanos , Factores de Riesgo , Factores Socioeconómicos
11.
PLoS One ; 10(6): e0128248, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26030626

RESUMEN

BACKGROUND: Children from disadvantaged socioeconomic backgrounds are at greater risk of a range of negative outcomes throughout their life course than their peers; however the specific mechanisms by which socioeconomic status relates to different health outcomes in childhood are as yet unclear. AIMS: The current study investigates the relationship between socioeconomic disadvantage in childhood and attention deficit/hyperactivity disorder (ADHD), and investigates putative mediators of this association in a longitudinal population-based birth cohort in the UK. METHODS: Data from the Avon Longitudinal Study of Parents and Children was used (n = 8,132) to explore the relationship between different measures of socioeconomic status at birth-3 years and their association with a diagnosis of ADHD at age 7. A multiple mediation model was utilised to examine factors occurring between these ages that may mediate the association. RESULTS: Financial difficulties, housing tenure, maternal age at birth of child and marital status were significantly associated with an outcome of ADHD, such that families either living in financial difficulty, living in council housing, with younger or single mothers' were more likely to have a child with a research diagnosis of ADHD at age 7. Financial difficulties was the strongest predictor of ADHD (OR 2.23 95% CI 1.57-3.16). In the multiple mediation model, involvement in parenting at age 6 and presence of adversity at age 2-4 mediated 27.8% of the association. CONCLUSIONS: Socioeconomic disadvantage, conceptualised as reported difficulty in affording basic necessities (e.g. heating, food) has both direct and indirect impacts on a child's risk of ADHD. Lower levels of parent involvement mediates this association, as does presence of adversity; with children exposed to adversity and those with less involved parents being at an increased risk of having ADHD. This study highlights the importance of home and environmental factors as small but important contributors toward the aetiology of ADHD.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Clase Social , Adulto , Niño , Preescolar , Estudios de Cohortes , Escolaridad , Femenino , Humanos , Renta/estadística & datos numéricos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Salud Mental/estadística & datos numéricos , Modelos Estadísticos , Ocupaciones/estadística & datos numéricos , Padres , Embarazo
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