Feelings of Loneliness and Social Dissatisfaction in Siblings of Children with Autism Spectrum Disorders: The Role of Birth Order and Perceived Social Support.

Loneliness has been associated with several adverse psychosocial outcomes in childhood and adolescence. The present study aimed to investigate feelings of loneliness and social dissatisfaction in school-aged typically-developing (TD) siblings of children with an autism spectrum disorder (ASD). For this purpose, 118 siblings of children with ASD and 115 siblings of TD children and one of their parents participated in this study. Siblings of ASD-children reported higher levels of loneliness and social dissatisfaction than the controls. The hierarchical multiple regressions performed revealed that those feelings were inversely associated with being the first-born and with specific aspects of social support as perceived by the parent. The younger siblings of ASD-children seem to be in need of certain interventions beyond social support.

Factors Associated with Feeding Problems in Young Children with Gastrointestinal Diseases.

Feeding problems are associated with the consumption of a limited amount or restricted variety of foods and often occur in children with gastrointestinal diseases. The majority of studies to date do not use valid and reliable measurements to detect feeding problems. The aim of this cross-sectional study was to assess behavioral and skill-based feeding problems in young children with gastrointestinal diseases by using a well-established parent-reported feeding measure and identify demographic, anthropometric, and environmental factors associated with maladaptive feeding behaviors in this pediatric population. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and self-reported questionnaires assessing mealtime environment and parental feeding practices. It was found that 18.6% of the sample had abnormal Total Frequency Score (TFS) (frequency of problematic feeding behaviors) and 39.5% had abnormal Total Problem Score (TPS) (number of behaviors perceived as problematic by parents). Younger children, with lower body mass index, lower birth weight, and only children were more likely to have feeding problems. The study showed that parent-reported feeding problems are increased in young children with gastrointestinal diseases and are associated with specific aspects of mealtime environment and parental feeding practices.

Feeding Problems in Typically Developing Young Children, a Population-Based Study.

Feeding problems have been estimated to occur in approximately 25-45% of normally developing children. The aim of this study was to investigate the prevalence of feeding problems in typically developing young children in Greece. Child feeding behavior, parents' feelings about their child's feeding patterns, and parental feeding practices were also explored. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS). Data on 742 healthy, typically developing children aged two to seven years are presented. Overall, the majority of children in the sample showed high frequency of desirable mealtime behaviors and low frequency of undesirable mealtime behaviors. However, a significant proportion of the cohort presented with food neophobia and low consumption of vegetables. When applying test cut-off scores, it was found that 8.2% of the sample had abnormal Total Frequency Score (TFS) and 26.6% had abnormal Total Problem Score (TPS). The study showed that parent-reported feeding problems are quite common in children of typical development in Greece. Moreover, while the majority of the sample displayed a high frequency of favorable behaviors, specific child feeding behaviors are amenable to improvement.

Mealtime Environment and Control of Food Intake in Healthy Children and in Children with Gastrointestinal Diseases.

Parental feeding practices and mealtime routine significantly influence a child's eating behavior. The aim of this study was to investigate the mealtime environment in healthy children and children with gastrointestinal diseases. We conducted a cross-sectional case-control study among 787 healthy, typically developing children and 141 children with gastrointestinal diseases, aged two to seven years. Parents were asked to provide data on demographics and describe their mealtime environment by answering to 24 closed-ended questions. It was found that the majority of the children had the same number of meals every day and at the same hour. Parents of both groups exerted considerable control on the child's food intake by deciding both when and what their child eats. Almost one third of the parents also decided how much their child eats. The two groups differed significantly in nine of the 24 questions. The study showed that both groups provided structured and consistent mealtime environments. However, a significant proportion of children did not control how much they eat which might impede their ability to self-regulate eating. The presence of a gastrointestinal disease was found to be associated with reduced child autonomy, hampered hunger cues and frequent use of distractions during meals.

Depressive symptoms of autism spectrum disorder children's siblings in Greece: Associations with parental anxiety and social support.

LAY ABSTRACT: Typically developing siblings of children with autism spectrum disorders are often found to exhibit elevated levels of stress and depressive symptoms compared to siblings of typically developing children or siblings of children with other disabilities. Besides the behavioral problems of the child with autism and certain demographic characteristics that have been recognized as factors associated with typically developing siblings' psychological distress, the role of parental mental health and the social support from the family has not been studied sufficiently. The goal of this study is to assess depressive symptoms in 85 Greek school-aged typically developing siblings of children with autism and to investigate for any associations between siblings' depressive symptoms on one hand and demographics, parental mental health, and perceived social support on the other hand. It was found that typically developing siblings had higher levels of depressive symptoms compared to children from a general population sample. In addition, parental anxiety and social support from the family as perceived by the parents themselves were identified as independently associated with typically developing siblings' depressive symptoms. Of note, perceived social support failed to attenuate the association between parental anxiety and siblings' depressive symptoms. These results highlight the importance of assessing both parental and typically developing siblings' psychological state to implement interventions addressed to the needs of all family members.

Parental feeding practices data in healthy children and children with gastrointestinal diseases.

Parental feeding practices significantly influence child eating behavior. The data for this article was from a cross-sectional case control larger study that aimed to record parental practices to manage feeding problems in children with typical development and children with gastrointestinal diseases. A set of 23 Likert-type questions was used to investigate parental practices. Demographic and anthropometric data were obtained via a structured set of questions. In total 765 parents of healthy children and 136 parents of children with gastrointestinal diseases aged one to seven years participated in the study. Healthy controls were recruited from kindergartens located in various geographical areas in Greece. Children with gastrointestinal diseases were recruited from a Pediatric Gastroenterology Outpatient Clinic. Descriptive measures (i.e. frequencies, percentages, means and standard deviations) alongside with statistical analysis measures are presented in this article. Chi-square tests and U-tests were performed for the purpose of the comparison between the two groups. Spearman's rho correlation coefficient was also calculated for inter-item correlations among the 23-items of the questionnaire.

Parental management of feeding problems in young children-a population-based study.

OBJECTIVES: To investigate the practices that parents use to manage feeding problems in healthy children and in children with gastrointestinal diseases. Secondly, for each of these two groups we examined the association of select child and parent variables with parental feeding practices. METHODS: This is a cross-sectional case-control study. The sample consisted of 901 children (765 healthy children of typical development and 136 children with gastrointestinal diseases), aged one to seven years. The feeding problem management practices were investigated through 23 closed-ended questions. The anthropometric and demographic data of children and the demographic data of parents were collected by administering structured set of questions to parents. RESULTS: The prevalence of parent-reported feeding problems was 30.6% for healthy children and 45.7% for children with gastrointestinal diseases. The most common practices adopted by parents of healthy children were highlighting the benefits of food (80.5%), correlating food with pleasure (71.6%) and praising (59.1%), whereas almost half of the parents were found not to accept that their children may not be hungry and insisted on trying to feed them. Statistically significant differences were noted in many parental practices between the two groups. Parents of children with gastrointestinal diseases were generally more involved in the feeding process. Verbal praising (69.1%), correlation with pleasure (79.4%), promotion of benefits (77.2%) as well as assistance during feeding (63.2%) were the most common parental practices in the gastrointestinal group. Age, birth order, being the only child and weight status were child variables that differentiated parental behavior. Parental characteristics that affected feeding practises were age, education and work status. CONCLUSIONS: A high prevalence of feeding problems was reported by parents of both healthy children and children with gastrointestinal diseases. Beside the presence of a disease, specific child and parent variables are significantly related to parental behavior when managing feeding problems.

The Greek-Orthodox version of the Brief Religious Coping (B-RCOPE) instrument: psychometric properties in three samples and associations with mental disorders, suicidality, illness perceptions, and quality of life.

BACKGROUND: The B-RCOPE is a brief measure assessing religious coping. We aimed to assess the psychometric properties of its Greek version in people with and without long-term conditions (LTCs). Associations between religious coping and mental illness, suicidality, illness perceptions, and quality of life were also investigated. METHODS: The B-RCOPE was administered to 351 patients with diabetes, chronic pulmonary obstructive disease (COPD), and rheumatic diseases attending either the emergency department (N = 74) or specialty clinics (N = 302) and 127 people without LTCs. Diagnosis of mental disorders was established by the MINI. Associations with depressive symptom severity (PHQ-9), suicidal risk (RASS), illness perceptions (B-IPQ), and health-related quality of life (WHOQOL-BREF) were also investigated. RESULTS: The Greek version of B-RCOPE showed a coherent two-dimensional factor structure with remarkable stability across the three samples corresponding to the positive (PRC) and negative (NRC) religious coping dimensions. Cronbach's alphas were 0.91-0.96 and 0.77-0.92 for the PRC and NRC dimensions, respectively. Furthermore, NRC was associated with poorer mental health, greater depressive symptom severity and suicidality, and impaired HRQoL. In patients with LTCs, PRC correlated with lower perceived illness timeline, while NRC was associated with greater perceived illness consequences, lower perceived treatment control, greater illness concern, and lower illness comprehensibility. CONCLUSIONS: These findings indicate that the Greek-Orthodox B-RCOPE version may reliably assess religious coping. In addition, negative religious coping (i.e., religious struggle) is associated with adverse illness perceptions, and thus may detrimentally impact adaptation to medical illness. These findings deserve replication in prospective studies.

Sense of Coherence and Defense Style Predict Sleep Difficulties in Early Non-metastatic Colorectal Cancer.

BACKGROUND: Sleep disturbances are common in cancer patients, but little is known about the complex interplay between the background psychological profile, coping with health stressors capacities and psychological distress in the formation of sleep difficulties in colorectal cancer. AIMS: To study the course and to identify psychological predictors of sleep difficulties in early non-metastatic colorectal cancer patients over a one-year period. METHODS: In this 1-year prospective study, we assessed in 84 early non-metastatic colorectal cancer patients the association of psychological distress (SCL-90-R), sense of coherence (SOC-29), and defense styles (Defense Style Questionnaire) with sleep difficulties (SCL-90-R) in multiple regression models. Eighty-two patients with breast cancer and 50 patients with cancer of unknown primary site served as disease controls, and 84 matched for age and sex alleged healthy individuals served as healthy controls. RESULTS: Colorectal cancer patients presented more sleep difficulties compared to healthy participants but fewer than patients with breast cancer and cancer of unknown primary site. Colorectal cancer patients' trouble falling asleep (p = 0.033) and wakening up early in the morning (p < 0.001) deteriorated over time. Sleep that was restless or disturbed was independently associated with low SOC (p = 0.046) and maladaptive defenses (p = 0.008). Anxiety symptoms (p < 0.001) predicted deterioration in trouble falling asleep, while depressive symptoms (p = 0.022) and self-sacrificing defense style (p = 0.049) predicted deterioration in wakening up early in the morning. CONCLUSIONS: Psychological parameters and coping with health stressors capacities are independently associated with sleep difficulties in colorectal cancer patients, indicating the need for psychological interventions aiming at improving adjustment to the disease.

Religious coping and its influence on psychological distress, medication adherence, and quality of life in inflammatory bowel disease.

OBJECTIVE: Inflammatory bowel disease (IBD) is associated with elevated levels of anxiety and depression and a reduction in health-related quality of life (HRQoL). Nonadherence to treatment is also frequent in IBD and compromises outcomes. Religious coping plays a role in the adaptation to several chronic diseases. However, the influence of religious coping on IBD-related psychological distress, HRQoL, and treatment adherence remains unknown. METHOD: This cross-sectional study recruited 147 consecutive patients with either Crohn's disease or ulcerative colitis. Sociodemographic data, disease-related variables, psychological distress (Hospital Anxiety and Depression Scale), religious coping (Brief RCOPE Scale), HRQoL (WHOQOL-Bref), and adherence (8-item Morisky Medication Adherence Scale) were assessed. Hierarchical multiple regression models were used to evaluate the effects of religious coping on IBD-related psychological distress, treatment adherence, and HRQoL. RESULTS: Positive RCOPE was negatively associated with anxiety (b = 0.256; p = 0.007) as well as with overall, physical, and mental health HRQoL. Religious struggle was significantly associated with depression (b = 0.307; p < 0.001) and self-reported adherence (b = 0.258; p = 0.009). Finally, anxiety symptoms fully mediated the effect of positive religious coping on overall HRQoL. CONCLUSION: Religious coping is significantly associated with psychological distress, HRQoL, and adherence in IBD.

Religious coping and its influence on psychological distress, medication adherence, and quality of life in inflammatory bowel disease

Objective:Inflammatory bowel disease (IBD) is associated with elevated levels of anxiety and depression and a reduction in health-related quality of life (HRQoL). Nonadherence to treatment is also frequent in IBD and compromises outcomes. Religious coping plays a role in the adaptation to several chronic diseases. However, the influence of religious coping on IBD-related psychological distress, HRQoL, and treatment adherence remains unknown.Method:This cross-sectional study recruited 147 consecutive patients with either Crohn’s disease or ulcerative colitis. Sociodemographic data, disease-related variables, psychological distress (Hospital Anxiety and Depression Scale), religious coping (Brief RCOPE Scale), HRQoL (WHOQOL-Bref), and adherence (8-item Morisky Medication Adherence Scale) were assessed. Hierarchical multiple regression models were used to evaluate the effects of religious coping on IBD-related psychological distress, treatment adherence, and HRQoL.Results:Positive RCOPE was negatively associated with anxiety (b = 0.256; p = 0.007) as well as with overall, physical, and mental health HRQoL. Religious struggle was significantly associated with depression (b = 0.307; p < 0.001) and self-reported adherence (b = 0.258; p = 0.009). Finally, anxiety symptoms fully mediated the effect of positive religious coping on overall HRQoL.Conclusion:Religious coping is significantly associated with psychological distress, HRQoL, and adherence in IBD.

Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease.

AIM: To investigate the relationship between sense of coherence, psychological distress and health related quality of life in inflammatory bowel disease (IBD). METHODS: This cross-sectional study enrolled a consecutive sample of 147 IBD (aged 45.1 ± 14.1 years; 57.1% female) patients recruited from a tertiary gastroenterology service. Sixty-four participants met diagnostic criteria for Crohn's disease, while eighty-three patients had ulcerative colitis. Socio-demographic data (education, age, race, gender, gross monthly income and marital status), disease-related variables (illness activity, relapse rate in past 2 years, history of surgery and time since diagnosis), sense of coherence (Antonovsky's SOC scale), psychological distress symptoms (Hospital Anxiety and Depression Scale) and health-related quality of life (HRQoL; WHOQOL-Bref) were assessed. Hierarchical multiple regression analyses were performed to identify factors that are independently associated with psychological distress and HRQoL in patients with IBD and to provide indications for possible moderating or mediating effects. In addition, formal moderation and mediation analyses (Sobel tests) were performed to confirm potential moderators/mediators of the relationship between SOC, psychological distress symptoms and HRQoL. RESULTS: Lower SOC scores (std beta= -0.504; P < 0.001), female gender (std beta = 0.176; P = 0.021) and White race (std beta = 0.164; P = 0.033) were independently associated with higher levels of depressive symptoms, while lower levels of SOC (std beta = -0.438; P < 0.001) and higher relapse rate (std beta = 0.161; P = 0.033) were independently associated with more severe anxiety symptoms. A significant interaction between time since diagnosis and SOC was found with regard to the severity of depressive or anxiety symptoms, as the interaction term (time since diagnosis X SOC) had beta coefficients of -0.191 (P = 0.009) and -0.172 (P = 0.026), respectively. Lower levels of anxiety symptoms (std beta = -0.369; P < 0.001), higher levels of SOC (std beta = 0.231; P = 0.016) and non-White race (std beta = -0.229; P = 0.006), i.e., mixed-race, which represented the reference category, were independently associated with higher levels of overall HRQoL. Anxiety symptoms were the most potent independent correlate of most aspects of HRQoL. In addition, anxiety mediated the association between SOC and satisfaction with health, as well as its relationship with physical, mental, and social relations HRQoL. Depressive symptoms also mediated the association between SOC and mental HRQoL. CONCLUSION: Our data indicated that SOC is an important construct, as it influences psychological distress and has significant albeit indirect effects on several HRQoL domains in IBD.

Sense of coherence and self-sacrificing defense style as predictors of psychological distress and quality of life in rheumatoid arthritis: a 5-year prospective study.

Individual differences in adjustment during a disease's course determine psychological response and outcome. This study aimed to investigate prospectively whether coping with health stressors and self-sacrificing defense style could predict psychological adjustment and health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA). Seventy-four consecutive RA patients attending a rheumatology clinic were assessed for psychological distress (SCL-90-R), sense of coherence (SOC scale), self-sacrificing defense style (Defense Style Questionnaire-88), disease activity (DAS-28), pain, disability (Health Assessment Questionnaire) and HRQoL (World Health Organization Quality of Life Instrument, Short Form) at baseline and 5 years later. Multiple regression and moderator analyses were carried out. The results showed that disease activity (p < .001), pain (p = .005), psychological distress (p = .031), social relations HRQoL (p = .042) and environment HRQoL (p = .020) significantly improved over time. SOC was found an independent predictor of improvement in psychological distress (p = .003), overall general health (p = .002) and social relations HRQoL (p = .004); self-sacrificing independently predicted environment HRQoL (p = .042). The self-sacrificing defense style moderated the relationships between improvement in pain and improvement in overall general health (p = .024) and between improvement in pain and improvement in social relations HRQoL (p = .006). These findings indicate that, in RA, SOC predicts improvement in psychological distress and HRQoL over time, while a self-sacrificing defense style moderates the relationship of pain with HRQoL in the long term. These variables may partly explain inter-individual differences in adaptation to RA. Therefore, the design of psychotherapeutic trials targeting the patients' defensive profiles and coping with health stressors capacities is an important research perspective.

HSP70 polymorphisms in first psychotic episode drug-naïve schizophrenic patients.

AIMS: The aim of this study is to investigate differences in HSPA8 polymorphisms between first-episode psychotic (FEP) schizophrenic patients and healthy participants after adjustment for temperamental personality traits. MAIN METHODS: This study included fifty drug-naive schizophrenic patients with an FEP and fifty healthy participants who served as controls. Genotyping of HSPA8 polymorphisms was performed in patients and healthy subjects as well. Personality characteristics were assessed using the standardized Greek version of the Alternative Five-Factor Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). KEY FINDINGS: Our results showed that FEP patients presented a polymorphism differentiation related to the HSPA8 gene (rs1136141), and a higher frequency of T carriers compared to healthy controls was observed. The HSP8A polymorphism and the levels of Neuroticism as measured by the Alternative Five-Factor ZKPQ were the variables most closely and independently associated with FEP in multiple logistic regression analysis, and the odds of being assessed with a FEP was 2.8 times greater in T carriers compared to non-carriers. SIGNIFICANCE: Present findings indicate a role of HSP8A in FEP and underline the importance of including personality traits in the study of the factors associated with the development of schizophrenia.

No differences between drug naive and drug experienced unipolar depressed patients in terms of neurobiological testing: a cross sectional study.

Successful antidepressant treatment has been associated with concomitant changes in brain function, consolidated as long as treatment is continued and remission is preserved. The present study aimed at assessing the impact of prior antidepressant treatment on brain function in currently depressed but unmedicated individuals by investigating for any differences between antidepressant-naïve vs. antidepressant-experienced subjects. Fifty right-handed patients (22 medication-naïve vs. 28 medication-experienced), suffering from major depression participated in the study. They all underwent a standardised clinical interview and psychometric assessment combined with neurobiological tests (brain SPECT, Dexamethasone Suppression Test, Dexfenfluramine Challenge Test, electro-oculogram, flash-electroretinogram and flash-visual evoked potentials and pattern-reversal visual evoked potentials). No significant differences between medication-naïve and medication-experienced depressed subjects were found in terms of the neurobiological markers assessed, after controlling for age, sex, age at onset, number of depressive episodes, depression subtype (melancholic, atypical or undifferentiated) and severity of current episode. Unmedicated currently depressed patients, no matter their previous exposure to antidepressants, show similar changes in brain function. This does not necessarily mean that antidepressants do not have a long term effect on brain physiology, since not all patients relapse. However, it seems that those patients who relapse after stopping medication, seem to 'regress' to an 'as if never medicated' state, with regard to brain function. These findings might suggest that continuous maintenance treatment with antidepressants is essential for patients at high risk to relapse. Alternatively, they might suggest that our methodology assesses only a shallow and mainly state part of the pathophysiology of depression.

Bipolar disorder and resembling special psychopathological manifestations in multiple sclerosis: a review.

PURPOSE OF REVIEW: The higher prevalence of psychiatric disorders in multiple sclerosis (MS) compared with the general population is well documented, with depression being the leading disorder. Apart from depression, other psychiatric disorders and symptoms such as bipolar disorder, pseudobulbar affect, euphoria sclerotica, anxiety and personality changes are also reported to be overpresented in MS patients. Psychiatric disorders in MS lead to significant disruption in patients' family, work and social life, affecting patients' quality of life in general. Moreover, they are reported to be associated with poorer adherence to MS medication. The literature concerning bipolar disorder and affect disorders in MS is rather scarce. The purpose of this article is to provide a critical review on the latter subject. RECENT FINDINGS: This review focuses upon the recent findings with regard to the epidemiology and the comorbidity rates of bipolar and affect disorders in MS, questions raised about the potential underlying mechanisms that could explain such a high comorbidity, diagnostic issues and the recent developments in the treatment of those psychiatric disorders in MS. SUMMARY: Despite the fact that the higher prevalence of psychiatric disorders in MS is well established, such disorders still remain underdiagnosed and undertreated. A shift in the clinical suspicion towards the psychiatric morbidity in MS patients and the optimal treatment of those disorders is fundamental.