Three reasons why parental burnout is more prevalent in individualistic countries: a mediation study in 36 countries.

PURPOSE: The prevalence of parental burnout, a condition that has severe consequences for both parents and children, varies dramatically across countries and is highest in Western countries characterized by high individualism. METHOD: In this study, we examined the mediators of the relationship between individualism measured at the country level and parental burnout measured at the individual level in 36 countries (16,059 parents). RESULTS: The results revealed three mediating mechanisms, that is, self-discrepancies between socially prescribed and actual parental selves, high agency and self-directed socialization goals, and low parental task sharing, by which individualism leads to an increased risk of burnout among parents. CONCLUSION: The results confirm that the three mediators under consideration are all involved, and that mediation was higher for self-discrepancies between socially prescribed and actual parental selves, then parental task sharing, and lastly self-directed socialization goals. The results provide some important indications of how to prevent parental burnout at the societal level in Western countries.

Linking child adjustment difficulties with mother's maladaptive parental behavior: The mediating roles of parental cognitions and parenting stress.

Child abuse is prevalent worldwide, with most of the burden in developing countries. To reduce and prevent child abuse occurrence, many efforts are directed toward reducing maladaptive parental behaviors (MPBs), a predictor of parents' risk of engaging in child abusive behaviors. MPBs have been associated with child (e.g., behavioral difficulties) and parent characteristics (e.g., parenting stress and parental cognitions), although little research tested for mediational pathways. This study aimed to test the pathways through which child and parent characteristics are linked to MPB. Consistent with the social information processing model of parenting, we hypothesized that child behavioral difficulties would exert an indirect influence on MPB through parenting stress and that parenting stress will exert a direct and indirect effect on MPB through parental cognitions (i.e., expectations, attitudes, and attributions). This study used data from 243 mothers of children aged between 2 and 9 years in Romania. Two-stage structural equation modeling was employed to test the hypothesized model. Results support the role of child behavior, parenting stress, and parental cognitions in predicting MPB (R2 = 0.69). Significant indirect effects were found from child behavior to MPB via parenting stress and parental cognitions. Direct effects from parenting stress and parental cognitions to MPB were significant. Findings show that parenting stress and parental cognitions are important mechanisms through which child behavioral difficulties influence maladaptive parental behavior, underscoring the need to focus on these mechanisms when assessing or intervening with families at risk for child abuse.

The development, reliability, and validity of the Facilitator Assessment Tool: An implementation fidelity measure used in Parenting for Lifelong Health for Young Children.

BACKGROUND: The Parenting for Lifelong Health for Young Children (PLH-YC) programme aims to reduce violence against children and child behaviour problems among families in low- and middle-income countries (LMICs). Although the programme has been tested in four randomised controlled trials and delivered in over 25 countries, there are gaps in understanding regarding the programme's implementation fidelity and, more generally, concerning the implementation fidelity of parenting programmes in LMICs. AIMS: This study aims to address these gaps by examining the psychometric properties of the PLH-YC-Facilitator Assessment Tool (FAT)-an observational tool used to measure the competent adherence of PLH-YC facilitators. Examining the psychometric properties of the FAT is important in order to determine whether there is an association between facilitator competent adherence and programme outcomes and, if correlated, to improve facilitator performance. It is also important to develop the implementation literature among parenting interventions in LMICs. METHODS: The study examined the content validity, intra-rater reliability, and inter-rater reliability of the FAT. Revision of the tool was based on consultation with programme trainers, experts, and assessors. A training curriculum and assessment manual was created. Assessors were trained in Southeastern Europe and their assessments of facilitator delivery were analysed as part of a large-scale factorial experiment (N = 79 facilitators). RESULTS: The content validity process with PLH-YC trainers, experts, and assessors resulted in substantial improvements to the tool. Analyses of percentage agreements and intraclass correlations found that, even with practical challenges, assessments were completed with adequate yet not strong intra- and inter-rater reliability. CONCLUSIONS: This study contributes to the literature on the implementation of parenting programmes in LMICs. The study found that the FAT appears to capture its intended constructs and can be used with an acceptable degree of consistency. Further research on the tool's reliability and validity-specifically, its internal consistency, construct validity, and predictive validity-is recommended.

Limitations of benefit finding as a coping mechanism for combat-related PTSD symptoms.

Benefit finding has been identified as a buffer of the combat exposure-PTSD symptom link in soldiers. However, benefit finding may have a limited buffering capacity on the combat-PTSD symptom link over the course of a soldier's post-deployment recovery period. In the present study, soldiers returning from Operation Iraqi Freedom (OIF) were surveyed at two different time periods post-deployment: Time 1 was 4 months post-deployment (n = 1,510), and Time 2 was at 9 months post-deployment (n = 783). The surveys assessed benefit finding, PTSD symptoms, and combat exposure. Benefit finding was a successful buffer of the cross-sectional relationship between combat exposure and PTSD reexperiencing symptoms at Time 1, but not at Time 2. In addition, the benefit finding by combat interaction at time 1 revealed that greater benefit finding was associated with higher symptoms under high combat exposure at Time 2 after controlling for PTSD arousal symptoms at Time 1. The results of the present study indicate that benefit finding may have a buffering capacity in the immediate months following a combat deployment, but also indicates that more time than is allotted during the post-deployment adjustment period is needed to enable recovery from PTSD. Theoretical implications are discussed.

Psychological violence in dating relationships among adolescents: A systematic review and meta-analysis of prevention programs.

Teen Psychological Dating Violence (TPDV) is a serious public health concern. However, there is limited evidence on the capacity of programs to prevent this form of violence. This study aimed to conduct a systematic review and meta-analysis of RCTs to evaluate the efficacy of prevention programs for TPDV. PsycINFO/Eric/PsycArticles, PubMed and Web of Science were searched from inception through January 2021 to identify RCTs of prevention programs for adolescents that reported a measure of TPDV. The effect sizes were computed as the difference between the prevention program and control group at post or follow-up assessment by calculating Hedges's g with a random-effect model. Thirteen trials met inclusion criteria and were included in the meta-analysis. There was a small but significant effect size in favor of the prevention group as compared to the control condition for victimization (g = 0.23; 95% CI, 0.10 to 0.37; p < 0.001) and perpetration (g = 0.24; 95% CI, 0.12 to 0.37; p < 0.001) of TPDV. Overall, the combined effect size for any TPDV perpetration/victimization was 0.22 (95% CI, 0.11 to 0.34; p < 0.001). Exploratory subgroup analysis showed that programs implemented at multiple levels (such as home, school, community) reported significantly larger effect sizes compared to single-level interventions. Significant differences in effect sizes were also associated with the type of scale used to assess TPDV. Current evidence suggests that intervention programs for TPDV may be effective, particularly when implemented at multiple levels. Further research focusing on refining tools to assess TPDV is needed.

Predicting smoking behavior: intention and future self-continuity among Austrians.

Smoking is a major public health problem in Austria, but relevant research and intervention is limited. Based on the Theory of Planned Behavior (TPB), the present study aimed to test the model utility in an Austrian sample. As future self-continuity is likely to impact on health behavior, we also hypothesized an extended TPB with future self-continuity could further explain the variance in smoking. Using a prospective design, 94 current smokers (74.5% women; Mage = 24.27 years; 61.7% daily smokers) from a university in South Austria completed the baseline and follow-up survey (one month after the baseline). Consistent with the TPB, intention and perceived behavioral control (PBC) significantly predicted smoking behavior; affective attitude and PBC were significantly associated with smoking intention. In contrast, cognitive attitude and subjective norm were unrelated to smoking intention. As hypothesized, the TPB explained 42% variance of smoking behavior and 31% variance of smoking intention. Participants' future self-continuity further explained the variance of smoking behavior. Our study demonstrates the utility of the TPB in understanding Austrian smoking behavior. The role of psychological perception of future self among smokers has been highlighted. Future smoking intervention may target PBC, affective attitude, as well as a life-span perspective.

Preventing child mental health problems in southeastern Europe: Feasibility study (phase 1 of MOST framework).

The prevalence of child emotional and behavioral problems is an international problem but is higher in low- and middle-income countries (LMIC) where there are often less mental health supports for families. Parenting programs can be an effective means of prevention, but must be low-cost, scalable, and suitable for the local context. The RISE project aims to systematically adapt, implement, and evaluate a low-cost parenting program for preventing/reducing child mental health problems in three middle-income countries in Southeastern Europe. This small pre-post pilot study is informed by the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework and tested the feasibility of the intervention, the implementation, and evaluation procedures: Phase 1 of the three-phase Multiphase Optimization Strategy (MOST) for program adaptation. Local facilitators delivered the Parenting for Lifelong Health (PLH) for Young Children program to parents of children aged 2-9 in North Macedonia, the Republic of Moldova and Romania in 2018. Parents completed assessments pre- and post-program. Results demonstrated positive pre-post change for participating families (N = 140) on various outcomes including child externalizing and internalizing symptoms and parenting behavior, in all three countries, all in the expected direction. Program participation was associated with positive outcomes in participating families. Based on the experiences of this pilot study, we outline the practical implications for the successful implementation of parenting programs in the three countries that will inform our next study phases, factorial experiment, and RCT.

El predominio de los problemas emocionales y conductuales de los niños es un problema internacional, pero es mayor en los países de ingresos bajos y medios donde generalmente hay menos asistencia para la salud mental de las familias. Los programas de crianza pueden ser un medio de prevención eficaz, pero deben ser de bajo costo, escalables y adecuados para el contexto local. El proyecto RISE tiene como finalidad adaptar, implementar y evaluar sistemáticamente un programa de crianza de bajo costo para prevenir o reducir los problemas de salud mental infantil en tres países de ingresos medios del Sudeste de Europa. Este pequeño estudio piloto previo y posterior está fundamentado por el marco de Alcance, Eficacia, Adopción, Implementación y Mantenimiento (RE-AIM, por sus siglas en inglés) y evaluó la viabilidad de los procedimientos de intervención, de implementación y de evaluación: Fase 1 de la Estrategia de Optimización Multifase (MOST) de tres fases para la adaptación del programa. Un grupo de moderadores locales impartió el programa Crianza para la Salud Durante Toda la Vida (Parenting for Lifelong Health, PLH) para Niños Pequeños a padres de niños de entre 2 y 9 años en Macedonia del Norte, República de Moldavia, y Rumania en 2018. Los padres completaron evaluaciones antes y después del programa. Los resultados demostraron cambios positivos después del programa para las familias participantes (N = 140) en varias respuestas, entre ellas, los síntomas de exteriorización y de interiorización de los niños y la conducta de crianza, en los tres países, todos en la dirección esperada. La participación en el programa estuvo asociada con resultados positivos en las familias participantes. Sobre la base de las experiencias de este estudio piloto, describimos las consecuencias prácticas para la implementación satisfactoria de los programas de crianza en los tres países que servirán como base para las fases de nuestro próximo estudio, del experimento factorial y del ensayo controlado aleatorizado.

Interparental Relationship Adjustment, Parenting, and Offspring's Cigarette Smoking at the 10-Year Follow-up.

Familial influences on children's cigarette smoking have been established, yet little is known about whether these influences in childhood relate to offspring's smoking behavior in adolescence. Drawing on prior work showing that children's emotional and behavioral problems (i.e., internalizing and externalizing behavior problems) are influenced by both interparental and parent-child relationships, we examined whether children's emotional and behavioral problems would further predict their smoking behavior in adolescence. Two hundred and twenty-one families were followed from early childhood (Mage  = 4.05 years) to the 10-year follow-up. Interparental relationship adjustment and disagreement, dysfunctional parenting, and children's emotional and behavioral problems were reported by both mothers and fathers. Adolescents' self-reported cigarette smoking status was assessed along with other demographic variables. Using structural equation modeling, the hypothesis was only supported based on mothers' reports, suggesting that early couple relationship adjustment and parenting relate to children's emotional and behavioral problems, which associate with smoking behavior in adolescence. When the hypothesized model was tested with emotional and behavioral problems separately, only behavioral problems were related to adolescent smoking for both parents. Findings from this study support models of family environment and children's behavioral problems, providing evidence of the long-term links with adolescent cigarette smoking behaviors. Further family-focused research and preventive work, for instance, testing the combination of partner support and parent training, are needed.

Se han establecido las influencias familiares en el consumo de cigarrillos de los niños, sin embargo, se sabe poco acerca de si estas influencias en la niñez se relacionan con la conducta de consumo de cigarrillos de los niños en la adolescencia. Teniendo en cuenta trabajos anteriores que demuestran que los problemas conductuales y emocionales de los niños (p. ej.: los problemas de conductas de exteriorización e interiorización) están influenciados tanto por las relaciones interparentales como por las relaciones entre padres e hijos, analizamos si los problemas emocionales y conductuales de los niños predecirían, además, su conducta de consumo de cigarrillos en la adolescencia. Se siguió a doscientas veintiuna familias desde la primera infancia (edad promedio = 4.05 años) hasta el control a los diez años. Tanto las madres como los padres informaron adaptación y desacuerdo en las relaciones interparentales, crianza disfuncional y problemas conductuales y emocionales de los niños. Se evaluó la situación de consumo de cigarrillos autoinformada por los adolescentes junto con otras variables demográficas. Utilizando modelos de ecuaciones estructurales, se respaldó la hipótesis solo sobre la base de los informes de las madres, lo cual sugiere que la adaptación temprana en la relación de pareja y la crianza se relacionan con los problemas emocionales y conductuales de los niños, los cuales se asocian con la conducta de fumar en la adolescencia. Cuando el modelo hipotetizado se probó con problemas conductuales y emocionales por separado, solo los problemas conductuales se relacionaron con el consumo de cigarrillos de los adolescentes para ambos padres. Los hallazgos de este estudio respaldan los modelos de entorno familiar y los problemas conductuales de los niños, ya que ofrecen indicios de los vínculos a largo plazo con las conductas de consumo de cigarrillos en los adolescentes. Se necesitan más investigaciones centradas en la familia y trabajos preventivos, por ejemplo, la evaluación de la combinación de apoyo para padres y de capacitaciones para padres.

Online Health Information Seeking by Parents for Their Children: Systematic Review and Agenda for Further Research.

BACKGROUND: Parents commonly use the internet to search for information about their child's health-related symptoms and guide parental health-related decisions. Despite the impact of parental online health seeking on offline health behaviors, this area of research remains understudied. Previous literature has not adequately distinguished searched behaviors when searching for oneself or one`s child. OBJECTIVE: The purpose of this review is to examine prevalences and associated variables of parent-child online health information seeking; investigate parents' health-related online behavior regarding how they find, use, and evaluate information; and identify barriers and concerns that they experience during the search. Based on this analysis, we develop a conceptual model of potentially important variables of proxy online health information seeking, with a focus on building an agenda for further research. METHODS: We conducted a comprehensive systematic literature review of the PsycINFO, JMIR, and PubMed electronic databases. Studies between January 1994 and June 2018 were considered. The conceptual model was developed using an inductive mixed methods approach based on the investigated variables in the study sample. RESULTS: A total of 33 studies met the inclusion criteria. Findings suggest that parents worldwide are heavy online users of health-related information for their children across highly diverse circumstances. A total of 6 studies found high parental health anxiety, with prevalences ranging from 14% to 52%. Although parents reported wishing for more guidance from their pediatrician on how to find reliable information, they rarely discussed retrieved information from the web. The conceptual model of proxy online health information seeking includes 49 variables. CONCLUSIONS: This systematic review identifies important gaps regarding the influence of health-related information on parents' health behavior and outcomes. Follow-up studies are required to offer parents guidance on how to use the web for health purposes in an effective way, as well as solutions to the multifaceted problems during or after online health information seeking for their child. The conceptual model with the number of studies in each model category listed highlights how previous studies have hardly considered relational variables between the parent and child. An agenda for future research is presented.

Identifying unique and shared risk factors for physical intimate partner violence and clinically-significant physical intimate partner violence.

Intimate partner violence (IPV) is a significant public health concern. To date, risk factor research has not differentiated physical violence that leads to injury and/or fear (i.e., clinically significant IPV; CS-IPV) from general physical IPV. Isolating risk relations is necessary to best inform prevention and treatment efforts. The current study used an ecological framework and evaluated relations of likely risk factors within individual, family, workplace, and community levels with both CS-IPV and general IPV to determine whether they were related to one type of IPV, both, or neither for both men and women. Probable risk and promotive factors from multiple ecological levels of influence were selected from the literature and assessed, along with CS-IPV and general IPV, via an anonymous, web-based survey. The sample comprised US Air Force (AF) active duty members and civilian spouses (total N = 36,861 men; 24,331 women) from 82 sites worldwide. Relationship satisfaction, age, and alcohol problems were identified as unique risk factors (in the context of the 23 other risk factors examined) across IPV and CS-IPV for men and women. Other unique risk factors were identified that differed in prediction of IPV and CS-IPV. The results suggest a variety of both established and novel potential foci for indirectly targeting partner aggression and clinically-significant IPV by improving people's risk profiles at the individual, family, workplace, and community levels. Aggr. Behav. 41:227-241, 2015. © 2014 Wiley Periodicals, Inc.

Enhanced definitions of intimate partner violence for DSM-5 and ICD-11 may promote improved screening and treatment.

Nuanced, multifaceted, and content valid diagnostic criteria for intimate partner violence (IPV) have been created and can be used reliably in the field even by those with little-to-no clinical training/background. The use of such criteria such as these would likely lead to more reliable decision making in the field and more consistency across studies. Further, interrater agreement was higher than that usually reported for individual mental disorders. This paper will provide an overview of (a) IPV's scope and impact; (b) the reliable and valid diagnostic criteria that have been used and the adaptation of these criteria inserted in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) and another adaptation proposed for the forthcoming International Statistical Classification of Diseases and Related Health Problems (ICD); (c) suggestions for screening of IPV in primary care settings; (d) interventions for IPV; and (e) suggested steps toward globally accepted programs.

Child maltreatment in DSM-5 and ICD-11.

Child maltreatment is widespread and has a tremendous impact on child victims and their families. Over the past decade, definitions of child maltreatment have been developed that are operationalized, face valid, and can be reliably applied in clinical settings. These definitions have informed the revised Diagnostic and Statistical Manual (American Psychiatric Association, 2013) and are being considered for the International Classification of Disease-11 (World Health Organization). Now that these definitions are available in major diagnostic systems, primary healthcare providers and clinicians who see children and families are poised to help screen for, identify, prevent, and treat child maltreatment. This article reviews the definitions of maltreatment in these diagnostic systems, along with assessment and screening tools, and empirically supported prevention and intervention approaches.

Intimate partner relationship distress in the DSM-5.

Over the past 40 years, a large body of literature has documented intimate partner relationship distress as a primary reason for seeking mental health services as well as an integral factor in the prognosis and treatment of a range of mental and physical health conditions. In recognition of its relevance to clinical care, the description of intimate partner relationship distress has been expanded in the DSM-5. Nonetheless, this is irrelevant if the DSM-5 code for intimate partner relationship distress is not reliably used in clinical practice and research settings. Thus, with the goal of dissemination in mind, the purpose of this paper was to provide clinicians and researchers with specific guidelines on how to reliably assess intimate partner relationship distress and how this information can be used to inform treatment planning. In addition to the implications for direct clinical care, we discuss the importance of reliable assessment and documentation of intimate partner relationship distress for future progress in epidemiology, etiology, and public health research.

The Role of Intimate Partner Violence, Couple Dissatisfaction and Parenting Behaviors in Understanding Parental Burnout.

Parental burnout (PB), a relatively new and under-studied construct, is defined as a condition resulting from chronic parenting stress. While recent research confirmed its negative associations with familial variables, such as relationship satisfaction and positive parenting practices, little is known about the role of intimate partner violence (IPV) and how it relates to parental burnout. The present study, therefore, aimed to extend existing knowledge on chronic parenting stress by 1) testing for the mediational role of couple dissatisfaction in explaining the link from IPV victimization to PB as well as the link from IPV victimization to dysfunctional parenting, and 2) investigating how specialist gender roles and parental responsibilities for child care relate to IPV victimization and PB. Data collection was part of an international collaboration on factors related to parental satisfaction and exhaustion across different countries. Self-report data from Austrian mothers (N = 121) were collected online and analyzed using structural equation modeling. Results indicated that couple dissatisfaction mediates the link from IPV victimization to PB, as well as IPV victimization to dysfunctional parenting. Furthermore, only specialist gender roles were significantly related to IPV, while parental responsibilities for child care did not significantly relate to experiences of violence. Additionally, neither specialist gender roles nor parental responsibilities were significantly associated with PB in the final model. Overall, our findings connect to family models, such as the Family System Theory and Spillover Theory, underscoring the importance of couples' relationship quality for understanding parental burnout and parenting behaviors in mothers.

Long-term Adverse Outcomes Associated With Teen Dating Violence: A Systematic Review.

CONTEXT: Evidence suggests that teen dating violence (TDV) is associated with long-term adverse outcomes, but these associations have not been systematically assessed. OBJECTIVES: To conduct a systematic review of the longitudinal associations between TDV and negative outcomes, including mental and physical health, reoccurrence of violence in intimate relationships, and high-risk behaviors (substance use and sexual behaviors). DATA SOURCES: Peer-reviewed articles published in English were searched in PsycINFO/Eric/PsycArticles, PubMed, and Web of Science database from inception to November 2022. STUDY SELECTION: Prospective studies that assessed TDV during adolescence, had a follow-up of at least ≥1 year, and evaluated the associations of TDV with health, violence in romantic intimate relationships, or risk behaviors were included. DATA EXTRACTION: Study characteristics, baseline data, and follow-up outcomes were extracted from included studies. RESULTS: Thirty-eight studies involving 23 unique samples were analyzed. Findings showed that TDV in adolescence was associated with future teen dating and intimate partner violence in adulthood. Studies also indicated that TDV was longitudinally associated with increasing high-risk behaviors (ie, marijuana and alcohol use) and poor mental health outcomes (particularly for victimization). There was unclear evidence on the longitudinal link between TDV and suicidal attempts. Significant associations between TDV and negative outcomes were reported more frequently among females compared with males. LIMITATIONS: Length of follow-up varied across studies. CONCLUSIONS: Dating violence in adolescence may represent a risk factor for a wide range of long-term outcomes. Female adolescents reporting TDV may be at higher risk of adverse outcomes compared with males.

Co-Occurrence of Intimate Partner Violence Against Mothers and Maltreatment of Their Children With Behavioral Problems in Eastern Europe.

This study investigates the co-occurrence of intimate partner violence (IPV) against mothers and their risk of perpetrating child maltreatment (CM) in North Macedonia, the Republic of Moldova, and Romania. Risk factors for IPV, CM, and their co-occurrence were identified. Two samples (N1 = 112, N2 = 701) of mothers with children with behavioral problems were assessed. IPV was reported by 64% of mothers, CM by 96%, and their co-occurrence by 63%. Mothers exposed to emotional IPV reported more physical and emotional CM. Mothers exposed to physical IPV reported more physical CM. Mothers own history of CM and offspring's behavior problems were associated with IPV and CM co-occurrence.

Family-focused intervention to promote adolescent mental health and well-being in Moldova and North Macedonia (FLOURISH): feasibility study protocol.

INTRODUCTION: Family-Focused Adolescent & Lifelong Health Promotion (FLOURISH) project will adapt, implement and evaluate a programme to support adolescent mental health and well-being through strategies, such as strengthening parenting practices, adolescent-caregiver relationships, adolescent and parent socioemotional skills, and social support. METHODS AND ANALYSIS: The project will focus on adolescents aged 10-14 years and their caregivers in North Macedonia and Moldova. The countries were selected based on implementation readiness of two organisations and a need for accessible evidence-informed services to help mitigate health risks due to economic, social and political challenges. Parenting for Lifelong Health (PLH) for Parents and Teens is a family-based programme developed for low-resource settings. PLH has been adapted with input from advisory groups. The programme includes additional components to strengthen impacts on adolescents: adolescent mental health tools, based on UNICEF's Helping Adolescents Thrive, adolescent peer support and participation booster. This pilot is first of three study phases. The pilot will be a feasibility testing of the adapted intervention and the assessment and implementation procedures to determine further refinements. The pilot will examine if the adapted programme is acceptable for adolescents, their families and providers, explore contextual factors relevant to embedding this programme into longer-term scale-up and investigate whether the programme can be delivered with fidelity and participation; whether the participants report changes in adolescent emotional and behavioural problems, well-being and other outcomes; and whether the study tools are feasible and appropriate. Pre-post adolescent and caregiver questionnaires will provide outcome data. Process evaluation will include attendance and fidelity data, and focus groups. We will examine delivery cost and resource requirements. ETHICS AND DISSEMINATION: The study was approved at the University of Klagenfurt (Austria), Medical Faculty at St. Cyril and Methodius University (North Macedonia) and National Committee of Ethical Expertise for Clinical Trials (Moldova). Through stakeholder engagement and dissemination, FLOURISH will advance scale-up of open-source family interventions. TRIAL REGISTRATION NUMBER: Trial registration: ID101095528; project page: https://www.flourish-study.org/about.html; https://www.linkedin.com/company/flourish-study/.

Alcohol problems, aggression, and other externalizing behaviors after return from deployment: understanding the role of combat exposure, internalizing symptoms, and social environment.

OBJECTIVES: The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care). DESIGN: A model of combat exposure, social environment, internalizing symptoms, and externalizing behaviors was tested in a military unit following a fifteen-month deployment to Iraq. The sample included 1,397 soldiers assessed four month post-deployment; 589 of these soldiers were assessed again nine months post-deployment. RESULTS: Externalizing behaviors were highly stable over the five-month post-deployment period. Both social environment and internalizing symptoms were significantly associated with level of externalizing behaviors at four months and nine months post-deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow-up period. CONCLUSIONS: Results suggest the need to broaden the scope of interventions targeted to combat veterans and have implications for care providers and military leaders.

Postdeployment behavioral health screening: face-to-face versus virtual behavioral health interviews.

Virtual behavioral health (VBH) services are used frequently to address the high demand for behavioral health (BH) services in the military. Few studies have investigated the relationship between the use of VBH services and BH outcomes or preferences for the use of VBH technologies. In this article, we evaluated BH interviews conducted via video teleconferencing (VTC) or face-to-face in terms of BH symptoms, satisfaction rates, stigma, barriers to care, and preferences for future use of BH care. Soldiers (n = 307) from the headquarters element of an operational unit were surveyed 4 months following a 12-month deployment to Iraq. There were no significant differences in satisfaction rates based on interview modality, but significantly more soldiers preferred face-to-face interviews over VTC interviews in the future. Soldiers who preferred face-to-face interviews also reported higher levels of anxiety and depression symptoms than those who preferred VTC interviews. No significant age differences were found in terms of interview modality satisfaction or preference. Soldiers with greater deployment experience were more likely to report that they would not like using VTC if seeking BH care in the future than soldiers with less deployment experience. These findings highlight the importance of promoting choice in type of BH interview modality.

Online Health Information Seeking for Self and Child: An Experimental Study of Parental Symptom Search.

BACKGROUND: Parents often search the web for health-related information for themselves or on behalf of their children, which may impact their health-related decision-making and behaviors. In particular, searching for somatic symptoms such as headaches, fever, or fatigue is common. However, little is known about how psychological and relational factors relate to the characteristics of successful symptom-related internet searches. To date, few studies have used experimental designs that connect participant subjective search evaluation with objective search behavior metrics. OBJECTIVE: This study aimed to examine the features of web-based health-related search behaviors based on video-coded observational data, to investigate which psychological and relational factors are related to successful symptom search appraisal, and to examine the differences in search-related outcomes among self-seekers and by-proxy seekers. METHODS: In a laboratory setting, parents living in Austria (N=46) with a child aged between 0 and 6 years were randomized to search their own (n=23, 50%) or their child's (n=23, 50%) most recent somatic symptom on the web. Web-based activity was recorded and transcribed. Health anxiety, eHealth literacy, attitude toward web-based health information, relational variables, state of stress, participants' search appraisals, and quantitative properties of the search session were assessed. Differences in search appraisals and search characteristics among parents who searched for themselves or their children were examined. RESULTS: Across both groups, searches were carried out for 17 different symptom clusters. Almost all parents started with Google (44/46, 96%), and a majority used initial elaborated key phrases with >1 search keyword (38/45, 84%) and performed on average 2.95 (SD 1.83) search queries per session. Search success was negatively associated with health anxiety (rs=-0.39, P=.01), stress after the search (rs=-0.33, P=.02), and the number of search queries (rs=-0.29, P=.04) but was not significantly associated with eHealth literacy (rs=0.22, P=.13). Of note, eHealth literacy was strongly and positively correlated with satisfaction during the search (rs=0.50, P<.001) but did not significantly correlate with search characteristics as measured by search duration (rs=0.08, P=.56), number of performed search queries (rs=0.20, P=.17), or total clicks (rs=0.14, P=.32). No differences were found between parents searching for their own symptoms and parents searching for their child's symptoms. CONCLUSIONS: This study provides exploratory findings regarding relevant dimensions of appraisals for symptom-based information seeking on the web. Consistent with previous literature, health anxiety was found to be associated with poorer search evaluation. Contrary to expectations, eHealth literacy was related neither to search success nor to search characteristics. Interestingly, we did not find significant differences between self-seekers and by-proxy seekers, suggesting similar search and evaluation patterns in our sample. Further research with larger samples is needed to identify and evaluate guidelines for enhanced web-based health information seeking among parents and the general public.