Correlates of hair cortisol concentrations in disadvantaged young children

Children from highly disadvantaged families tend to experience worse health, educational, and job outcomes than less disadvantaged peers. However, the mechanisms underlying these relationships remain to be explicated. In particular, few studies have investigated the relationships between the psychosocial influences that children are exposed to early in life and longer term cortisol output. This study aims to contribute to the literature by exploring how disadvantaged young children's experiences of family adversity, and parenting and family functioning, are related to their long‐term cortisol levels. A sample of 60 children (26 males, mean = 4.25 years, SD = 1.68) and their mothers (mean = 34.18 years, SD = 7.11) from a low‐income population took part in a single assessment. Mothers completed questionnaires on the family environment, parenting practices, and child behaviour. Children provided a hair sample for cortisol assay and anthropometric measures. A parsimonious multivariate regression model (including potential predictors identified by a selection algorithm) was used to investigate the correlates of hair cortisol concentration (HCC) in children. Higher levels of social exclusion, being male, and younger age were each associated with higher HCC. Maternal nurturing and emotion coaching were associated with lower HCC. Findings suggest that chronic stress may underlie relationships between adversity and its long‐term effects and that HCC offers a promising method for examining chronic stress in children and evaluating interventions by which it can be ameliorated.     

Association of Posttraumatic Growth and Illness‐Related Burden With Psychosocial Factors of Patient,Family, and Provider in Pediatric Cancer Survivors

Research has indicated that childhood cancer may lead to posttraumatic growth (PTG), given cancer's association with posttraumatic stress. PTG may be associated with family/home and health care dynamics, as well as parental resilience, distress, and coping. This cross‐sectional study investigated the associations of psychosocial factors of the patient, family, and health care team with PTG and illness‐related burden (IRB) in childhood cancer survivors. The sample comprised 61 children and adolescents (7–18 years of age), their parents, and their nurses. Respondents completed their assessment an average of 1.73 years after the end of treatment for the child's disease, which was either leukemia, a solid tumor, or lymphoma. Regression analyses showed that PTG was positively associated with the patients’ posttraumatic stress symptoms. It was also positively associated with the parents’ religious coping, and with measures of stronger family and oncologist relationships (R² = .32). IRB was positively associated with patient‐reported posttraumatic stress symptoms, negatively associated with the nurse's trust in the family, and positively associated with parent‐reported mental distress, lower family socioeconomic status, and female gender (R² = .53). There was no significant association with parenting style or parent‐reported posttraumatic stress symptoms in the child. The findings suggested that the young cancer patient's psychosocial and resource milieu (e.g., financial) may be instrumental in PTG and IRB. Psychosocial interventions with high‐risk families and their health care teams could increase growth and reduce burden.     

Stigma and Demographic Correlates of Help‐Seeking Intentions in Returning Service Members

Many U.S. Iraq/Afghanistan‐era veterans return from deployment with posttraumatic stress (PTS) symptoms, but few veterans seek psychological help. Research on barriers to care is growing, but the link between stigma and help‐seeking is understudied. The present study examined anticipated enacted stigma from military and nonmilitary sources, self‐stigma, PTS, perceived likelihood of deploying again, marital status, and history of mental health care engagement as correlates of help‐seeking intentions from a mental health professional or medical doctor/advance practice registered nurse (MD/APRN) in a sample of 165 combat veterans. Using structural equation modeling, results demonstrated that self‐stigma was negatively associated with help‐seeking intentions from a mental health professional and MD/APRN with small‐to‐medium effect sizes. Being married was positively associated with help‐seeking intentions from a mental health professional and MD/APRN with small effect sizes. History of previous mental health care engagement was positively associated with help‐seeking intentions from a mental health professional with a medium effect size, but unrelated to help‐seeking intentions from a MD/APRN. Anticipated enacted stigma from any source, PTS, and greater perceived likelihood of deploying again were unrelated to help‐seeking intentions from a mental health professional and MD/APRN. Implications for interventions aimed at decreasing self‐stigma and increasing intention to seek help are discussed.     

Posttraumatic stress among young urban children exposed to family violence and other potentially traumatic events

This study examines the relationship between the number of types of traumatic events experienced by children 3 to 6 years old, parenting stress, and children's posttraumatic stress (PTS). Parents and caregivers provided data for 154 urban children admitted into community-based mental health or developmental services. By parent and caregiver report, children experienced an average of 4.9 different types of potentially traumatic events. Nearly one quarter of the children evidenced clinically significant PTS. Posttraumatic stress was positively and significantly related to family violence and other family-related trauma exposure, nonfamily violence and trauma exposure, and parenting stress. Additionally, parenting stress partially mediated the relationship between family violence and trauma exposure and PTS. This study highlights the need for early violence and trauma exposure screening in help-seeking populations so that appropriate interventions are initiated.     

Parental stress and burden following traumatic brain injury amongst children and adolescents

Primary objectives: To assess parental stress following paediatric traumatic brain injury (TBI), and examine the relationship between self-reported problems, parental stress and general health.

Research design: Parents of 97 children admitted with a TBI (49 mild, 19 moderate, 29 severe) to North Staffordshire National Health Service Trust, and parents of 31 uninjured children were interviewed and assessed.

Methods and procedures: Structured interviews were carried out with families, and parents assessed on the Parenting Stress Index (PSI/SF) and General Health Questionnaire (GHQ-12) at recruitment, and repeated 12 months later.

Main outcomes and results: Forty parents (41.2%) of children with TBI exhibited clinically significant stress. Regardless of injury severity, parents of injured children suffered greater stress than control parents as measured by the PSI/SF (p = 0.001). There was a highly significant relationship between number of problems reported and level of parental stress (p = 0.001). Financial burden was related to severity of TBI. At follow-up, one third of parents of children with severe TBI scored ≥18 on the GHQ-12, signifying poor psychological health.

Conclusions: The parents of a child with serious TBI should be screened for abnormal levels of stress. Parental stress and family burden may be alleviated by improved information, follow-up and support.     

Improvements in the Child‐Rearing Attitudes of Latina Mothers Exposed to Interpersonal Trauma Predict Greater Maternal Sensitivity Toward Their 6‐Month‐Old Infants

The current study investigated maternal sensitivity in a treatment‐seeking sample of predominately Latina, low‐income pregnant women with histories of interpersonal trauma exposure. Pregnant women (N = 52; M = 27.08 years, SD = 5.66) who enrolled in a study of a perinatal adaptation of child–parent psychotherapy reported on their posttraumatic stress symptoms and child‐rearing attitudes at baseline and again at 6‐months postpartum. Maternal sensitivity was measured via observational coding of a free‐play episode at 6‐months postpartum. Two thirds of mothers exhibited healthy levels of maternal sensitivity, M > 4.0 (range = 2.5–7.0). The results of multiple linear regression predicting maternal sensitivity, R² = .26, indicated that greater improvements in child‐rearing attitudes over the course of treatment predicted higher levels of maternal sensitivity, β = .33, whereas improvements in posttraumatic stress symptoms over the course of treatment did not, β = ?.10. Mothers’ attitudes regarding parenting during the perinatal period may be a mechanism by which intervention fosters healthy mother–infant relationship dynamics. Thus, parenting attitudes are a worthy target of intervention in vulnerable families.     

Psychological characteristics and physiological reactivity to acute stress in mothers of children with autism spectrum disorder

Stress related to parenting a child with autism spectrum disorder can differently affect caregiver's physiological reactivity to acute stress. Here, parental stress levels, psychological characteristics, and coping strategies were assessed alongside measures of heart rate, heart rate variability, and cortisol during a psychosocial stress test in mothers of children with ASD (M‐ASD, n = 15) and mothers of typically developing children (n = 15). M‐ASD reported significantly higher levels of parental stress, anxiety, negative affectivity, social inhibition, and a larger preference for avoidance strategies. M‐ASD showed larger heart rate and cortisol responses to the psychosocial stress test. A positive relationship was found between parental stress levels and the magnitude of the cortisol stress response in both groups. The present findings indicate exaggerated physiological reactivity to acute psychosocial stress in M‐ASD and prompt further research to explore the role of individual differences in mediating the effects of parental stress on physiological stress responses.     

Perceived Changes in Social Relations after Earthquake Trauma among Eastern Anatolian Women: Associated Factors and Mental Health Consequences

In this study, we examined social relations in women exposed to earthquake trauma in Eastern Anatolia, Turkey. We examined women's perceptions regarding the changes in their social relations within their neighbourhood, within their marriage and with their children; analysed the factors that were associated with these relations; and tested the hypothesis that an improvement in social relations will protect women's mental health from the negative impact of earthquake trauma. Participants consisted of a random selection of 1253 women, who were interviewed regarding their psychosocial needs and mental health status 1 year after earthquake. They reported trauma‐related changes in their social relations; their mental health was evaluated using the Post Traumatic Stress Diagnostic Scale and Brief Symptom Inventory. Our study demonstrated severe earthquake trauma was associated with deteriorated social relations, especially neighbourhood and marital relations. Deteriorated marital and child relations were associated with increased levels of psychiatric distress; deteriorated neighbourhood relations were associated with intrusive posttraumatic stress symptoms. Improved neighbourhood relations, but not family relations, were able to protect women's mental health from the negative impact of trauma. The results are discussed regarding their relevance to gender effects and the provision of relation‐specific and symptom‐specific disaster relief. Copyright © 2014 John Wiley & Sons, Ltd.     

Do perceived parenting styles influence stress coping in patients with major depressive disorders?

Parenting styles can influence an individual's ability to cope with stress; consequently, coping strategies may moderate the interaction between stress and psychiatric disorders. The correlation between perceived parenting styles and stress‐coping strategies in 50 outpatients in remission from major depressive disorders was investigated. Using multiple regression analysis including symptoms, gender and age of subjects as independent variables, maternal care and male gender were significant variables for predicting task‐oriented coping strategies (p<0.05). Low maternal care and highly overprotective parenting were significant variables for predicting emotion‐oriented coping strategies (p<0.05). These findings suggest that perceived parenting styles of the mother experienced in childhood may be related to stress‐coping styles in adulthood. It should nevertheless be considered whether parents’ actual child‐rearing methods affect their offspring's ability to cope with stress or whether an individual who retrospectively perceives a lack of parental affection tends to use more emotion‐oriented coping and less task‐oriented coping. Copyright © 1999 John Wiley & Sons, Ltd.     

Parent Discrepancies in Ratings of Child Behaviors Following Wartime Deployment

Researchers have shown that parents often disagree in their ratings of their children's behavior, and that these discrepancies are typically related to child and family characteristics (e.g., child's age, parent psychopathology). Few studies, however, have examined discrepancies in how mothers and fathers rate child behavior during a stressful family context such as a parent's wartime deployment. The present study of 174 military families (children aged 6 to 11 years; 54.0% female) examined whether family factors (parental sense of control, marital satisfaction) and contextual risk factors related to a parent's wartime deployment (number and length of deployments, battle experiences, and posttraumatic stress disorder [PTSD] symptoms) were associated with discrepancies in how mothers and fathers rated internalizing and externalizing behaviors in their children. Using a latent congruency model, our results showed that when parents self‐reported higher levels of PTSD symptoms, both mothers, β = ?.33, p = .021, and fathers, β = .41, p = .026, tended to also report higher levels of internalizing symptoms in their child, relative to what their spouse reported. In comparison to mothers, fathers also tended to report higher levels of child externalizing symptoms, β = .44, p = .019. Our findings may help clinicians understand how parent mental health within a stressful family context relates and/or informs a parent's ratings on assessments of his or her child's internalizing and externalizing symptoms.     

Disadvantaged Family Background and Depression among Young Adults in the United States: The Roles of Chronic Stress and Self‐Esteem

Although several longitudinal studies have demonstrated that having a disadvantaged family background is a risk factor for subsequent symptoms of depression, few studies have examined the mediating mechanisms that explain this long‐term relationship. Thus, this study uses US national longitudinal data and integrates social stress theory with the life course perspective by focusing on two mediating mechanisms—the chronic stress of poverty and self‐esteem during the transition to adulthood. Results reveal that self‐esteem largely mediates the inverse relationship between parental education and levels of depressive symptoms in young adulthood. However, the inverse relationship between parental occupational prestige and depressive symptoms among young adults is not mediated by self‐esteem, but rather long durations of poverty across 16 years. Overall, these findings suggest that different components of family socioeconomic status can leave a lasting imprint on mental health via the self‐concept and the chronic stress of poverty throughout the journey to adulthood. Copyright © 2013 John Wiley & Sons, Ltd.     

Families in the Shadow of Traumatic Experiences: Negative World Assumptions and Family Relationships

World assumptions (WAs) are cognitive schemas concerning an individual's views of themselves, the world, and others. Although it is well established that WAs are negatively distorted by trauma exposure and strongly associated with posttraumatic psychopathology, the potential impact of WAs on close interpersonal relationships remains largely uninvestigated. The current study explored the implications of veterans’ and their spouses’ WAs on their marital and parental relationships. Male Israeli veterans (N = 213) from the 1973 Yom Kippur War and their wives were assessed for WAs, marital adjustment, and positive parenting 35–37 years postwar. Analyses included actor–partner interdependence modeling with mediators (APIMem) and were conducted separately for the three domains of WAs: world benevolence, world meaningfulness, and self‐worth. The results indicated that both husbands’ and wives’ lower scores for all domain‐specific WA scales were associated with lower scores on measures of marital adjustment and positive parenting. Lower scores for both spouses on scales measuring world benevolence and self‐worth were associated with a spillover from lower marital adjustment to lower positive parenting. Finally, associations between one spouse's lower WA scores and the other spouse's spillover from lower marital adjustment to lower positive parenting (i.e., cross–spillover effects) were identified for wives’ world benevolence ratings and husbands’ self‐worth, ds = 0.14–0.72. These results point to the detrimental ramifications of negative WAs on family relationships and the dynamics between the marital and parental family subsystems.     

Posttraumatic Stress Symptoms and Disorders in Parents of Children and Adolescents With Chronic Physical Illnesses: A Meta‐Analysis

The present meta‐analysis analyzed whether parents of young people with pediatric chronic physical illnesses experience higher levels of posttraumatic stress symptoms (PTSS) and higher rates of posttraumatic stress disorder (PTSD) than other adults and searched for correlates of PTSS in these parents. Based on a systematic search in electronic databases, 184 studies were included in the meta‐analysis. On average, 18.9% of the parents fulfilled the criteria for PTSD, and PTSS were more common among parents of young people with pediatric chronic physical illnesses than in other adults, with Hedges' g showing a 0.85 increase in standard deviation units. Parental PTSS were most prevalent among parents of children with epilepsy, g = 1.25, and diabetes, g = 1.16, and were positively associated with being the mother, r = .19; illness severity, r = .18; treatment duration/intensity, r = .21; and PTSS of the child, r = .34. In contrast, longer illness duration, r = ?.19; longer time since active treatment, r = ?.10; and better social resources, rs = ?.17 to ?.07, were associated with lower parental PTSS. The findings indicate that parents who have faced traumatic events in the context of their child's chronic illnesses should be screened for PTSS and PTSD and receive psychological interventions when needed.     

Latent classes of resilience and psychological response among only‐child loss parents in China

Only‐child loss parents in China recently gained extensive attention as a newly defined social group. Resilience could be a probable solution out of the psychological dilemma. Using a sample of 185 only‐child loss people, this study employed latent class analysis (a) to explore whether different classes of resilience could be identified, (b) to determine socio‐demographic characteristics of each class, and (c) to compare the depression and the subjective well‐being of each class. The results supported a three‐class solution, defined as ‘high tenacity‐strength but moderate optimism class’, ‘moderate resilience but low self‐efficacy class’ and ‘low tenacity but moderate adaption‐dependence class’. Parents with low income and medical insurance of low reimbursement type and without endowment insurance occupied more proportions in the latter two classes. The latter two classes also had a significant higher depression scores and lower subjective well‐being scores than high tenacity‐strength but moderate optimism class. Future work should care those socio‐economically vulnerable bereaved parents, and an elastic economic assistance policy was needed. To develop targeted resilience interventions, the emphasis of high tenacity‐strength but moderate optimism class should be the optimism. Moderate resilience but low self‐efficacy class should be self‐efficacy, and low tenacity but moderate adaption‐dependence class should be tenacity.     

Quality of life assessment between laparoscopic appendectomy at presentation and interval appendectomy for perforated appendicitis with abscess: analysis of a prospective randomized trial

Purpose

The current study examined the impact of immediate laparoscopic surgery vs nonoperative initial management followed by interval appendectomy for appendicitis with abscess on child and family psychosocial well-being.

Methods

After obtaining Internal Review Board approval, 40 patients presenting with a perforated appendicitis and a well-formed abscess were randomized to surgical condition. Parents were asked to complete child quality of life and parenting stress ratings at presentation, at 2 weeks postadmission, and at approximately 12 weeks postadmission (2 weeks postoperation for the interval appendectomy group).

Results

Children in the interval arm experienced trends toward poorer quality of life at 2 and 12 weeks postadmission. However, no group differences in parenting stress were observed at 2 weeks postoperation. At 12 weeks postadmission, participants in the interval condition demonstrated significant impairment in both frequency and difficulty of problems contributing to parenting distress.

Conclusion

Families experience significant parenting distress related to the child's functioning and disruption in the child's quality of life that may be because of the delay in fully resolving the child's medical condition. In addition, parents experience negative consequences to their own stress as a result of the delay before the child's appendectomy.     

Parent experiences and psychosocial support needs 6 months following paediatric critical injury: A qualitative study

IntroductionParents of critically injured children can experience high levels of psychological distress post-injury, however little is known about their experiences and needs following injury. This study aimed to explore parent experiences and psychosocial support needs in the six months following child critical injury.MethodsAn interpretive qualitative design was used. Semi-structured interviews were conducted with 30 parents of 23 critically injured children. Interviews explored parent experiences and psychosocial support needs. Qualitative data were managed using NVIVO 10 and analysed thematically.ResultsFour themes were identified: integrating back into home life; adjusting mentally and emotionally to injury; coping with injury as a family; and navigating resources to meet family needs. Parents and families experienced substantial ongoing emotional impacts at 6 months following child injury. Parents were unprepared for the negative changes in their child’s psychological wellbeing and behaviour post injury, and parents’ mental health was negatively impacted, with mothers more likely to seek emotional support than fathers. Parents reported receiving no psychosocial follow-up from the hospital and limited information about community services and accessing local community resources on returning home.ConclusionsThere is a need to include all family members in discharge planning, and to use a family-centred continuity-of-care approach from the time of child injury through to post-discharge recovery. To strengthen parent and family wellbeing, a biopsychosocial holistic approach is recommended, including cognitive-behavioural and other psychological strategies to help reduce distress for parents and all family members and strengthen their coping capacity. A dedicated family support coordinator role to facilitate care over the child recovery trajectory, and development of accessible online and e-psychosocial support resources for parents and families are recommended.     

Health-related quality of life, psychosocial strains, and coping in parents of children with chronic renal failure

Health-related quality of life (HRQOL) in parents of children suffering from renal disease is often diminished by the illness burden experienced in daily life and by unfavorable ways of coping. Our aim was to examine the relationship between psychosocial strains perceived by parents, their ways of coping, and HRQOL. In an anonymous cross-sectional study, parents completed a questionnaire concerning psychosocial strains, coping strategies, and HRQOL, as well as sociodemographic and illness parameters. Study participants were recruited in two outpatient dialysis centers. Participating in the study were 195 parents (105 mothers, 90 fathers; age 43?±?8 years; representing 108 families) of children suffering from renal disease (age 12?±?5 years). Parents of children with chronic renal failure reported moderate HRQOL with parents of children undergoing dialysis experiencing more limitations in quality of life than parents of children living with a kidney graft and parents of children undergoing conservative treatment. Mothers experienced lower HRQOL and higher psychosocial strains than fathers. HRQOL was predicted by the coping strategies “focusing on child” (β?=?–0.25), “improving marital relationship” (β?=?0.24), “seeking social support” (β?=?–0.22) and “self-acceptation and growth” (β?=0?.19) as well as parents′ perceived limitation by illness in daily life (β?=?–0.15; explained variance 57%). In the comprehensive care for families with a child suffering from a renal disease, screening for psychosocial strains and ways of coping, along with applying interventions to strengthen adaptive coping strategies, may be a preventative means of improving parents′ quality of life.     

Posttraumatic stress in children with first responders in their families

High levels of exposure and occupational stress of first responders may have caused children in first-responder families to become traumatized following the September 11th, 2001 terrorist attacks. New York City public school children (N = 8,236) participated in a study examining mental health problems 6 months after the World Trade Center attack. Results revealed that children with emergency medical technician (EMT) family members had a high prevalence of probable posttraumatic stress disorder (PTSD; 18.9%). Differences in rates of probable PTSD among EMTs' and firefighters' children were explained by demographic characteristics. Where EMTs are drawn from disadvantaged groups, one implication of this study is to target EMT families in any mental health interventions for children of first responders.     

PTSD Symptom Trajectories in Disaster Volunteers: The Role of Self‐Efficacy,Social Acknowledgement,and Tasks Carried Out

Millions of volunteers respond after disasters, with a 24% to 46% risk of developing posttraumatic stress disorder (PTSD). It is unclear which symptom trajectories develop and how they differ between core (volunteering before the disaster) and noncore volunteers (joining after the disaster) and which factors predict trajectories. Symptoms of PTSD were assessed at 6‐, 12‐, and 18‐months postearthquake in 449 volunteers in Indonesia. Demographics, previous mental health service use, self‐efficacy, social acknowledgment, and type of tasks were assessed at 6 months. In both core and noncore volunteers, 2 PTSD symptom trajectories emerged: a resilient trajectory (moderate levels of symptoms with a slow decrease over time; 90.9%) and a chronic trajectory (higher levels of symptoms with an increase over time; 9.1%). In both trajectories, core volunteers had fewer symptoms than noncore volunteers. Core volunteers in the chronic trajectory were characterized by having sought prior mental help, reported lower levels of self‐efficacy and social acknowledgment, and were more likely to have provided psychosocial support to beneficiaries (Cramér's V = .17 to .27, partial η² = .02 to .06). Aid organizations should identify and follow up chronic PTSD trajectories in volunteers, including the noncore, who may be out of sight to the organization after the acute response phase.     

Psychological Functioning, Nonadherence and Health Outcomes After Pediatric Liver Transplantation

The present study empirically assessed the relationships between adherence behaviors and HRQOL, parent and child psychological functioning and family functioning, and investigated the relationship between adherence behaviors and health outcomes in children who were within 5 years of their liver transplantation. Participants included 38 children (mean = 8.5 years, range 28 months to 16 years) and their parent/guardian(s). HRQOL and psychological functioning were examined using well-validated assessment measures. Measures of adherence included the rate of clinic attendance and standard deviations (SDs) of consecutive tacrolimus blood levels, which were collected and evaluated retrospectively. Measures of child health status included the frequency of hospital admissions, liver biopsies, episodes of rejection and graft function for the year prior to study participation. Results indicated that nonadherence was related to lower physical HRQOL, more limitations in social and school activities related to emotional and behavioral problems, parental emotional distress and decreased family cohesion. Nonadherence was also related to frequency and duration of hospitalizations, liver biopsies and rejection episodes. These results suggest that empirically based assessment of HRQOL, parenting stress and family functioning may help identify patients at risk for nonadherence, and may allow for the need-based delivery of appropriate clinical interventions.