Childhood adversity and traumatic exposures during deployment as predictors of mental health in Australian military veterans

Objective : To examine whether the relationship between traumatic exposure on deployment and poor mental health varies by the reported level of childhood adversity experienced in Australian military veterans deployed to the Bougainville or East Timor military operations. Methods : Cross‐sectional self‐reported survey data were collected in 2008 from 3,564 Australian military veterans who deployed to East Timor or Bougainville on their deployment experiences, health and recall of childhood events. Multivariable logistic regression was used to investigate the association between childhood adversity, deployment exposures and mental health. Results : The most common childhood adversity reported was ‘not having a special teacher, youth worker or family friend who looked out for them while growing up’. On average, responders reported experiencing 3.5 adverse childhood experiences (SD 2.7) and averaged 5.3 (SD 4.9) traumatic exposures on deployment. Both childhood adversity and traumatic exposures on deployment were associated with higher odds of poorer mental health. However, there was no evidence that level of childhood adversity modified the association between traumatic exposure and mental health. Conclusions/Implications : These findings suggest that military personnel who recalled a higher level of childhood adversity may need to be monitored for poor mental health and, if required, provided with appropriate support.     

Resilience as Regulation of Developmental and Family Processes

Resilience can be defined as establishing equilibrium subsequent to disturbances to a system caused by significant adversity. When families experience adversity or transitions, multiple regulatory processes may be involved in establishing equilibrium, including adaptability, regulation of negative affect, and effective problem‐solving skills. The authors' resilience‐as‐regulation perspective integrates insights about the regulation of individual development with processes that regulate family systems. This middle‐range theory of family resilience focuses on regulatory processes across levels that are involved in adaptation: whole‐family systems such as routines and sense of coherence; coregulation of dyads involving emotion regulation, structuring, and reciprocal influences between social partners; and individual self‐regulation. Insights about resilience‐as‐regulation are then applied to family‐strengthening interventions that are designed to promote adaptation to adversity. Unresolved issues are discussed in relation to resilience‐as‐regulation in families, in particular how risk exposure is assessed, interrelations among family regulatory mechanisms, and how families scaffold the development of children's resilience.     

A Family Resilience Framework: Innovative Practice Applications

An overview of a research‐informed family resilience framework, developed as a conceptual map to guide clinical intervention and prevention efforts with vulnerable families is presented. Building on studies of individual and family resilience and developments in strength‐based approaches to family therapy, this practice approach is distinguished by its focus on strengthening family functioning in the context of adversity. Key processes that foster resilience are outlined, as are several innovative family systems training and service applications.     

Toward a Framework for Military Family Life Education: Culture,Context, Content,and Practice

Grounded in multiple ways of thinking about families, we propose a beginning framework for developing and implementing military family life education. We first situate this work within the context of established family life education frameworks. Then, we discuss features of military culture, including its contexts and demands on families, to highlight the realities of life as a military family and underscore available strengths that family life educators may build upon. This is followed by a discussion of family science theories emphasizing components that can inform and ground military family life education. Next, we draw on lessons from recent comprehensive reviews of programs, including their merits and demerits. Finally, we cite example programs, including those embedded in military family support systems themselves, and resources that are available to family life educators. Ultimately, we propose a set of ideas that inform a framework for developing and implementing military family life education aligned with the realities of family life as well as the vulnerabilities and the resilience of military families.     

Childhood adversity and combat as predictors of depression and post-traumatic stress in deployed troops

BACKGROUND: Previous studies have shown a relationship between childhood adversity and health outcomes in adulthood. The military represents a segment of the young working population that faces unique hazards that may be worsened by previous adverse life experiences. To date, no comprehensive studies of childhood adversity have been conducted with military samples that have included combat troops before and after a combat deployment. METHODS: Surveys were administered in 2003 to 4529 male soldiers who had not deployed to Iraq, and in 2004 to a separate group of 2392 male soldiers 3 months after returning from Iraq. The main predictor was adverse childhood experiences, an aggregated construct representing incremental exposure to six types of traumatic childhood experiences. This construct correlated with depression and post-traumatic stress disorder rates, as well as symptom scores. For the post-Iraq sample, analyses were conducted to assess whether individuals with childhood trauma were affected differently by exposure to combat. RESULTS: The likelihood of screening positive for depression and post-traumatic stress disorder was significantly higher for individuals reporting exposure to two or more categories of childhood adversity. Core analyses showed that adverse childhood experiences were a significant predictor of mental health symptoms, beyond the expected contribution of combat. CONCLUSIONS: This study confirms the high prevalence of adverse childhood experiences and the association of these experiences with key mental health outcomes. In addition, the results highlight the importance of considering pre-enlistment childhood traumatic experiences as well as the level of combat exposure in the treatment of military personnel returning from combat operations.     

Family Resilience: Moving into the Third Wave

Family resilience has progressed through two waves and is poised for Wave 3. During Waves 1 and 2, family resilience perspectives were conceptualized, researched, and applied as a strengths‐based approach focused on positive family adaptation despite significant risk using an integration of concepts from individual resilience, general systems perspectives on families, and family stress theory. For Wave 3, the authors advocate for increased consistency in terminology and present the family resilience model (FRM) within which existing models interface with family adaptive systems (meaning systems, emotion systems, control systems, maintenance systems, and family stress‐response systems). The authors also argue for increased focus on trajectories and cascades, and enhanced prevention, intervention, and policy. The authors provide a hypothetical case study applying the FRM.     

Short‐Term Resilience Processes in the Family

The authors review naturalistic studies of short‐term processes that appear to promote resilience in children in the context of everyday family life and argue that warm and supportive family interactions foster resilience through their cumulative impact on children's emotional and physiological stress response systems. In the short‐term, these family interactions promote the experience and expression of positive emotion and healthy patterns of diurnal cortisol. Over time, these internal resources – a propensity to experience positive emotion and a well‐functioning hypothalamic‐pituitary‐adrenal axis system – enhance a child's capacity to avoid, or limit, the deleterious effects of adversity. This article highlights naturalistic research methods that are well suited to the study of these short‐term resilience processes and points to clinical applications of our conceptual and methodological approach.     

大学生不同时期不良经历与抑郁症的关系

探讨大学生不同时期不良经历与抑郁症的关系,为预防大学生抑郁症提供参考.方法 采用分层整群抽样方法抽取湖北省6所高校5 913名在校本科生,采用网络调查问卷,问卷内容包括大学生基本信息、家庭有关信息、不同时期不良经历以及是否患有抑郁症.率之间的比较用x2/Fisher检验,多元Logistic回归分析相关影响因素.结果 5 913名大学生中,自我报告被医生诊断患有/患过抑郁症的有82名,患病率为1.4%.2 198名(37.2%)有童年期不良经历,l 757名(29.7%)有青少年期不良经历,5 158名(87.2%)有上大学后的挫折经历.1 329名(22.5%)同时有童年期和青少年期不良经历,1 160名(19.6%)同时有童年期和青少年期不良经历以及上大学后挫折经历.童年期不良经历与抑郁症有关,童年期有不良经历者患抑郁症的可能性是童年期无不良经历者的2.351倍(95%CI=1.475~ 3.747),而青少年期不良经历、上大学后的挫折经历以及各时期不良经历的叠加均与抑郁症无关(P值均>0.05).结论 需积极关注有童年期不良经历的大学生,给予一定的心理辅导和社会支持,预防或减少抑郁情绪的产生.     

Can We Fix This? Parent–Child Repair Processes and Preschoolers' Regulatory Skills

The repair of difficult parent–child interactions is a marker of healthy functioning in infancy, but less is known about repair processes during early childhood. We used dynamic systems methods to investigate dyadic repair in mothers and their 3‐year‐old children (N = 96) and its prediction of children's emotion regulation and behavior problems at a 4‐month follow‐up. Mothers and children completed free play and challenging puzzle tasks. Repair was operationalized as the conditional probability of moving into a dyadic adaptive behavior region after individual or dyadic maladaptive behavior (e.g., child noncompliance, parental criticism). Overall, dyads repaired approximately half their maladaptive behaviors. A greater likelihood of repair during the puzzle task predicted better child emotion regulation and fewer behavior problems in preschool. Results suggest dyadic repair is an important process in early childhood and provide further evidence for the connection between parent–child coregulation and children's developing regulatory capacities. Implications for family‐based interventions are discussed.     

Parental coping and family stress I: Resources for and functioning of families with a preschool child having a developmental disability

While some families function well in the face of the demands of raising a handicapped child, many experience considerable stress. To assist these families, it is important to identify the characteristics of some families which allow them to raise their children while maintaining the well being of individual family members and the family system.

The purpose of this study was to examine the T-Double ABCX Model of Family Adaptation in relation to the adaptive functioning of 16 families raising preschoolers with developmental disabilities. It was concluded that the model provided a useful framework for guiding future research into the adaptive process of families raising children having disabilities.     

Information and professional support: key factors in the provision of family-centred early childhood intervention services

Background Much has been written on the principles of family‐centred practice and on the service delivery methods and skills required of its practitioners. Far less has been written from the perspective of families whose children have a disability. The aims of this study were twofold: firstly to understand families' experiences of family‐centred early childhood intervention services and secondly to explore other factors that might impact on these experiences. Methods One hundred and thirty families attending two established early childhood intervention services in New South Wales, Australia completed a survey incorporating the Measure of Processes of Care‐56, the Family Empowerment Scale, the Family Support Scale and the Parenting Daily Hassles Scale. Results Consistent with previous research using the Measure of Processes of Care‐56, ‘respectful and supportive care’ was the domain of care families rated to occur most and ‘provision of general information’ was the domain they rated to occur least. Significant positive relationships existed between families' ratings of family‐centred care and feelings of empowerment. Being provided with general information was strongly correlated with family empowerment. Families' social support networks played an important role but support from professionals was most strongly correlated with families' experiences of family‐centred care. Finally, families whose children's early intervention services were co‐ordinated by a professional experienced significantly better care. Conclusions The provision of general information and professional support are key components of family‐centred early childhood intervention services.     

Perceived stress,resilience, and health‐related quality of life among Parkinson's disease caregivers in Mexico

The stress process model of caregiving posits that caregivers' internal psychosocial resources may serve as buffers between the stress associated with caregiving and well‐being. Empirical support for the stress process model exists for several caregiving contexts, but little research has investigated the Parkinson's disease caregiving experience in Mexico. Using a cross‐sectional, correlational design, the objective of this study was to examine whether resilience moderates the relation between perceived stress and health‐related quality of life (HRQOL) among Parkinson's disease caregivers in Mexico. Data were collected from April 2015 to February 2016 during outpatient neurology appointments in Mexico City, Mexico. Participants included informal caregivers (N = 95) for a family member with Parkinson's disease. Participants completed a battery of questionnaires assessing their level of perceived stress, resilience, and HRQOL. Regression analyses indicated that resilience moderated the inverse relation between perceived stress and mental HRQOL. However, contrary to hypotheses, resilience did not moderate the relation between stress and physical HRQOL. Findings shed light on resilience as a potential protective factor for mental HRQOL among Parkinson's disease caregivers in Mexico and indicate that resilience may be beneficial to target in mental health promotion interventions.     

Parent‐child relationships and quality of life: Resilience among childhood cancer survivors*

Abstract: According to The Resiliency Model of Family Stress, Adjustment, and Adaptation, certain family strengths can promote positive outcomes for children undergoing adverse or stressful circumstances. We proposed that chief among these potential strengths are high quality parent‐child relationships. Data from self‐report questionnaires from 190 long‐term survivors (3+ years posttreatment) of childhood cancer were analyzed. The findings indicated that survivors who report better relationships with their mothers and fathers consistently report a higher quality of life, especially in the psychological domain. Although survivors reported better relationships with their mothers than with their fathers, father‐child relations were associated more highly with survivors’ reports of selective quality of life scales. Important implications for family therapists and practitioners are discussed, especially those that employ a growth or resilience approach.     

Cross-Sectional Study into the Costs and Impact on Family Functioning of 4-Year-Old Children with Aggressive Behavior

Early-onset aggressive behavior is known for its negative developmental consequences, and the associated high costs for families, the health care system and wider society. Although the origins of aggressive behavior are to be found in early childhood, the costs incurred by aggressive behavior of young children have not been studied extensively. The present study aimed to investigate whether preschool children with a high level of aggressive behavior already differ in the generated amount of costs and impact on family functioning from children with lower levels of aggressive behavior. A population-based sample of 317 preschool children was divided into four groups with different levels of aggression (moderate, borderline, clinical). Parents filled out questionnaires to assess service use (lifetime and past 3 months) and impact on family functioning. Over the past 3 months as well as over the first 4 years of life, children with a clinical level of aggression were more costly than children with a low level of aggression (mean total costs over the past 3 months: low = €167,05 versus clinical € = 1034,83 and mean lifetime costs: low € = 817,37 versus clinical € = 1433,04), due to higher costs of services used by the child. In addition, families of children with a borderline or clinical level of aggressive behavior reported more impairment in their daily functioning than families of children with lower levels of aggression. The findings demonstrate that a high level of aggressive behavior results in high costs and impaired family functioning in the preschool years already.     

The cycle of uncertainty: parents’ experiences of childhood epilepsy

Uncertainty has been highlighted as an important aspect of experiences of chronic conditions generally and epilepsy in particular. However, there is little research exploring the extent to which uncertainty features in the experiences of family members or the form that this uncertainty may take. Drawing on in‐depth semi‐structured interviews with 27 parents who had a child with epilepsy, this article explores parents’ experiences of uncertainty and the way in which their views on childhood and epilepsy interacted and contributed to the uncertainties they experienced. It is argued that the occurrence of epilepsy during childhood shaped parents’ experiences as they used their ‘social clocks’ in order to interpret symptoms. Furthermore, parents described what has been termed a ‘cycle of uncertainty’. Indeed, the combination of epilepsy (a condition with various inherent forms of uncertainty) and childhood (a period in the life course that is seen as a time of development) meant that parents could not be sure which changes in their child were a result of the condition and which were a normal part of the ageing process. Overall, this article demonstrates that it is important to contextualise experiences of chronic conditions in relation to different stages in the life course.     

Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study

CONTEXT: Adverse childhood experiences such as physical abuse and sexual abuse have been shown to be related to subsequent unintended pregnancies and infection with sexually transmitted diseases. However, the extent to which sexual risk behaviors in women are associated with exposure to adverse experiences during childhood is not well-understood. METHODS: A total of 5,060 female members of a managed care organization provided information about seven categories of adverse childhood experiences: having experienced emotional, physical or sexual abuse; or having had a battered mother or substance-abusing, mentally ill or criminal household members. Logistic regression was used to model the association between cumulative categories of up to seven adverse childhood experiences and such sexual risk behaviors as early onset of intercourse, 30 or more sexual partners and self-perception as being at risk for AIDS. RESULTS: Each category of adverse childhood experiences was associated with an increased risk of intercourse by age 15 (odds ratios, 1.6-2.6), with perceiving oneself as being at risk of AIDS (odds ratios, 1.5-2.6) and with having had 30 or more partners (odds ratios, 1.6-3.8). After adjustment for the effects of age at interview and race, women who experienced rising numbers of types of adverse childhood experiences were increasingly likely to see themselves as being at risk of AIDS: Those with one such experience had a slightly elevated likelihood (odds ratio, 1.2), while those with 4-5 or 6-7 such experiences had substantially elevated odds (odds ratios, 1.8 and 4.9, respectively). Similarly, the number of types of adverse experiences was tied to the likelihood of having had 30 or more sexual partners, rising from odds of 1.6 for those with one type of adverse experience and 1.9 for those with two to odds of 8.2 among those with 6-7. Finally, the chances that a woman first had sex by age 15 also rose progressively with increasing numbers of such experiences, from odds of 1.8 among those with one type of adverse childhood experience to 7.0 among those with 6-7. CONCLUSIONS: Among individuals with a history of adverse childhood experiences, risky sexual behavior may represent their attempts to achieve intimate interpersonal connections. Having grown up in families unable to provide needed protection, such individuals may be unprepared to protect themselves and may underestimate the risks they take in their attempts to achieve intimacy. If so, coping with such problems represents a serious public health challenge.     

Are family‐centred principles,functional goal setting and transition planning evident in therapy services for children with cerebral palsy?

Background Family‐centred service, functional goal setting and co‐ordination of a child's move between programmes are important concepts of rehabilitation services for children with cerebral palsy identified in the literature. We examined whether these three concepts could be objectively identified in programmes providing services to children with cerebral palsy in Alberta, Canada. Methods Programme managers (n= 37) and occupational and physical therapists (n= 54) representing 59 programmes participated in individual 1‐h semi‐structured interviews. Thirty‐nine parents participated in eleven focus groups or two individual interviews. Evidence of family‐centred values in mission statements and advisory boards was evaluated. Therapists were asked to identify three concepts of family‐centred service and to complete the Measures of Process of Care for Service Providers. Therapists also identified therapy goals for children based on clinical case scenarios. The goals were coded using the components of the International Classification of Functioning Disability and Health. Programme managers and therapists discussed the processes in their programmes for goal setting and for preparing children and their families for their transition to other programmes. Parents reflected on their experiences with their child's rehabilitation related to family‐centredness, goal setting and co‐ordination between programmes. Results All respondents expressed commitment to the three concepts, but objective indicators of family‐centred processes were lacking in many programmes. In most programmes, the processes to implement the three concepts were informal rather than standardized. Both families and therapists reported limited access to general information regarding community supports. Conclusion Lack of formal processes for delivery of family‐centred service, goal‐setting and co‐ordination between children's programmes may result in inequitable opportunities for families to participate in their children's rehabilitation despite attending the same programme. Standardized programme processes and policies may provide a starting point to ensure that all families have equitable opportunities to participate in their child's rehabilitation programme.     

Parental Deployment and Youth in Military Families: Exploring Uncertainty and Ambiguous Loss*

Abstract: Parental deployment has substantial effects on the family system, among them ambiguity and uncertainty. Youth in military families are especially affected by parental deployment because their coping repertoire is only just developing; the requirements of deployment become additive to normal adolescent developmental demands. Focus groups were used to inquire about uncertainty, loss, resilience, and adjustment among youth aged 12–18 that had a parent deployed, most often to a war zone. The nature of uncertainty and ambiguous loss was explored. Response themes included overall perceptions of uncertainty and loss, boundary ambiguity, changes in mental health, and relationship conflict. These accounts suggest that ambiguous loss is a useful concept for understanding the experiences of these youth and for structuring prevention and intervention efforts.     

Assessing the Families’ Perceptions of Their Young Children's Acquisition of Literacy

The purpose of this study was to develop a family literacy questionnaire that could be used in a survey or interview to examine the families’ perceptions of their contributions to promoting the acquisition of literacy in their young children. An in‐depth open ended interview was conducted with 10 families of young children. Family members identified literacy experiences that they shared with their children. The interviewer asked about specific experiences and asked respondees to elaborate on their responses. These questions helped family members to think of literacy experiences that they shared with their children. The information from these interviews provided the basis for the questions that became the family literacy questionnaire. A questionnaire containing 60 items in nine sections was generated. Each section contained from 1 to 8 items. To validate the questionnaire, factors in the questions were matched with factors that emerged from a review of the literature on family variables that have been found to affect literacy in the home. In addition, the questionnaire was shared with a reading specialist, a kindergarten teacher and a well known scholar in early childhood education. There was a 95#pc agreement on the items and directions. Where differences emerged items were either deleted or modified based on the suggestions of the panel.