Adverse life experiences and common mental health problems in pregnancy: a causal pathway analysis

Risk factors for antenatal common mental problems include a history of depression, lack of social support and a history of both childhood and adulthood sexual and physical abuse. However, it is less clear whether pregnancy is a time of particular susceptibility to mental disorders due to prior childhood experiences. The aim of the paper was to investigate the potential pathways to antenatal mental health problems. A total of 521 women attending prenatal care attended a clinical interview and answered psychological questionnaires. Univariate analysis, sequential binary logistic regression and structural equation modelling (SEM) were used to analyse the relationships between variables. Having experienced parental maladjustment, maltreatment and serious physical illness in childhood and domestic violence, financial difficulties and serious spousal substance abuse in adulthood significantly predicted antenatal common mental health symptoms. SEM showed that history of depression and adverse experiences in adulthood had mediating effects on the relationship between adverse childhood events and symptoms of antenatal common mental disorders. Adverse childhood experiences are distal risk factors for antenatal common mental health problems, being significant indicators of history of depression and adverse experiences in adulthood. We therefore conclude that pregnancy is not a time of particular susceptibility to common mental health problems as a result of childhood abuse, but rather, these childhood experiences have increased the risk of adulthood trauma and prior mental disorders. Women at risk for antenatal common mental disorders include those with a history of depression, domestic violence, financial difficulties, spousal substance abuse and lack of social support.

     

Trauma, depression, coping, and mental health service seeking among impoverished women

The authors examined the relationship among trauma, coping, depression, and mental health service seeking in a probability sample of sheltered homeless and low-income housed women. Results highlight the diversity of trauma. In a longitudinal analysis, women who lived in shelters or experienced major violence had a twofold increase in their risk of depression over the 6-month follow-up. In a cross-sectional analysis, childhood sexual abuse, living in a shelter, physical violence, childhood physical abuse, and death or injury of a friend or relative predicted avoidant coping and symptoms of depression. Active coping and depression predicted mental health service seeking among traumatized women. Modifying coping strategies may ameliorate some of the negative impact of trauma and potentially enhance mental health service use among at-risk women.     

Sexual assault history,PTSD, and mental health service seeking in a national sample of women

This study examined correlates of posttraumatic stress disorder (PTSD) and mental health service seeking for women sexually assaulted in childhood and/or adulthood (N = 619) identified from the National Comorbidity Survey (1990–1992). Factors related to correlates of PTSD and mental health service seeking varied according to sexual assault history. Ethnic minority women with less formal education, more traumatic and stressful life events, and longer duration of sexual abuse had greater odds of PTSD within certain sexual assault history subgroups. Mental health service seeking was predicted by demographics (e.g., more education, Caucasian race), as well as other psychosocial factors (e.g., life events, social support), and medical insurance status, especially for adult sexual assault victims. Implications for mental health treatment and intervention are drawn for women with different sexual assault histories. © 2002 Wiley Periodicals, Inc.     

Psychosocial Functioning of Carcinoid Cancer Patients: Test of a Stress and Coping Mediated Model1

This study examined a mediated‐effects stress and coping model among cancer patients with carcinoid tumors to identify specific pathways with a view toward determining (a) which coping strategies predict more positive adjustment, (b) which strategies predict less positive adjustment, and (c) whether coping would mediate the effect of optimism on psychosocial outcomes. Coping strategies partially mediated the effects of optimism on the psychological adjustment in cancer patients with carcinoid tumors. Specifically, self‐blame and active coping significantly predicted outcomes of distress. Thirty‐seven percent of the respondents met criteria for elevated depressive symptoms warranting intervention. Generalizability of the mediated‐effects stress and coping model and findings unique to the carcinoid population are discussed.     

Longitudinal predictors of adult socioeconomic attainment: the roles of socioeconomic status, academic competence, and mental health

Educational attainment and occupational status are key markers of success in adulthood. We expand upon previous research that focused primarily on the contributions of academic competence and family socioeconomic status (SES) by investigating the role of mental health in predicting adult SES. In a longitudinal study spanning 30 years, we used structural equation modeling to examine how parental mental health in early childhood and family SES, offspring academic competence, and offspring mental health in adolescence relate to occupational and educational attainment at age 30. Results were that adolescent academic competence predicted adult educational attainment, and that educational attainment then predicted occupational attainment. The pathways between academic competence and occupational attainment, family SES and educational attainment, and family SES and occupational attainment were not significant. In contrast, adolescent mental health not only predicted educational attainment, but was also directly related to adult occupational attainment. Finally, early maternal mental health was associated with offspring's adult socioeconomic attainment through its relations with adolescent academic competence and mental health. These results highlight the importance of mental health to adult socioeconomic attainment.     

Homelessness and mental health in Ghana: everyday experiences of Accra's migrant squatters

This article discusses everyday experiences of transient homelessness in Ghana's capital, Accra. Episodic interviews with individuals living in squatter settlements in the wealthy East Legon suburb explored: (1) roots of homelessness; (2) everyday experiences and coping strategies; (3) relationship between experiences and (mental) health; (4) needs and interventions. Three intersecting forms of insecurity framed participants' everyday experience: financial, legal and psychosocial. Physical and psychological stresses were common; physical illnesses rare. Coping strategies facilitated adaptation but not transformation of everyday circumstances. We explore possibilities for intervention and discuss relevance of this study to the health psychology and African literatures on homelessness.     

The Afro-American life cycle: success, failure, and mental health

The author examines the Afro-American life cycle from the period of the 1900s to the 1980s and discusses the psychosocial context for a three-generation Afro-American family living in America in the 1980s. The specific stresses and successful or maladaptive coping strategies of the members are presented as well as the potential mental health problems arising from ineffective mastery of developmental transitions.     

Exploring the meaning of separation in second‐generation young South Asian women in Britain

Objectives . To explore the experiences of young second‐generation South Asian women living in Britain; to try and understand their experiences, deconstruct the term cultural conflict and understand it within a psychological framework. In particular, the aim was to explore issues of separation and individuation, and the meanings attributed to these concepts. Design . An interview‐based study using Interpretative Phenomenological Analysis to analyse the data. Methods . Interviews were conducted with six second‐generation South Asian women aged 16–20, who had no prior contact with mental health services. Results . Five main themes were identified from the analysis: differences in the meaning of adulthood, community policing, pressures and stressors, protective factors/coping and barriers to coping. Conclusions . The participants' perceived differences in the meaning of adulthood in Asian cultures in comparison with Western cultures. These differences, in conjunction with the community policing that they were exposed to, contributed to the pressures and stressors ‐ in particular lack of control and a desire to make individual decisions. The results indicated that the differences in the meaning of adulthood in a collective culture challenged the assumptions of the separation‐individuation model, and was a key element in cultural conflict. This highlighted the complexities of generalizing research findings across all social groups, and questioned the validity of applying existing psychological theory to this population. The clinical implications of coping/protective factors and barriers to coping were discussed.     

Teenage night owls or early birds? Chronotype and the mental health of adolescents

Evidence suggests that the timing of sleep (chronotype) impacts mental health in young people, but previous studies have not accounted for sleep duration or school start time in this association, or examined a broad range of mental outcomes. In this study, we investigated the association between chronotype and mental health in a representative sample of adolescents from the 2014 Canadian Health Behaviour in School‐Aged Children survey (29,635 students, 362 schools). We examined positive and negative aspects of mental health, using scores for emotional problems (range 0–33), emotional well‐being (0–22), behavioural problems (0–28) and prosocial behaviours (0–25). We estimated chronotype using the time of mid‐sleep on weekends and examined the associations using multilevel regressions, adjusted for sleep duration, school start time, individual, family and geographic characteristics. The average time of mid‐sleep (chronotype) was 04:11 hr. An hour delay in mid‐sleep time was associated with more emotional problems (0.34 [95% confidence interval 0.23, 0.45] point higher score), more behavioural problems (2.0% [95% confidence interval 1.4%, 2.6%] higher score), less emotional well‐being (0.19 [95% confidence interval 0.09, 0.20] point lower score), and fewer prosocial behaviours (0.18 [95% confidence interval 0.08, 0.29] point lower score). A later chronotype was associated with poorer mental health, independent of sleep duration and school start time, and across internalizing and externalizing mental health domains. Further research is needed to clarify the mechanisms underlying this association. The timing of sleep, and not just its duration, may be an additional consideration for youth mental health.     

Mild mental retardation: psychosocial functioning in adulthood

BACKGROUND: Evidence on the adult adaptation of individuals with mild mental retardation (MMR) is sparse, and knowledge of the factors associated with more and less successful functioning in MMR samples yet more limited. METHOD: Prospective data from the National Child Development Study were used to examine social circumstances and psychosocial functioning in adulthood in individuals with MMR and in a non-retarded comparison group. RESULTS: For many individuals with MMR, living circumstances and social conditions in adulthood were poor and potential stressors high. Self-reports of psychological distress in adulthood were markedly elevated, but relative rates of psychiatric service use fell between childhood and adulthood, as reflected in attributable risks. Childhood family and social disadvantage accounted for some 20-30% of variations between MMR and non-retarded samples on a range of adult outcomes. Early social adversity also played a significant role in contributing to variations in functioning within the MMR sample. CONCLUSIONS: MMR appears to be associated with substantial continuing impairment for many individuals.     

Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers

Adverse childhood experiences (ACEs) can have long‐term impacts on a person's mental health, which extend into adulthood. There is a high prevalence of ACEs among service members. Further, service members also report frequently experiencing disrupted sleep. We hypothesized that disrupted sleep may serve a mechanistic function connecting ACEs to functional impairment and poorer mental health. In a cross‐sectional sample (n = 759), we found evidence for an indirect effect of ACEs on mental health outcomes through disrupted sleep. In a different sample using two time‐points (n = 410), we found evidence for an indirect effect of ACEs on changes in mental health outcomes and functional impairment during a reset period, through changes in disrupted sleep during the same period. Implications, limitations and future research directions are discussed.     

精神疾病患者家属病耻感现况及影响因素

目的:对精神疾病患者家属的感知病耻感状况进行描述,并分析病耻感的影响因素。方法:采取随机抽样方法抽取157名住院精神疾病患者的家属,对其进行病耻感以及影响因素的问卷调查,分析了病耻感在年龄、性别、婚姻状况、职业、受教育程度等的分布差异,并从社会和人口学、精神卫生和心理健康知识、社会支持、应对方式等角度分析病耻感的影响因素。结果:78.3%的精神疾病患者家属存在感知病耻感,不同年龄、性别、婚姻状况、受教育程度等的家属,其病耻感程度不同(t=31.319,-3.105,32.300,23.868;P0.01)。多元逐步回归分析发现,消极应对、年龄、性别、患者住院次数、客观支持、患者病程、积极应对为病耻感的显著影响因素(P0.01)。结论:精神疾病患者家属的感知病耻感不容忽视,消极应对方式越强、客观支持与积极应对方式越少的患者家属,病耻感越强。本研究所得结果为改善精神疾病患者家属的心理健康状况提供了部分参考依据。     

Predictors of Positive Psychosocial Functioning of Older Adults in Residential Care Facilities

This research examined the contributions of active and passive coping for health problems, and meaning-based coping, to positive psychosocial functioning in a sample of 100 individuals in residential care with a mean age of 83.11 years old. Study participants resided in skilled care, intermediate care, or assisted living facilities. Based on interview data collected on site in participants' residential settings, hierarchical multiple regression analyses revealed that active and passive coping and meaning-based coping had separate influences on measures of positive psychosocial functioning. Active coping was correlated with higher positive affect, whereas passive coping was associated with higher negative affect and self-acceptance. Positive reappraisal, a meaning-based coping strategy, was uniquely associated with higher positive affect, positive social relations, and self-acceptance. Positive religious coping was not independently associated with positive psychosocial functioning indices, whereas negative religious coping was related to higher negative affect. Health functioning did not contribute to positive psychosocial functioning in this sample. The results confirm the separate importance of health-related and meaning-based coping strategies in explaining positive psychosocial functioning in older adults living in residential care settings.     

Cross‐sectional and longitudinal associations between psychosocial well‐being and sleep in European children and adolescents

Research on associations of positive mental health, in contrast to mental ill‐health, with sleep duration and sleep disturbances in young populations is scarce. In particular, longitudinal studies focussing on the influence of positive mental health on sleep characteristics are lacking. Therefore, we investigated cross‐sectional and longitudinal associations of psychosocial well‐being with sleep duration and sleep disturbances. For the cross‐sectional analysis, we used data of 3‐15‐year‐old children and adolescents participating in the 2013/14 examination of the European IDEFICS/I.Family cohort study (N = 6,336). The longitudinal analysis was restricted to children who also participated in the 2009/10 examination (N = 3,379). Associations between a psychosocial well‐being score created from 16 items of the KINDL^R Health‐Related Quality of Life Questionnaire covering emotional well‐being, self‐esteem and social relationships, an age‐standardized nocturnal sleep duration z‐score and two sleep disturbance indicators (“trouble getting up in the morning”, “difficulties falling asleep”) were estimated using linear and logistic mixed‐effects models. Cross‐sectionally, a higher well‐being score was associated with longer sleep duration and lower odds of sleep disturbances. A positive change in the well‐being score over the 4‐year period was associated with longer sleep duration and lower odds of sleep disturbances at follow‐up. However, there was only weak evidence that higher psychosocial well‐being at baseline was associated with better sleep 4 years later. Thus, our results suggest that increases in well‐being are associated with improvements in both sleep duration and sleep disturbances, but that well‐being measured at one point in time does not predict sleep characteristics several years later.     

Child sexual abuse and number of sexual partners in young women: the role of abuse severity, coping style, and sexual functioning

The authors proposed and tested a model describing distinct pathways through which childhood sexual abuse (CSA) may lead to relatively low or high numbers of sexual partners in adulthood. Path analyses were conducted on survey responses of young female US Navy recruits who reported CSA (N=547). Use of avoidant strategies to cope with CSA was expected to produce higher levels of sexual problems and fewer heterosexual sex partners, whereas use of self-destructive coping strategies was expected to result in more dysfunctional sexual behavior and more heterosexual sex partners. As predicted, the effect of CSA on number of sex partners was largely mediated by coping strategies and dysfunctional sexual behavior.     

The Cardiff dental study: A 20‐year critical evaluation of the psychological health gain from orthodontic treatment

Objectives. Despite the widespread belief that orthodontics improves psychological well‐being and self‐esteem, there is little objective evidence to support this ( Kenealy et al., 1989a ; Shaw, O'Brien, Richmond, & Brook, 1991 ). A 20 year follow‐up study compared the dental and psychosocial status of individuals who received, or did not receive, orthodontics as teenagers. Design. A prospective longitudinal cohort design with four studies of the effect of orthodontic treatment. Secondary analysis of outcome data incorporated orthodontic need at baseline and treatment received in a 2 × 2 factorial design. Methods. A multidisciplinary research programme studied a cohort of 1,018, 11–12 year old participants in 1981. Extensive assessment of dental health and psychosocial well‐being was conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pre‐treatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow‐up 337 (30–31 year olds) were re‐examined in 2001. Results. Participants with a prior need for orthodontic treatment as children who obtained treatment demonstrated better tooth alignment and satisfaction. However when self‐esteem at baseline was controlled for, orthodontics had little positive impact on psychological health and quality of life in adulthood. Lack of orthodontic treatment where there was a prior need did not lead to psychological difficulties in later life. Dental status alone was a weak predictor of self‐esteem at outcome explaining 8% of the variance. Self‐esteem in adulthood was more strongly predicted (65% of the variance) by psychological variables at outcome: perception of quality of life, life satisfaction, self‐efficacy, depression, social anxiety, emotional health, and by self‐perception of attractiveness. Conclusion. Longitudinal analysis revealed that the observed effect of orthodontic treatment on self esteem at outcome was accounted for by self esteem at baseline. Prior need for treatment assessed in childhood made a small contribution to the prediction of self‐esteem 20 years later in adulthood. Dental status in adulthood, whilst statistically significant, appeared to be of minor importance in a model that included other psychological variables. When prior need for treatment was taken into account there was little objective evidence to support the assumption that orthodontics improves long‐term psychological health.     

Resilient coping: applying adaptive responses to prior adversity during treatment for hepatitis C infection

Social marginalization is associated with poor health outcomes for affected people. However, in a psychosocial study of treatment for hepatitis C infection conducted in Sydney, Australia, participants living in socially disadvantaged circumstances applied adaptive approaches learned from past experiences of drug dependence, living with symptoms of chronic illness, coping with depression and childhood sexual abuse to enable them to cope with severe treatment-related side-effects. This finding has implications for the clinical management of hepatitis C treatment; the factors and processes that facilitate adaptive coping to adversity associated with social marginalization can be assessed for their clinical contribution to coping with an arduous regimen.     

Coping styles in youths with insulin-dependent diabetes mellitus

The relationships between two coping styles (i.e., use of personal and interpersonal resources; ventilation and avoidance) and two health outcomes (i.e., adherence and metabolic control) were evaluated in 135 youths with insulin-dependent diabetes mellitus (IDDM). Individual characteristics (i.e., age, duration of illness) and contextual variables (i.e., stress, family relations) were used to predict coping styles. Poor adherence to treatment, older adolescent age, and long duration of IDDM were correlated with ventilation and avoidance coping. Youths with short duration of IDDM were more likely to cope through the use of personal and interpersonal resources, although this strategy was not associated with health outcomes. A multiple regression analysis indicated that high ventilation and avoidance coping was predicted by high stress, low family cohesion, and older adolescent age. In addition, the interaction between family adaptability and duration of IDDM significantly predicted ventilation and avoidance coping.     

A systematic literature review of childhood externalizing psychopathology and later psychotic symptoms

Childhood onset mental health difficulties are known to be associated with later mental health disorders and worse prognoses in adulthood. Individuals who develop schizophrenia present, from childhood onwards, with cognitive deficits, psychotic-like experiences (PLEs) and internalizing and externalizing problems (EPs). People with a diagnosis of a schizophrenia spectrum disorder (SSD) are also more likely than people without this diagnosis to engage in aggressive behaviour towards others. This systematic review examines the evidence base investigating associations between childhood EPs and later psychotic symptoms. Searches were conducted on Ovid (Medline and Psychinfo), Pubmed and Scopus. PRISMA best-practice guidelines for conducting systematic literature reviews were followed. Data were extracted from predefined items and assessed using a quality rating scale. Fifteen studies were identified. Eleven of the 15 studies reported significant associations between childhood externalizing psychopathology and later psychotic symptoms, one study reported an association that did not reach significance, and three studies found no associations. Despite the substantial variations in conceptualization of EP, PLEs and SSD, this review found preliminary evidence for an association between childhood antisocial and aggressive behaviour and the later development of psychotic symptoms. Assessing children with EP for PLEs may be important to inform psychological therapies. More longitudinal studies are needed to better understand outcomes for children with presentations across the EP spectrum.     

The outcome of episodic versus persistent adolescent depression in young adulthood

OBJECTIVE: Study of the impact of episodic and persistent depression on psychosocial and mental functioning of young adults. METHODS: In a longitudinal representative community sample, four groups of subjects were identified who were depressed either in pre-adolescence, late adolescence or young adulthood or persistently depressed across time, and compared among each other and with a young adult control group. The 90th percentile on one or two self-reported symptom scales (i.e., the Center for Epidemiological Depression Scale (CES-D) or the Anxious/Depressed subscale of either the Youth Self-Report (YSR) or the Young Adult Self-Report (YASR)) served as the cut-off for the depression groups. Outcome was studied with regard to various psychosocial variables including life events, coping, self-related cognitions, size and efficiency of the social network, perceived parental behaviour, family relations and mental functioning. RESULTS: For the large majority of psychosocial variables, the persistent depression group showed the most abnormal scores. The YASR profile of mental functioning at outcome of the persistent depression group was also clearly distinguishable by higher scores from all other groups on the majority of scales. On a few scales, the young adult episodic group was not significantly different from the persistent depression group. CONCLUSION: This study shows that persistent rather than episodic adolescent depression carries a risk for abnormal psychosocial and mental functioning in young adulthood. The study also reflects the burden of young adult depression.