Intervention for homeless, substance abusing mothers: findings from a non-randomized pilot

Little empirically-based information is available regarding how best to intervene with substance-abusing homeless mothers. This study pilot-tested a comprehensive intervention with 15 homeless women and their 2- to 6-year-old children, recruited from a local family shelter. All participants were offered integrated intervention with three major components. The first component was housing which included 3 months of rental and utility assistance, and these services were not contingent upon women's abstinence from drugs or alcohol. The second and third components included 6 months of case management services and an evidence-based substance abuse treatment (Community Reinforcement Approach; CRA). Analysis revealed that women showed reductions in substance use (F(2,22) = 3.63; p < .05), homelessness (F(2,24) = 25.31; p < .001), and mental health problems (F(2,20) = 8.5; p < .01). Further, women reported reduced internalizing (F(2,22) = 4.08; p < .05) and externalizing problems (F(2,24) = 7.7; p = .01) among their children. The findings suggest that the intervention is a promising approach to meet the multiple needs of this vulnerable population. These positive outcomes support the need for future research to replicate the findings with a larger sample using a randomized design.     

The role of self-assessed health in the relationship between gender and depressive symptoms among adolescents

OBJECTIVE: To examine the concurrent and longitudinal relations between gender, self-assessed health (SAH), and depressive symptoms among adolescents. METHOD: Two measures of SAH (physical symptom reports and global health ratings) and a measure of depression were completed on two occasions over two years by 232 adolescent boys and girls. RESULTS: Physical symptom reports were related to depressive symptoms both concurrently and longitudinally. Longitudinal path analysis revealed a significant path from gender to physical symptom reports (Wave 1) to depressive symptoms (Wave 2). Although global health ratings were related to depressive symptoms concurrently, the prospective relation was not significant in the cross-lagged path model. CONCLUSIONS: These findings suggest that the development of poorer SAH, particularly the perception of physical symptoms, may place adolescent girls at risk for subsequent depressive symptoms. Potential mechanisms for the SAH-depression relationship are discussed.     

Socioeconomic status and substance use behaviors in adolescents: the role of family resources versus family social status

The aims of this study were to test the associations among socio-economic status (SES) and substance use in adolescents, and to compare the relative strength of associations for different types of SES markers, including financial resources and family social status. A total of 113 teenagers reported their substance use, and parents reported family SES. High SES teens were more likely to use substances than low SES teens. Family financial resources were a stronger predictor of substance use than family status. Programs aimed at reducing teen substance use should be aware of these risk factors when developing substance use interventions.     

Stability and individual change in depressive symptoms among mothers raising young children with ASD: maternal and child correlates

Mothers raising children with Autism Spectrum Disorders (ASD) evidence elevated depressive symptoms, but symptom stability has not been examined. Mothers (N=143) of toddlers with ASD (77% boys) were enrolled and assessed when their children were 18 to 33 months old and followed annually for 2 years. Multilevel modeling revealed no significant change in group depressive symptom level, which was in the moderately elevated range (Intercept=13.67; SE=.96). In contrast, there was significant individual variation in change over time. Child problem behaviors and delayed competence, maternal anxiety symptoms and angry/hostile mood, low parenting efficacy and social supports, and coping styles were associated with depression severity. Only maternal anxiety and parenting efficacy predicted individual change. Many mothers do not appear to adapt, supporting the need for early intervention for maternal well-being. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–11, 2009.     

Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour

Hardly any research has examined the link between postpartum anxiety disorder and maternal bonding. This study examined if postpartum anxiety disorder and maternal bonding are related in the postpartum period. Thereby, subclinical depressive symptoms and specific aspects of an anxious symptomatology were also taken into consideration. The German sample of N?=?78 mother–infant dyads is composed of n?=?30 mothers with postpartum anxiety disorders but without major or minor depression according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and n?=?48 healthy mothers. Subjects were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M?=?4.1 months. Moreover, mothers filled out the Postpartum Bonding Questionnaire-16. The Anxiety Cognitions Questionnaire, the Body Sensations Questionnaire and the Mobility Inventory were chosen to assess different aspects of anxious symptomatology. To control for concurrent subclinical depressive symptoms, we used the German Edinburgh-Postnatal-Depression Scale. Mothers with postpartum anxiety disorder reported significantly lower bonding than healthy mothers. However, in a linear regression analysis, concurrent subclinical depressive symptoms and avoidance of anxiety-related situations in company explained 27 % of the overall variance in maternal bonding. The perceived lower bonding of mothers with anxiety disorder could be due to aspects of a concurrent subclinical depressive symptomatology. This notion emphasizes the need to target even mild depressive symptoms in the treatment of postpartum anxiety disorders. The outcomes also underline that the severity of anxious symptomatology, reflected by avoidance behaviour in company, puts the mother–infant bond at risk.     

The difficult temperament in adolescence: associations with substance use, family support, and problem behaviors

This study investigated interrelations between the number of difficult temperament factors (e.g., arrhythmicity, inflexibility, high distractibility) and substance use, perceived family support, and problem behaviors for a sample of 297 adolescents (M age = 15.7 years). The number of adolescent difficult temperament factors was associated significantly with more childhood behavior problems (e.g., hyperactivity, conduct disordered symptoms), which suggests some continuity of disordered behavior from childhood to adolescence. Number of adolescent difficult temperament factors also was associated with a higher percentage of substance users (for cigarettes, alcohol, marijuana, hard drugs), lower perceived family support, higher levels of depressive symptoms, and more delinquent activity. Number of difficult temperament factors was not associated significantly with gender or age of respondents.     

The relationship of prenatal alcohol exposure and the postnatal environment to child depressive symptoms

OBJECTIVE: This study examined the association between prenatal alcohol exposure and child depressive symptoms, and the mediating effects of maternal and child characteristics. METHODS: Participants were 42 children aged 4-5 years and their biological mothers. Prenatal alcohol consumption was assessed by self-report of maximum drinks per drinking occasion. The Pictorial Depression Scale (PDS) measured child depressive symptoms. Mother-child interactions were assessed using the family interaction puzzle task. RESULTS: Structural equation modeling indicated that prenatal alcohol exposure was associated with more negative child affect. In turn, mothers of more negative children were less emotionally connected to their children, and those children had higher levels of depressive symptomatology. Results could not be explained by current maternal drinking patterns or maternal depression. CONCLUSIONS: Study findings highlight the importance of examining prenatal alcohol exposure as a risk factor in the prediction of childhood-onset depression and the environmental mechanisms that may mediate that relationship.     

Husbands' and wives' marital quality: The role of adult attachment orientations,depressive symptoms,and conflict resolution behaviors

Although previous research has examined the role of adult attachment orientations, depressive symptoms, and conflict resolution behaviors (attacking and compromising) in marital quality, these variables have typically been considered separately. In the present study, these attributes were examined together in a community sample of 64 married couples. Correlational analyses revealed significant associations among the study variables and generally supported the hypothesized relations. When a regression series was applied to the data in order to examine indirect links between husbands' and wives' attachment orientations and their marital satisfaction, results provided some support for mediation; husbands' conflict resolution behaviors partially mediated the association between husbands' depressive symptoms and marital satisfaction. Interestingly, wives' conflict resolution behaviors did not mediate the association between wives' depressive symptoms and marital satisfaction. Instead, a different pattern was found; wives' conflict resolution behaviors partially mediated the association between wives' attachment anxiety and marital satisfaction. Findings highlight the importance of considering husbands' and wives' attributes separately and suggest directions for future research on this topic.     

Associations among maternal depressive symptomatology,state of mind and parent and child behaviors: Implications for attachment-based interventions

Associations among maternal depressive symptomatology, maternal state of mind with regard to attachment, and mother and child behaviors were examined in the treatment groups of an attachment-oriented intervention for primiparous women at high risk for parenting difficulties. The Adult Attachment Interview (AAI) was completed by 48 intervention and 62 control subjects when their children were 19 months old and the Center for Epidemiologic Studies-Depression Inventory (CES-D) and parent-child laboratory tasks were completed by the same subjects when their children were 24 months old. In the control group, preoccupied tendencies were repeatedly associated with poor outcome; in theintervention group coherence of mind was associated with positive outcome. Maternal depression tended to be associated with hostility in the intervention group. Results suggest that maternal state of mind may exert powerful effects on parenting behavior and that an attachmentoriented intervention may influence these associations, particularly among preoccupied subjects. Results also demonstrated potential benefits of using AAI scales in addition to the traditional categories.     

Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child PTSD, especially in girls.     

Husbands' and wives' marital quality: the role of adult attachment orientations, depressive symptoms, and conflict resolution behaviors

Although previous research has examined the role of adult attachment orientations, depressive symptoms, and conflict resolution behaviors (attacking and compromising) in marital quality, these variables have typically been considered separately. In the present study, these attributes were examined together in a community sample of 64 married couples. Correlational analyses revealed significant associations among the study variables and generally supported the hypothesized relations. When a regression series was applied to the data in order to examine indirect links between husbands' and wives' attachment orientations and their marital satisfaction, results provided some support for mediation; husbands' conflict resolution behaviors partially mediated the association between husbands' depressive symptoms and marital satisfaction. Interestingly, wives' conflict resolution behaviors did not mediate the association between wives' depressive symptoms and marital satisfaction. Instead, a different pattern was found; wives' conflict resolution behaviors partially mediated the association between wives' attachment anxiety and marital satisfaction. Findings highlight the importance of considering husbands' and wives' attributes separately and suggest directions for future research on this topic.     

Trajectories of maternal depressive symptoms across the birth of a child: associations with toddler emotional development

Depression during the perinatal period is common and impacts the physical and psychological well-being of those who experience it. One area of particular significance is the course of maternal depression across time, including the differential effects of depression trajectories during the perinatal period on early child development. The current study explored trajectories of maternal depressive symptoms from pregnancy through 2 years postpartum and their relation to toddler emotional development. Participants included 120 primarily low-income, ethnically diverse women and their toddlers. Depression was assessed during pregnancy, at 3 months postpartum, and at 1 and 2 years postpartum. Toddler emotional development was assessed at age 2 via video observations and mother report. Results indicated a four-class model that best fits the data: low-decreasing (47.5 %), stable-low (22.5 %), stable-moderate (21.7 %), and increasing (8.3 %) trajectories of maternal depressive symptoms. Women in the increasing group reported significantly more toddler social and emotional problems at age 2 than women in all other groups, and women in the stable-moderate group reported significantly more toddler social and emotional problems at age 2 than women in the stable-low group. No associations between trajectories and observed toddler affect expression were found. Results highlight variable courses of depressive symptoms for women across the birth of a child as well as the importance of reducing depression for the benefit of both mother and child. It is important for clinicians working with pregnant and postpartum mothers to assess for depressive symptoms over time and not just at a single time point.     

Relation of perseverative tendency and life events to depressive symptoms: findings from a prospective study in non-referred adolescents in Taiwan

This study aimed to explore the role of perseveration in the relations between life events and depression in a 2-year prospective study of non-referred adolescents. Participants were 400 middle school students randomly selected in Taipei. Baseline perseveration was measured using Perseverative Errors on the Wisconsin Card Sorting Test and psychological distress was measured using Anxious/Depressed syndrome on the Child Behavior Checklist. These individuals also completed the Life Event Checklist and the Center for Epidemiologic Studies Depression Scales at follow-up. With adjustment for initial psychological distress and demographic features, the results of multiple regression analyses showed that more perseveration at baseline was associated with greater influence of negative life events on the subsequent depressive symptoms. Perseveration might act as a moderator on the relations of life events to depressive symptoms and lowering perseveration may be a plausible way to decrease the impact of negative life events on adolescent depressive symptoms.     

A follow-up study of postpartum depressed women: recurrent maternal depressive symptoms and child behavior after four years

Summary Objective: To investigate the prevalence of depressive symptoms and self reported health of women who have shown previous postpartum depressive symptoms. To examine the behavior of four-year-old children born to mothers affected by postpartum depression. Methods: Longitudinal study. The index group (n = 251) constituted of all women with postpartum depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS), in a population-based study made in the late 1990s. The control group (n = 502) consisted of women without postpartum depressive symptoms on the EPDS at the same occasion. Approximately four years after delivery these women were asked to answer a short questionnaire on general health, the EPDS, and also to assess their child’s behavior with the Richman Pre-School Behaviour Checklist. Results: Women with a history of postpartum depressive symptoms were approximately 6 times more likely to have recurrent depressive symptoms (OR = 5.82, 95% CI: 3.79–8.93), compared to those without postpartum depressive symptoms, and they were also more likely to experience physical and mental illness. Although postpartum depressive symptoms in the mothers were involved in explaining the likelihood of behavioral problems in their four-year-old children, mothers with current depressive symptoms were the most likely to have a child with behavioral problems (OR = 4.71, 95% CI: 1.88–11.78). Conclusion: Postpartum depressive illness constitutes a risk for future illness as well as maternal perceived behavioral problems in offspring. In order to diminish long-term adverse consequences for the mother and the child there is a great need to recognize and treat women with postpartum depressive symptoms as early as possible.     

Effect of gender and social environment on gender role perceptions and identity: Comparative study of kibbutz and urban adolescents in Israel

The study examined perceptions of gender roles in the family and society, occupational sex-typing, and gender identity among 100 kibbutz and 66 urban adolescents in Israel. Overall, the kibbutz adolescents expressed more liberal attitudes toward gender roles in the family and society than did their urban counterparts. Likewise, they expressed less stereotyped perceptions of occupations than did the urban adolescents. Regarding gender identity, no differences were found between the two groups. Finally, the girls were more liberal than the boys in their gender role perceptions, regardless of social environment. © 1998 John Wiley & Sons, Inc.     

The prevention of depressive symptoms in children and adolescents: A meta-analytic review

Research on the prevention of depressive symptoms in children and adolescents was reviewed and synthesized with meta-analysis. When all 30 studies were included, selective prevention programs were found to be more effective than universal programs immediately following intervention. Both selective and indicated prevention programs were more effective than universal programs at follow-up, even when the 2 studies with college students were excluded. Effect sizes for selective and indicated prevention programs tended to be small to moderate, both immediately postintervention and at an average follow-up of 6 months. Most effective interventions are more accurately described as treatment rather than prevention. Suggestions for future research include testing potential moderators (e.g., age, gender, anxiety, parental depression) and mechanisms, designing programs that are developmentally appropriate and gender and culturally sensitive, including longer follow-ups, and using multiple measures and methods to assess both symptoms and diagnoses.     

Predicting inept discipline: The role of parental depressive symptoms, anger, and attributions

Relations among parents' psychological difficulties (i.e., depressive symptoms, overt anger), dysfunctional attributions for child misbehavior, and inept discipline were investigated in a representative community sample of 451 mothers and 449 fathers. Depressive symptoms and anger were hypothesized to relate to discipline via their link with parents' attributions. Path analyses revealed that depressive symptoms predicted parent-centered causal attributions (i.e., stable, global, and dispositional), which, in turn, related to laxness. Depressive symptoms also predicted child-centered responsibility attributions (i.e., controllable, intentional, and negative), which, in turn, related to overreactivity. Anger predicted overreactivity directly. The patterns of relations were similar for fathers and mothers. The importance of addressing parents' psychological difficulties and dysfunctional attributions in interventions for families with disruptive children is discussed.     

Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome

BACKGROUND: The goal was to study the effects of social support during pregnancy on maternal depressive symptoms, quality of life and pregnancy outcomes. METHODS: Eight hundred ninety-six women were prospectively studied in the first trimester of pregnancy and following completion of the pregnancy. The sample was divided into quartiles yielding groups of low, medium and high social support based on perceived social support. RESULTS: Pregnant women with low support reported increased depressive symptoms and reduced quality of life. The effects of social support on pregnancy outcomes were particularly pronounced in women who had smoked during pregnancy, with significant main effects of social support in a two-way analysis of variance (smoking status and social support) for child body length (F = 4.26, P = 0.04; 50.43 +/- 2.81 cm with low support versus 51.76 +/- 2.31 cm with high support) and birthweight (F = 11.35, P = 0.001; 3175 +/- 453 g with low support versus 3571 +/- 409 g with high support). In smokers, pregnancy complications occurred more frequently when given low support {34 versus 10.3% with high support, chi(2) = 5.49, P = 0.019; relative risk (RR) = 3.3 [95% confidence interval (95% CI) = 1.1-10.2]}, and the proportion of preterm deliveries was greater given low support (10.0 versus 0% with high support, chi(2) = 3.84, P = 0.05, odds ratio = 8.1). CONCLUSIONS: Lack of social support constitutes an important risk factor for maternal well-being during pregnancy and has adverse effects on pregnancy outcomes.