Mental health literacy and attitudes in a Swedish community sample – Investigating the role of personal experience of mental health care

Background

The role of social and family environments in the development of mental health problems among children and youth has been widely investigated. However, the degree to which parental working conditions may impact on developmental psychopathology has not been thoroughly studied.

Methods

We conducted a case-control study of several mental health outcomes of 19,833 children of sawmill workers and their association with parental work stress, parental socio-demographic characteristics, and paternal mental health.

Results

Multivariate analysis conducted with four distinct age groups (children, adolescents, young adults, and adults) revealed that anxiety based and depressive disorders were associated with paternal work stress in all age groups and that work stress was more strongly associated with alcohol and drug related disorders in adulthood than it was in adolescence and young adulthood.

Conclusion

This study provides support to the tenet that being exposed to paternal work stress during childhood can have long lasting effects on the mental health of individuals.     

Psychosocial determinants of quality of life in parents of obese children seeking inpatient treatment

Purpose

To examine and identify predictors of parental health-related quality of life (HRQoL) in a sample of obese and very obese children participating in an inpatient program for treating obesity.

Methods

Data are part of a prospective multicenter randomized-controlled intervention trial. Parents (n = 463) of obese and very obese children (7–13 years) completed standardized questionnaires assessing their own and their child’s HRQoL, psychosocial functioning, demographics and parental weight-specific self-efficacy on the child’s admission to an inpatient pediatric weight management program. Weight and height of the children were measured by trained personnel; parental weight was assessed via self-report.

Results

Parents reported lower mental HRQoL compared to healthy adults and even lower than reference values for acute or chronic illness. With respect to physical HRQoL, parents of obese children reported higher scores than both groups. Effect sizes were small to medium. Overweight parents reported a lower physical HRQoL. Mental HRQoL was higher for married parents with a higher educational level and a higher self-efficacy and for those whose children depicted fewer behavioral problems and reported a higher HRQoL. Hierarchical regression analyses revealed that weight-specific self-efficacy explained 3 % of variance in mental HRQoL in addition to the demographic and child psychosocial variables. Parental self-efficacy also partially mediated the association between the child’s HRQoL and parental mental HRQoL.

Conclusion

Childhood obesity is associated with reduced parental HRQoL. Interventions for obesity in children should consider the parents’ psychosocial situation as well. Enhancing parental self-efficacy may be a promising approach.     

Combining scores from different patient reported outcome measures in meta-analyses: when is it justified?

Background

The estimated prevalence rate of Pervasive Developmental Disorders (PDD) in children is 6 per 1.000. Parenting children who are intellectually impaired and have PDDs is known to be linked to the impaired well-being of the parents themselves. However, there is still little available data on health-related quality of life (HRQL) in parents of children with Asperger Syndrome (AS) and High-Functioning Autism (HFA), or other PDD diagnoses in children of normal intelligence. The present study aimed to evaluate aspects of HRQL in parents of school-age children with AS/HFA and the correlates with child behaviour characteristics.

Methods

The sample consisted of 31 mothers and 30 fathers of 32 children with AS/HFA and 30 mothers and 29 fathers of 32 age and gender matched children with typical development. Parental HRQL was surveyed by the use of the 12 Item Short Form Health Survey (SF-12) which measures physical and mental well-being. The child behaviour characteristics were assessed using the structured questionnaires: The High-Functioning Autism Spectrum Screening Questionnaire (ASSQ) and The Strengths and Difficulties Questionnaire (SDQ).

Results

The mothers of children with AS/HFA had lower SF-12 scores than the controls, indicating poorer physical health. The mothers of children with AS/HFA also had lower physical SF-12 scores compared to the fathers. In the AS/HFA group, maternal health was related to behaviour problems such as hyperactivity and conduct problems in the child.

Conclusion

Mothers but not fathers of children with AS/HFA reported impaired HRQL, and there was a relationship between maternal well-being and child behaviour characteristics.     

The influence of parental education on child mental health in Spain

Purpose

To analyze the association between parental education and offspring’s mental health in a nationally representative Spanish sample, and assess the contribution of other socioeconomic factors to the association.

Methods

We conducted a secondary analysis of data on 4- to 15-year-olds participating in the 2006 Spanish National Health Survey. Mental health was assessed using the parent-reported Strengths & Difficulties Questionnaire. Parents’ respective educational levels were summarized in a single variable. Univariate and multivariate analyses, controlling for family-, child- and parent-related characteristics, were used to study the association.

Results

The final sample comprised 5,635 children. A strong association between parental education and parent-reported child mental health was observed among 4- to 11-year-olds, with odds ratios (ORs) increasing as parental educational level decreased. Where both parents had a sub-university level, maternal education showed a stronger association than did paternal education. Following adjustment for covariates, parental education continued to be the strongest risk factor for parent-reported child mental health problems, OR = 3.7 (95% CI 2.4–5.8) for the lowest educational level, but no association was found among 12- to 15-year-olds. Male sex, immigrant status, activity limitation, parent’s poor mental health, low social support, poor family function, single-parent families, low family income and social class were associated with parent-reported child mental health problems in both age groups.

Conclusions

Our results show that there is a strong association between parental education and parent-reported child mental health, and that this is indeed stronger than that for income and social class. Among adolescents, however, the effect of parental education would appear to be outweighed by other factors.     

Health-related quality of life in mothers of children with epilepsy: 10 years after diagnosis

Purpose

Epilepsy in childhood extends far beyond seizures and affects child and parental well-being. The long-term impact of childhood-onset epilepsy on parental well-being is unknown. This study assessed health-related quality of life (HRQOL) in mothers 10 years after their child’s diagnosis of epilepsy.

Methods

Data come from the Health-Related Quality of Life in Children with Epilepsy Study, a multicenter prospective cohort study of children with newly diagnosed epilepsy. Mothers completed a mailed questionnaire at the 10-year follow-up, which included the Short-Form Health Survey (SF-12-v2) to evaluate the physical and mental health components of their HRQOL. Block-wise linear regressions identified child/epilepsy, maternal/family, and maternal psychosocial factors associated with mothers’ HRQOL.

Results

A total of 159 mothers participated in this study (46% of the sample assessed at baseline). At follow-up, 69% of youth had been seizure free for the past 5 years. Mothers scored similarly to population norms (mean: 50, SD: 10) on the mental health subscale (mean: 49.5, SD: 9.3) and significantly better on the physical health subscale (mean: 53.0, SD: 7.6). Better family resources were associated with higher (better) scores on the physical health subscale (B?=?0.20; 95% CI 0.03, 0.36). Better family functioning (B?=?0.34; 95% CI 0.06, 0.62), fewer maternal depressive symptoms (B?=?0.33; 95% CI 0.20, 0.47), and perception of less stress (B?=?0.70; 95% CI 0.52, 0.88) were associated with higher (better) scores on the mental health subscale.

Conclusion

Ten years after the diagnosis of epilepsy in children, the HRQOL of mothers was similar to reports from women in the general population. This study identified factors contributing to better maternal HRQOL and highlights the importance of family environment over epilepsy-related variables.

     

Socioeconomic inequalities in mental health and health-related quality of life (HRQOL) in children and adolescents from 11 European countries

Objectives

To assess the presence and magnitude of social inequalities in mental health and health-related quality of life (HRQOL) in the population aged 8–18 years in 11 European countries.

Methods

Cross-sectional surveys were carried out in representative samples of children/adolescents (8–18 years) from the participating countries of the KIDSCREEN project. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and HRQOL by means of the KIDSCREEN-10. Socioeconomic status (SES) was assessed using the Family Affluence Scale and parental level of education. The association between health outcomes and SES was analyzed with the regression-based relative index of inequalities (RII) and population attributable risk.

Results

A total of 16,210 parent–child pairs were included. The SDQ showed inequalities in mental health according to family level of education in all countries (RII = 1.45; 1.37–1.53). The RII for HRQOL was 2.15 (1.79–2.59) in the whole sample, with less consistent results by age and country.

Conclusions

Socioeconomic inequalities in mental health were consistently found across Europe. Future research should clarify the causes of these inequalities and define initiatives which prevent them continuing into adulthood.     

The mediating effect of parents’ educational status on the association between adherence to the Mediterranean diet and childhood obesity: the PANACEA study

Objectives

To investigate the potential mediating effect of parental education on the association between adherence to the Mediterranean diet and obesity, in 10–12 years old children.

Methods

A cross-sectional survey was performed among 1,125 (529 male) children in Greece. Children and their parents completed standardized questionnaires, which evaluated parents’ educational level and dietary habits. Body mass index was calculated and children were classified as normal, overweight or obese (IOTF classification). Adherence to the Mediterranean diet was assessed using the KIDMED score.

Results

27.7% of the children were overweight and 6.3% were obese; 12.3% of children reported high adherence to the Mediterranean diet. Multi-adjusted analysis, stratified by parental education, revealed that adherence to the Mediterranean diet was inversely associated with children’s obesity status only in families in which at least one parent was of higher educational level (stratum-specific adjusted odds ratio: 0.41; 95% CI 0.17–0.98), but not those in which both parents were of low educational level.

Conclusions

Parental education status seems to play a mediating role in the beneficial effect of Mediterranean diet on children’s obesity status.     

Assessment of health-related quality of life 6 years after childhood cochlear implantation

Purpose

To examine the impact of cochlear implant (CI) intervention on health-related quality of life (HRQOL) assessed by both self- and parent-reported measures.

Methods

In this national study of children implanted between ages 6 months and 5 years, HRQOL of 129 children 6-year post-CI was compared to 62 internal study (NH1) and 185 external (NH2) samples of hearing children frequency-matched to the CI group on sociodemographic variables. HRQOL ratings of children and their parents in each group, measured using the Child Health and Illness Profile-Child Edition, were compared, and their associations with the Family Stress Scale were investigated.

Results

CI children reported overall and domain-specific HRQOL that was comparable to both NH1 and NH2 peers. CI parents reported worse child scores than NH1 parents in Achievement, Resilience, and Global score (p’s < 0.01) but similar or better scores than socioeconomically comparable NH2 parents. Higher family stress was negatively associated with all parent-reported HRQOL outcomes (p’s < 0.01). Parent–child correlations in HRQOL global scores trended higher in CI recipients (r = 0.50) than NH1 (r = 0.42) and NH2 (r = 0.35) controls.

Conclusions

CI recipients report HRQOL comparable to NH peers. These results, from both child and parent perspective, lend support to the effectiveness of CI intervention in mitigating the impact of early childhood deafness. Family stress was associated with worse HRQOL, underscoring a potential therapeutic target. Parent–child agreement in HRQOL scores was higher for CI families than NH families, which may reflect higher caregiver insight and involvement related to the CI intervention.     

Internet use among mothers of young children in Norway—a survey of Internet habits and perceived parental competence when caring for a sick child

Aim

The Internet has become the leading source of child health information for parents. Perceived parental competence, self-efficacy, education and satisfaction with traditional health services may influence Internet use. The aim of study was to investigate the interplay between these factors.

Subject and methods

A survey that included 99 Norwegian mothers to young children was conducted to assess the relationship between Internet use concerning child health, perceived parental competence, self-efficacy and demographic factors in the context of having a sick child.

Results

Nearly all Norwegian parents have Internet access at home and use the net regularly, including when their child is sick. The Internet was the main source of information about child health in general, while most parents used the traditional health services when their child became sick. Internet usage was negatively correlated to mother’s education, but not to mother’s age, number of children or degree of satisfaction with traditional health services. A third of mothers reported that they became very anxious and nearly half reported lack of knowledge when their child was sick. Parental perceived competence and self-efficacy were not correlated with maternal age, education or number of children, and it did not influence the extent of Internet searching for child health information.

Conclusion

The Internet is the main source of child health information for Norwegian mothers of young children, and usage seems mainly independent of maternal age, education, perceived competence and self-efficacy, and the degree of satisfaction with traditional health services.     

Gastrointestinal (GI)-Specific patient reported outcomes instruments differentiate between renal transplant patients with or without GI symptoms: results from a South American cohort

Background

The objective of this study was to validate the Impact of a Child with Congenital Anomalies on Parents (ICCAP) questionnaire. ICCAP was newly designed to assess the impact of giving birth to a child with severe anatomical congenital anomalies (CA) on parental quality of life as a result of early stress.

Methods

At 6 weeks and 6 months after birth, mothers and fathers of 100 children with severe CA were asked to complete the ICCAP questionnaire and the SF36. The ICCAP questionnaire measures six domains: contact with caregivers, social network, partner relationship, state of mind, child acceptance, and fears and anxiety. Reliability (i.e. internal consistency and test-retest) and validity were tested and the ICCAP was compared to the SF-36.

Results

Confirmatory factor analysis resulted in 6 six a priori constructed subscales covering different psychological and social domains of parental quality of life as a result of early stress. Reliability estimates (congeneric approach) ranged from .49 to .92. Positive correlations with SF-36 scales ranging from .34 to .77 confirmed congruent validity. Correlations between ICCAP subscales and children's biographic characteristics, primary CA, and medical care as well as parental biographic and demographic variables ranged from -.23 to .58 and thus indicated known-group validity of the instrument. Over time both mothers and fathers showed changes on subscales (Cohen's d varied from .07 to .49), while the test-retest reliability estimates varied from .42 to .91.

Conclusion

The ICCAP is a reliable and valid instrument for clinical practice. It enables early signaling of parental quality of life as a result of early stress, and thus early intervention.     

School Reintegration Following Psychiatric Hospitalization: An Ecological Perspective

Background

School reintegration following psychiatric hospitalization can be challenging for children, their families, and school personnel. While school reintegration of children with physical illness has received considerable professional attention, our knowledge about the needs of children returning to school after psychiatric hospitalization is still limited.

Objective

This paper delineates an ecological perspective on school reintegration of children after hospitalization for mental health reasons. This perspective takes into account the multiple social systems in which children are embedded and focuses on both individual and environmental factors that may contribute to a child’s well-being or, conversely, trigger emotional and behavioral difficulties.

Methods

This is a theoretical paper based on the systematic review of empirical literature related to psychiatric hospitalization of children, post discharge adjustment, school reintegration following hospitalization, mental health stigma in children, and cross-agency collaboration.

Results

Several ecological factors that may affect school reintegration after psychiatric hospitalization were identified, including: (1) child/youth experiences with and perceptions of having a mental health condition, being hospitalized, and subsequent school reentry; (2) parental experiences and perceptions of child/youth psychiatric condition and hospitalization; (3) attitudes and reactions from members of the child/youth school ecology including teachers and peers; and (4) inter-disciplinary collaboration. The paper proposes ecologically informed guidelines to facilitate successful school reintegration and discusses the roles of the school-based mental health professionals in this process.

Conclusions

While complex and challenging, a successful reintegration may be the key step in reducing inpatient recidivism rates and improving a child’s future academic and behavioral success.     

Coparenting and Parental School Involvement

Background

Parental school involvement is associated with social, psychological, and academic child outcomes. Beyond school, demographic, and individual influences, research on the relationship between family level processes and parental school involvement is limited. Coparenting is a unique family level relationship that influences parental engagement, but its link with parental school involvement is less understood.

Objective

The goal of this study was to examine the association between coparenting support and biological mothers’ and fathers’ home-based involvement and school-based involvement when the child was 9-years-old. This study also tested whether biological parental union transitions (i.e., parental union dissolution; parental union formation with each other; stable coresident relationship with one another) significantly moderated these relationships, and whether the associations among the variables of interest were empirically stronger for mothers or fathers.

Method

Using data from the Fragile Families and Child Wellbeing Study (N = 1896 biological mothers and fathers), the current study utilized multiple-sample latent variable structural equation modeling analyses to explore the above associations.

Results

Higher levels of coparenting support were associated with higher levels of mothers’ and fathers’ home-based involvement, and higher levels of fathers’ school-based involvement. Union transitions did not moderate these relationships. The link between coparenting support and home-based involvement was significantly stronger for mothers, and the link between coparenting support and school-based involvement was significantly stronger for fathers.

Conclusions

Coparenting support may be important to understanding the many components that influence parental school involvement.

     

Health related quality of life in children with spina bifida in Uganda

Background

Studies on health related quality of life (HRQOL) of children with disabilities in low income countries are limited.

Overweight and obesity in primary school: native children versus migrant children

Aim

To compare the means of body mass index (BMI) and the prevalences of overweight and obesity between native Dutch and migrant primary school children and to assess to what degree differences between these children could be explained by socioeconomic position and BMI of the mother and the father.

Subjects and methods

A cross-sectional survey was performed among children at the age of 8–9 years old. Subjects were a total of 1,943 children and their primary caregiver. Outcome measures were BMIs and the prevalence of overweight, including obesity. Main independent variables were migrant background, based on country of birth of the parents, socioeconomic status, as indicated by educational level, and parental BMI. Other independent variables were the age and sex of the child.

Results

Overall, our findings show that overweight and obesity are significantly more prevalent among migrant children of non-Western descent as compared to native children and children of Western descent.

Conclusion

Parental BMI is an important predictor of a child’s BMI. However, socioeconomic position is not. Because children of non-Western migrant origin are at higher risk for overweight and obesity, insight into differences in both physical activity and energy intake as well as how these behaviors relate to cultural contrasts in parental beliefs and practices is needed.     

Impact of mental disorders and chronic physical conditions in health-related quality of life among primary care patients: results from an epidemiological study

Purpose

To estimate the comorbidity of mental disorders with chronic physical conditions and to assess their independent and combined effects on health-related quality of life (HRQOL).

Methods

Face-to-face cross-sectional survey of adult attendants to public primary care (PC) centres from Catalonia (Spain). A total of 3,815 out of 5,402 selected patients provided data for this study. We report frequency of chronic physical conditions among participants with mental disorders and the contribution of each mental disorder and chronic physical condition to HRQOL.

Results

Chronic pain is the most frequent condition among those with mental disorders (74.54%). The effect of chronic physical conditions on HRQOL is rather minor when compared to the effect of mental disorders (especially mood disorders). However, chronic pain plays an important role in HRQOL loss.

Conclusions

Mood disorders and chronic pain negatively affect HRQOL of PC patients. Especial efforts should be made to detect and treat mental disorders and chronic pain at this level.     

The relationship between proxy reported health-related quality of life and parental distress: gender differences

Objective Although primary caregiver proxy reports of health‐related quality of life (HRQOL) are often used for healthcare decision making when child self‐reports are unable to be collected (because of a variety of reasons such as child illness, disability or age), we have little understanding of the correlates of parent‐proxy reports. The aim of this study was to examine the relationship between parental depression and parent‐proxy reported QOL for primary caregivers (mothers and fathers), using a multidimensional HRQOL instrument. It was hypothesized that maternal depression would be negatively correlated with maternal reported HRQOL, but that paternal depression would not be correlated with paternal reported HRQOL. Methods Data were from parents of children aged 4–5 years (n = 4983) involved in the Longitudinal Study of Australian Children. A questionnaire assessing parental depression (Kessler‐6) and proxy reported HRQOL (Pediatric Quality of Life Inventory) was completed by the primary caregiver. Results For maternal primary caregivers, maternal depression was negatively correlated with all domains of maternal proxy reports of HRQOL (r = ?0.24 to r = ?0.36). For paternal primary caregivers, there was no relationship between paternal depression and paternal proxy reports of HRQOL. Multiple regression analyses demonstrated that maternal depression was a significant predictor of total HRQOL, accounting for 12% of the variance. For paternal mental health, depression did not predict parent‐proxy reported total HRQOL. Conclusion These results highlight the importance of assessing maternal mental health when measuring proxy reported QOL. Further research is needed in this area to examine the relationship between parental depression and proxy reported HRQOL (including both mothers and fathers, where possible), as well as child self‐reported HRQOL.     

Does parental involvement make a difference in school-based nutrition and physical activity interventions? A systematic review of randomized controlled trials

Objectives

Parental involvement is often advocated as important for school-based interventions, however, to date, only inconsistent evidence is available. Therefore, this study aimed at determining the impact of parental involvement in school-based obesity prevention interventions in children and adolescents.

Methods

A systematic review of obesity prevention studies published from 1990 to 2010 including a comparison between school-based interventions with and without parental component was conducted. Only studies reporting effects on health behaviour-related outcomes were included.

Results

Some positive effects of parental involvement were found on children’s behaviours and behavioural determinants. Parental modules including different strategies and addressing several home-related determinants and parenting practices concerning eating and physical activity behaviours were more likely to be effective. However, no conclusive evidence could be provided concerning the added value of parent involvement, because of the paucity of studies to test this hypothesis. The few studies that are available provide inconsistent evidence.

Conclusions

There is a need for more studies comparing school-based interventions with and without a parental component, and dose, strategies and content of parental components of school-based interventions should be better reported in articles.     

Promoting School Readiness in the Context of Socio-Economic Adversity: Associations with Parental Demoralization and Support for Learning

Background

Existing research suggests that parenting stress and demoralization, as well as provision of learning activities at home, significantly affect child school readiness. However, the degree to which these dimensions of parenting uniquely influence child school readiness remains unclear.

Objective

This study tested the hypothesis that parent demoralization and support for learning are distinct constructs that independently influence child school readiness. Direct and indirect (mediated) models of association were examined.

Methods

117 kindergarten children with low literacy and language skills and their parents were recruited from three Northeastern school districts serving primarily low-income families. Parents reported on their own depressive symptoms, parenting difficulties, attitudes and behaviors related to learning activities, and the frequency of parent–child conversation at home. Teachers rated child school readiness, as indicated by classroom behaviors, approaches to learning, and emergent language and literacy skills.

Results

In a factor analysis, parent demoralization and support for learning emerged as distinct constructs. Structural equation models revealed that parent demoralization was negatively associated with child school readiness, whereas parent support for learning was positively associated with child school readiness. Neither parenting construct mediated the effect of the other.

Conclusions

Among low-income families with children at high risk for school difficulties, parental demoralization and support of learning opportunities at home appear to independently influence child school readiness. Thus, parent-based interventions targeting child school readiness would likely benefit from enhancing both parental self-efficacy and provision of learning activities.     

Zusammenh?nge zwischen elterlicher depressiver Symptomatik, Stressbelastung und Koh?renzgefühl in Risikofamilien.

Background

Determinants for the severity of risk factors should be identified to improve the effectiveness of intervention programs and health resources for families at risk.

Object

Focusing on the capabilities of fathers, factors influencing the risk factor of parental depressive symptoms were investigated. Therefore data from participants of the ?Nobody slips through the cracks?? intervention program were analyzed. The program supports families at risk by home visits of specially trained midwives.

Methods

Families at risk were identified by means of the ??Heidelberg stress scale??. Depressive symptoms were assessed using the Edinburgh postnatal depression scale (EPDS). Furthermore, the sense of coherence scale (SOC) and the parenting stress index (PSI) were applied.

Results

The severity of postnatal depressive symptoms for both parents is predicted not only by their own sense of coherence (a general attitude towards the world) but also by their partners sense of coherence and postnatal depressive symptoms. In addition parental distress proved to be highly predictive for fathers postnatal depressive symptoms.

Conclusions

The assessment of parental postnatal depressive symptoms and potential factors of influence indicate that fathers capabilities should be taken into account and provide an opportunity to improve early interventions.