Parental Alcohol Use Disorders and Child Delinquency: The Mediating Effects of Executive Functioning and Chronic Family Stress

Objective: This study examines the relationship between parental alcohol use disorders (AUDs) and child violent and nonviolent delinquency. It also explores the mediating effects of executive functioning and chronic family stress on the parental AUD/child delinquency relationship. Method: Participants were 816 families with children (414 boys and 402 girls) born between 1981 and 1984 at Mater Misericordiae Mother's Hospital in Brisbane, Australia. Parents and children completed semistructured interviews, questionnaires and neuropsychological tests that assessed parental alcohol use, family psychiatric history, chronic family stress, child delinquency and child executive functioning. Results: Paternal (but not maternal) AUDs predicted child violent and nonviolent delinquency. Executive functioning mediated the relationship between paternal AUDs and violent delinquency, whereas family stress mediated the relationship between paternal AUDs and both violent and nonviolent delinquency. Conclusions: Results support a biosocial conceptualization of the paternal AUD/delinquency relationship. They suggest that paternal AUDs may be associated with child executive functioning and Family stress, which may in turn lead to child delinquency

The Efficacy of Paroxetine and Placebo in Treating Anxiety and Depression: A Meta-Analysis of Change on the Hamilton Rating Scales

Background: Previous meta-analyses of published and unpublished trials indicate that antidepressants provide modest benefits compared to placebo in the treatment of depression; some have argued that these benefits are not clinically significant. However, these meta-analyses were based only on trials submitted for the initial FDA approval of the medication and were limited to those aimed at treating depression. Here, for the first time, we assess the efficacy of a selective serotonin reuptake inhibitor (SSRI) in the treatment of both anxiety and depression, using a complete data set of all published and unpublished trials sponsored by the manufacturer. Methods and Findings: GlaxoSmithKline has been required to post the results for all sponsored clinical trials online, providing an opportunity to assess the efficacy of an SSRI (paroxetine) with a complete data set of all trials conducted. We examined the data from all placebo-controlled, double-blind trials of paroxetine that included change scores on the Hamilton Rating Scale for Anxiety (HRSA) and/or the Hamilton Rating Scale for Depression (HRSD). For the treatment of anxiety (k = 12), the efficacy difference between paroxetine and placebo was modest (d = 0.27), and independent of baseline severity of anxiety. Overall change in placebo-treated individuals replicated 79% of the magnitude of paroxetine response. Efficacy was superior for the treatment of panic disorder (d = 0.36) than for generalized anxiety disorder (d = 0.20). Published trials showed significantly larger drug-placebo differences than unpublished trials (d’s = 0.32 and 0.17, respectively). In depression trials (k = 27), the benefit of paroxetine over placebo was consistent with previous meta-analyses of antidepressant efficacy (d = 0.32). Conclusions: The available empirical evidence indicates that paroxetine provides only a modest advantage over placebo in treatment of anxiety and depression. Treatment implications are discussed

Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale

Post-traumatic stress disorder (PTSD) affects 4% of women after birth yet there are very few questionnaire measures of postpartum PTSD that have been validated in this population. In addition, none of the available questionnaires assess postpartum PTSD in accordance with criteria specified in the latest edition of the Diagnostic and Statistical Manual [DSM-5, (1)]. The City Birth Trauma Scale is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria of: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (E), and exclusion criteria or other causes (H). Two additional items from DSM-IV were also included on the basis of evidence suggesting they might be important in this population. The first was criterion A2 that women responded to events during birth with intense fear, helplessness or horror. The second was symptoms of emotional numbing. Items were first reviewed by researchers (n = 9) and postpartum women (n = 8) and revised accordingly. The questionnaire was then completed by 950 women recruited online. Results showed the City Birth Trauma Scale had excellent reliability (Cronbach's α = 0.92) and is easy to understand (Flesch reading score 64.17). Exploratory factor analysis found two factors which together accounted for 56% of the variance: (i) Birth-related symptoms (40.8% variance) and (ii) General symptoms (15.5% variance). PTSD symptoms were highly associated with distress, impaired functioning, and women reporting they wanted treatment (r = 0.50–0.61). Removing DSM-IV A2 criteria only increased births classified as traumatic by 2%. Adding the item on emotional numbing did not change the psychometric properties of the scale. These items were therefore removed. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD. This scale therefore provides a promising measure of PTSD following childbirth that can be used in research and clinical practice. Future research should examine the scale's predictive validity using clinical interviews

Fecal microbiota transplantation may have clinical utility in reducing incidence of recurrent urinary tract infection

A critical appraisal and clinical application of Tariq R, Pardi DS, Tosh PK, Walker RC, Razonable RR, Khanna S. Fecal microbiota transplantation for recurrent Clostridium difficile infection reduces recurrent urinary tract infection frequency. Clinical Infectious Diseases. 2017 Oct 30;65(10):1745–1747. doi: 10.1093/cid/cix61

Factors associated with post-traumatic stress symptoms (PTSS) 4-6 weeks and 6 months after birth: A longitudinal population-based study

BACKGROUND: Identifying factors that precipitate and maintain post-traumatic stress symptoms (PTSS) after birth is important to inform clinical and research practice; yet, prospective longitudinal studies on the predictors of PTSS are limited. This study aimed to determine the pregnancy and postpartum factors associated with PTSS at 4-6 weeks and 6-months postpartum. METHOD: A systematic sample of 950 pregnant women were recruited from three maternity hospitals in Turkey. Participants completed assessments of depression, anxiety, PTSS and social support in pregnancy, 4-6 weeks and 6-months postpartum. Fear of childbirth was assessed in pregnancy and 4-6 weeks after birth. RESULTS: Regression models showed that PTSS six months after birth were associated with anxiety and PTSS in pregnancy, complications during birth, satisfaction with health professionals, fear of childbirth 4-6 weeks after birth, PTSS and depression 4-6 weeks after birth, social support 4-6 weeks after birth, traumatic events after birth, need for psychological help, and social support 6-months after birth. PTSS was highly comorbid with depression and anxiety at all-time points. The most robust predictor of PTSS at 6-months postpartum was PTSS at 4-6 weeks postpartum. Intra-partum complications were not associated with PTSS 4-6 weeks after birth. No socio-demographic variables were correlated with PTSS postpartum. LIMITATIONS: Self-report questionnaires were used to measure outcomes. This study is based on sampling from public hospitals so may not represent women treated in private hospitals. CONCLUSIONS: Associated risk factors may help to identify women at risk of PTSS after birth and to inform targeted early intervention

The Impact of Postpartum Posttraumatic Stress and Depression Symptoms on Couples' Relationship Satisfaction: A Population-Based Prospective Study

The couple relationship is of particular importance in the transition to parenthood and in the early childhood years because it is related to the well-being and mental health of partners, children, and the family. One factor that may substantially influence relationship quality and couple satisfaction after childbirth is the woman’s experience of birth. Approximately 2–4% of women develop posttraumatic stress disorder (PTSD) after childbirth, with potentially wide-ranging negative consequences for the women themselves and their families. To date, some qualitative studies have explored the influence of postpartum PTSD on couple relationship satisfaction. However, quantitative studies are sparse, with mixed results and methodological limitations. We hypothesized that postpartum PTSD will be prospectively associated with low couple relationship satisfaction, even when taking into account a variety of potential confounding variables, and that the effect of postpartum PTSD symptoms on couple relationship satisfaction will be mediated by postpartum depression symptoms. This study is based on data from the Akershus Birth Cohort study, a prospective cohort study. Information from hospital records and questionnaires completed at 17 weeks gestational age, as well as at 8 weeks and 2 years postpartum were used (n = 1480). PTSD symptoms were measured by the Impact of Event Scale and couple relationship satisfaction was assessed using a modified version of the Mehrabians Marital Satisfaction Scale. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale. Data were analyzed using bivariate correlations, multivariate regression analyses, and mediation analyses. Postpartum PTSD symptoms were prospectively related to low couple relationship satisfaction at 2 years postpartum, even when controlling for a considerable number of background factors. When including postpartum depression symptoms as predictor in the analyses, the effect of postpartum PTSD was no longer significant. Moreover, more detailed analyses showed that postpartum depression symptoms acted as a significant mediator, fully explaining the association of postpartum PTSD with couples’ relationship satisfaction. Early detection of couples’ relationship problems and the provision of professional help, particularly in high-risk couples may not only improve the quality of the couple relationship but also improve parenting and promote positive child outcomes

Computer- or web-based interventions for perinatal mental health: A systematic review

Background: Treating prenatal mental health issues is of great importance, but access to treatment is often poor. One way of accessing treatment is through computer- or web-based interventions. Reviews have shown that these interventions can be effective for a variety of mental health disorder across different populations. However, their effectiveness for women in the perinatal period has not been reviewed. This review therefore aimed to provide a first overview of computer- or web-based interventions for women's perinatal mental health issues by systematically identifying and reviewing their characteristics and efficacy. Methods: Twelve electronic databases were searched for published and unpublished literature using keywords, supplemented by hand searches. Data were extracted for characteristics of the intervention and the study, study findings and the methodological quality was assessed. Results: The majority of the eleven eligible studies were randomized controlled trials. Interventions were targeted at depression, stress, and complicated grief during the antenatal or postpartum period or the time after pregnancy loss. Findings suggest that computer- or web-based interventions targeted at improving mental health, especially depression and complicated grief, may be effective. Limitations: Findings and their generalizability is limited by the heterogeneity of reviewed interventions and study designs, as well as methodological limitations. Conclusions: This systematic review constitutes the first synthesis of research on computer- or web-based interventions for perinatal mental health issues and provides preliminary support that this could be a promising form of treatment during this period. However, there are significant gaps in the current evidence-base so further research is needed