The indirect effect of family cohesion on children’s weight status through maternal quality of life and children’s internalizing and externalizing symptoms

Background Obesity has serious psychosocial consequences for youth and family members and has reached epidemic levels in Portugal. Objective This study had two goals: (1) to investigate differences in family cohesion, mothers’ quality of life (QoL), and externalizing/internalizing symptoms between children/adolescents with healthy-weight and overweight/obesity; (2) to assess the mediating role of maternal QoL and children/adolescents’ externalizing/internalizing symptoms in the association between family cohesion and weight. Methods Children/adolescents with healthy-weight (n = 134) and with overweight/obesity (n = 163) and their mothers participated in the study. Mothers completed measures of family cohesion (FC) and QoL and children/adolescents completed measures of externalizing and internalizing symptoms. This study used a cross-sectional design. Results Children/adolescents with overweight/obesity reported higher levels of externalizing and internalizing symptoms than children/adolescents with healthy-weight. Mothers of children/adolescents with overweight/obesity reported lower levels of FC and QoL than mothers of children/adolescents with healthy-weight. Mothers’ QoL and children/adolescents’ externalizing symptoms sequentially mediated the relationship between FC and weight status. Specifically, an increase in FC and QoL resulted in a decreased likelihood of the child/adolescent reporting overweight or obesity, whereas an increase in externalizing symptoms resulted in a higher likelihood of the child/adolescent reporting overweight or obesity. Conclusions This study identifies mechanisms that might account for the link between FC and weight, suggesting the importance of mothers’ QoL and children’s externalizing symptoms. Moreover, it provides a better understanding of the psychosocial outcomes related to pediatric obesity, highlighting the relevance of working with the parents to promote weight reduction in youths

ROC curve for the decision-tree model.

<p>ROC curve for the decision-tree model.</p

Decision-tree model predicting borderline/clinically significant psychological problems.

<p><i>Note</i>. The colored terminal nodes show the rates of having borderline/clinical psychological symptoms within each profile (bold) and within the total target group (italic); The terminal nodes are colored coded into high-risk cases (> 50%); medium-risk cases (25–50%); and low-risk cases (< 25%); ^* <i>p</i> ≤ .05; ^** <i>p</i> ≤ .01, two-tailed.</p

Sociodemographic and clinical characteristics of the sample (<i>N</i> = 736).

<p>Sociodemographic and clinical characteristics of the sample (<i>N</i> = 736).</p

Establishing priorities for psychological interventions in pediatric settings: A decision-tree approach using the DISABKIDS-10 Index as a screening instrument

<div><p>Most children and adolescents with chronic health conditions have impaired health-related quality of life and are at high risk of internalizing and externalizing problems. However, few patients present clinically significant symptoms. Using a decision-tree approach, this study aimed to identify risk profiles for psychological problems based on measures that can be easily scored and interpreted by healthcare professionals in pediatric settings. The participants were 736 children and adolescents between 8–18 years of age with asthma, epilepsy, cerebral palsy, type-1diabetes or obesity. The children and adolescents completed self-report measures of health-related quality of life (DISABKIDS-10) and psychological problems (Strengths and Difficulties Questionnaire). Sociodemographic and clinical data were collected from their parents/ physicians. Children and adolescents were classified into the normal (78.5%) or borderline/clinical range (21.5%) according to the Strengths and Difficulties Questionnaire cut-off values for psychological problems. The overall accuracy of the decision-tree model was 78.1% (sensitivity = 71.5%; specificity = 79.9%), with 4 profiles predicting 71.5% of borderline/clinical cases. The strongest predictor of psychological problems was a health-related quality of life standardized score below the threshold of 57.5 for patients with cerebral palsy, epilepsy or obesity and below 70.0 for patients with asthma or diabetes. Other significant predictors were low socio-economic status, single-parent household, medication intake and younger age. The model showed adequate validity (risk = .28, SE = .02) and accuracy (area under the Receiver Operating Characteristic curve = .84; CI = .80/.87). The identification of pediatric patients at high risk for psychological problems may contribute to a more efficient allocation of health resources, particularly with regard to their referral to specialized psychological assessment and intervention.</p></div

Early trauma, attachment experiences and comorbidities in schizophrenia

<div><p>Abstract Objective To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Methods Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships – Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Results Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Conclusion Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.</p></div

Odds-ratio for abdominal obesity according to the educational level, for adults and old adults.

<p>Odds-ratio for abdominal obesity according to the educational level, for adults and old adults.</p

Descriptive characteristics.

<p>Abbreviations: BMI, body mass index; WC, waist circumference.</p>a<p>Significant differences between gender (p<0.05).</p

Body mass index and waist circumference and prevalence of overweight, obesity and abdominal obesity in the adult population of Portugal, by sex and age category, adjusted for educational level.

<p>Abbreviations: BMI, body mass index; WC, waist circumference.</p><p>Results presented are adjusted for the weight factor for educational level.</p>a<p>Significant differences between gender (p<0.05).</p>b<p>Significant differences between adult and older adults (p<0.05).</p

Prevalence of overweight and obesity in Portuguese adult population.

<p>Data from the current study, adjusted for national education and for the education reported in the 2003–2005 survey, and prevalence from the 2003–2005 survey in the adult population.</p