Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice

eCorrelates of prenatal and postnatal mother-to-infant bonding quality:A systematic review

Background Mother-to-infant bonding is defined as the emotional tie experienced by a mother towards her child, which is considered to be important for the socio-emotional development of the child. Numerous studies on the correlates of both prenatal and postnatal mother-to-infant bonding quality have been published over the last decades. An up-to-date systematic review of these correlates is lacking, however. Objective To systematically review correlates of prenatal and postnatal mother-to-infant bonding quality in the general population, in order to enable targeted interventions. Methods MEDLINE, Embase, CINAHL, and PsychINFO were searched through May 2018. Reference checks were performed. Case-control, cross-sectional or longitudinal cohort studies written in English, German, Swedish, Spanish, Norwegian, French or Dutch defining mother-to-infant bonding quality as stipulated in the protocol (PROSPERO CRD42016040183) were included. Two investigators independently reviewed abstracts, full-text articles and extracted data. Methodological quality was assessed using the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional studies and was rated accordingly as poor, fair or good. Clinical and methodological heterogeneity were examined. Main results 131 studies were included. Quality was fair for 20 studies, and poor for 111 studies. Among 123 correlates identified, 3 were consistently associated with mother-to-infant bonding quality: 1) duration of gestation at assessment was positively associated with prenatal bonding quality, 2) depressive symptoms were negatively associated with postnatal mother-to-infant bonding quality, and 3) mother-to-infant bonding quality earlier in pregnancy or postpartum was positively associated with mother-to-infant bonding quality later in time. Conclusion Our review suggests that professionals involved in maternal health care should consider monitoring mother-to-infant bonding already during pregnancy. Future research should evaluate whether interventions aimed at depressive symptoms help to promote mother-toinfant bonding quality. More high-quality research on correlates for which inconsistent results were found is needed

Individualized breastfeeding support for acutely ill, malnourished infants under 6 months old

Reestablishing exclusive breastfeeding is the cornerstone of the 2013 World Health Organization (WHO) treatment guidelines for acute malnutrition in infants less than 6 months. However, no studies have investigated guideline implementation and subsequent outcomes in a public hospital setting in Africa. To facilitate implementation of the WHO 2013 guidelines in Kilifi County Hospital, Kenya, we developed standard operating procedure, recruited, and trained three breastfeeding peer supporters (BFPS). Between September 2016 and January 2018, the BFPS provided individual breastfeeding support to mothers of infants aged 4 weeks to 4 months admitted to Kilifi County Hospital with an illness and acute malnutrition (mid-upper-arm circumference \u3c 11.0 cm OR weight-for-age z score \u3c -2 OR weight-for-length z score \u3c -2). Infants were followed daily while in hospital then every 2 weeks for 6 weeks after discharge with data collected on breastfeeding, infant growth, morbidity, and mortality. Of 106 infants with acute malnutrition at admission, 51 met the inclusion criteria for the study. Most enrolled mothers had multiple breastfeeding challenges, which were predominantly technique based. Exclusive breastfeeding was 55% at admission and 81% at discharge; at discharge 67% of infants had attained a weight velocity of \u3e5 g/kg/day for three consecutive days on breastmilk alone. Gains in weight-for-length z score and weight-for-age z score were generally not sustained beyond 2 weeks after discharge. BFPS operated effectively in an inpatient setting, applying the 2013 updated WHO guidelines and increasing rates of exclusive breastfeeding at discharge. However, lack of continued increase in anthropometric Z scores after discharge suggests the need for more sustained interventions

Pessary or progesterone to prevent preterm birth in women with short cervical length.: Protocol of the 4–6 year follow-up of a randomised controlled trial (Quadruple-P)

INTRODUCTION: Vaginal progesterone and a cervical pessary are both interventions that are investigated for the prevention of preterm birth (PTB). Thus far, beneficial or harmful effects of these interventions on long-term child health and development are described, but evidence is not robust enough to draw firm conclusions. With this follow-up study, we intent to investigate if progesterone or a pessary is superior for the prevention of PTB considering the child's health at 4-6 years of corrected age. METHODS AND ANALYSIS: This study is a follow-up study of the Quadruple-P trial; a multicentre, randomised clinical trial (NL42926.018.13, Eudractnumber 2013-002884-24) which randomises women with an asymptomatic midtrimester short cervix to daily progesterone or a pessary for the prevention of PTB. All children born to mothers who participated in the Quadruple-P study (n=628 singletons and n=332 multiples) will be eligible for follow-up at 4-6 years of corrected age. Children will be assessed using parental questionnaires. Main outcomes are child (neuro)development and behaviour. Other outcomes include child mortality, growth and general health. A composite of adverse child outcomes will be compared between the progesterone and pessary groups reporting OR and the corresponding 95% CI. Analyses will be performed separately for singletons and multiples and using the intention-to-treat approach. ETHICS AND DISSEMINATION: The Medical Research Ethics Committee from Amsterdam UMC confirmed that de Medical Research Involving Human Subjects Act (WMO) did not apply to our study (W20_481 #20.531). Results will be published in a peer-reviewed journal and shared with stakeholders and participants. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER: Dutch Trial Register (NL9646)

Effectiveness of an add-on guided internet-based emotion regulation training (E-TRAIN) in adolescents with depressive and/or anxiety disorders: study protocol for a multicenter randomized controlled trial

During adolescence, depressive and anxiety disorders are among the most common mental health disorders. Both disorders tend to persist, are predictive for other mental disorders, and are associated with severe impairment in diverse areas. Although Cognitive Behavioral Therapy (CBT) has proven to be an effective treatment, a considerable number of adolescents do not respond to CBT and residual symptoms often remain. Therefore, it is of great importance to improve treatment outcomes for depressed and/or anxious adolescents. Dysfunctional emotion regulation appears to be a transdiagnostic factor in the development and maintenance of aforementioned disorders. Enhancing emotion regulation skills may therefore reduce symptom severity. In light of this, we developed a guided internet-based emotion regulation training (E-TRAIN) that will be added to CBT. This study aims to evaluate the effectiveness of E-TRAIN + CBT compared to CBT alone on depressive and anxiety outcomes among adolescents with depressive and/or anxiety disorder. Methods: In this multicenter two-arm randomized controlled trial with parallel group design, we aim to include 138 adolescents, aged 13–19 years, referred for treatment and diagnosed with depressive and/or anxiety disorder. Participants will be allocated to either CBT or CBT + E-TRAIN. Assessments will take place at baseline, and at 3 (T1), 6 (T2) and 12 (T3) months after baseline. We will conduct multi-informant assessments: the adolescent, a parent/caregiver, and the CBT therapist will be asked to fill in questionnaires. The continuous primary outcome measure is self-reported depressive and anxiety symptoms at six months after baseline, measured with the RCADS25. Secondary outcome measures include anxiety or depression diagnosis based on a semi-structured clinical interview, emotion (dys) regulation, and parent-report measures of anxiety, depression and emotion (dys) regulation. Discussion: This study is the first randomized controlled trial to examine the additional value of a guided internet-based emotion regulation training to regular CBT in adolescents with depressive and/or anxiety disorders. If this intervention is effective, it can be implemented in mental health care and improve treatment for these young people. Trial registration: Registered on June 23, 2021 in The Netherlands Trial Register (NL9564). Retrospectively registered. Recruitment started in May 2021 and is ongoing

He is a stud, she is a slut! A meta-analysis on the continued existence of sexual double standards

(Hetero)sexual double standards (SDS) entail that different sexual behaviors are appropriate for men and women. This meta-analysis (k = 99; N = 123,343) tested predictions of evolutionary and biosocial theories regarding the existence of SDS in social cognitions. Databases were searched for studies examining attitudes or stereotypes regarding the sexual behaviors of men versus women. Studies assessing differences in evaluations, or expectations, of men's and women's sexual behavior yielded evidence for traditional SDS (d = 0.25). For men, frequent sexual activity was more expected, and evaluated more positively, than for women. Studies using Likert-type-scale questionnaires did not yield evidence of SDS (combined M = -0.09). Effects were moderated by level of gender equality in the country in which the study was conducted, SDS-operationalization (attitudes vs. stereotypes), questionnaire type, and sexual behavior type. Results are consistent with a hybrid model incorporating both evolutionary and sociocultural factors contributing to SDS

Sexual Double Standards: Contributions of Sexual Socialization by Parents, Peers, and the Media

(Hetero)sexual double standards (SDS) entail that different sexual behaviors are appropriate for men and women. There is large variation in whether people endorse SDS in their expectations about the sexual behavior of women and men (i.e., SDS-norms). To explain these individual differences, we examined associations between SDS-norms of Dutch adolescents (aged 16–20 years, N = 566) and what parents, peers, and the media teach adolescents about appropriate sexual behavior of boys and girls (i.e., SDS-socialization). Adolescents completed an online survey at school. Regarding SDS-socialization, more traditional SDS-norms conveyed by the media and peers, but not of parents, and less perceived sexual activity of female peers, were associated with more traditional SDS-norms. Only for boys, exposure to sexy girls/women on social media and sexual music videos of female artists were associated with more traditional SDS-norms. Thus, SDS-socialization by peers and the media and opposite gender models (for boys) are important in light of adolescents’ SDS-norms

The Importance of Mothers’ and Fathers’ Positive Parenting for Toddlers’ and Preschoolers’ Social-Emotional Adjustment

SYNOPSIS: Objective. Parental support, stimulation, positive discipline, and structure are all important for social-emotional adjustment of toddlers and preschoolers. However, less is known about the relative importance of these positive parenting practices. The current cross-sectional study examines the associations between positive parenting practices and child social-emotional difficulties in relation to child age and parental gender. Design. 446 Dutch families (446 mothers, Mage  = 33.51 years; 446 fathers, Mage  = 35.63 years) rearing a child (46.9% boys) between 17 and 48 months of age (Mage  = 31.64) participated. Parents reported on their own positive parenting practices, and mothers reported on child externalizing and internalizing behaviors as an indication of social-emotional difficulties. Results. Increased support from both mothers and fathers, and maternal provision of structure are associated with lower levels of child externalizing and internalizing behaviors. Positive discipline from both mothers and fathers, however, is related to higher levels of child externalizing and internalizing behaviors, and stimulation from both mothers and fathers is unrelated to either. These associations are not moderated by child age and are similar for mothers and fathers, except maternal structure is linked to lower levels of child externalizing and internalizing behaviors, whereas paternal structure is unrelated to child social-emotional difficulties. Conclusions. The present study underscores the significance of investigating the effects of multiple positive parenting practices simultaneously and calls for involving both mothers and fathers in parenting programs

What a cute baby! Preliminary evidence from a fMRI study for the association between mothers’ neural responses to infant faces and activation of the parental care system

Infant facial characteristics, i.e., baby schema, are thought to automatically elicit parenting behavior and affective orientation toward infants. Only a few studies, conducted in non-parents, have directly examined the neural underpinnings of this baby schema effect by manipulating distinctiveness of baby schema in infant faces. This study aims to further our understanding of the intuitive nature of parenting, by studying the baby schema effect in mothers of young children (at least one child aged between 2 and 6 years old). Functional magnetic resonance imaging (fMRI) was used to examine mothers’ (N = 23) neural responses to unfamiliar infant faces varying in distinctiveness of baby schema. Also, it was studied how this neural activation to infant faces was associated with maternal nurturance. Results revealed that infant faces elicited widespread activation in bilateral visual cortices, the hippocampus, sensory-motor areas, parietal and frontal cortices, and the insula, which was not modulated by the distinctiveness of baby schema in the infant faces. Furthermore, higher self-reported maternal nurturance was related to increased neural responses to infant faces in the putamen and amygdala, brain regions known to be associated with reward and salience processing. These findings could suggest that in our small sample of mothers some of the core networks involved in reward and salience processing might be less sensitive to variation in distinctiveness of baby schema. Also, unfamiliar infant faces seem to be rewarding only for mothers who report high nurturance. These findings should be considered preliminary, because they need to be replicated in studies with larger samples