Inter-parental conflict and outcomes for children in the contexts of poverty and economic stress: implications aimed at improving outcomes for children

This report provides a review of the evidence on discord between parents (interparental conflict) in the contexts of poverty and economic pressure, and the link to poor outcomes for children and adolescents across emotional, behavioural, social, academic and future relationship domains

Mothers with recurrent depression: co-occurring psychopathology and parenting as risks for offspring psychopathology

Offspring of depressed mothers are at increased risk of developing a variety of psychopathologies. Risk factors and mechanisms for the development of these heterogeneous outcomes are poorly understood. Disruptions in the mother-child relationship may be one mechanism by which maternal depression increases risk for offspring psychopathology. Many adults with depression present with co-occurring psychopathology, but how these co-occurring problems affect offspring risk, or impact upon the mother-child relationship, has rarely been considered. Data were from the Early Prediction of Adolescent Depression study. Mothers with a history of recurrent major depressive disorder and their adolescent offspring were assessed three times between 2007 and 2011. Mothers completed questionnaires assessing their own depression severity and co-occurring psychopathology (anxiety, antisocial behaviour (ASB), and alcohol misuse). Offspring psychopathology (presence of psychiatric disorder, symptoms of depression, anxiety and disruptive behaviour disorder (DBD)) were assessed using the Child and Adolescent Psychiatric Assessment. The mother-child relationship was assessed using parent-rated questionnaires and an interviewer-rated speech sample. Co-occurring problems in mothers predicted new-onset psychiatric disorder in offspring; this remained significant after controlling for maternal depression severity. When investigating the specificity of risk for offspring, maternal co-occurring ASB was specifically associated with offspring DBD, whereas maternal depression severity predicted offspring depression. The mother-child relationship mediated the effect of maternal depression severity on risk for offspring psychopathology. However this was better accounted for by co-occurring maternal ASB, which predicted both maternal warmth and hostility. Maternal hostility was a specific risk factor for offspring DBD. Bidirectional effects were observed between offspring DBD and maternal hostility. Findings highlight the importance of assessing co-occurring psychopathology in mothers with recurrent depression when considering risk for offspring. Parenting interventions that reduce hostility may be beneficial for preventing or reducing adolescent DBD, particularly when depressed mothers report additional ASB. Furthermore, interventions that reduce offspring DBD may also show benefits for the mother-child relationship

Brief report: a comparison of child mental health inequalities in three UK population cohorts

There are substantial health disparities between children from low and higher income families. The study aimed to test changes in child mental health inequalities across three large UK population cohorts of 11-year old children assessed in 1999, 2004 and 2012 as part of the British Child and Adolescent Mental Health Surveys and Millennium Cohort Study. Child mental health was assessed using parent and teacher versions of the Strengths and Difficulties Questionnaire. There were substantial differences in parent and teacher reported symptom scores between children from low and higher income families in each cohort. Differences in parent reported symptoms increased over time (ES = 0.35 [95%CI = 0.20, 0.49] in 1999, ES = 0.39 [95%CI = 0.17, 0.61] in 2004, ES = 0.54 [95%CI = 0.49, 0.58] in 2012); cohort interaction: p = 0.01). This study found that marked child mental health inequalities exist. The mental health gap between advantaged and disadvantaged children has not reduced over the last 20 years and may be getting worse

What works to enhance inter-parental relationships and improve outcomes for children

The review summarises the main research evidence on the importance of the relationship between parents to improve outcomes for children. It also reviews evaluation evidence of international interventions designed to improve relationships between parents and provides an assessment of the evidence for UK based programmes

Cross-cohort change in adolescent outcomes for children with mental health problems

Background Child mental health problems are common. Previous studies have examined secular changes in their prevalence but have not assessed whether later outcomes have changed. We therefore aimed to test whether outcomes of child mental health problems have changed over a 40-year period. Methods Three cohorts were utilised: the National Child Development Study (NCDS: N = 14544, aged 7 in 1965), the Avon Longitudinal Study of Parents and Children (ALSPAC: N = 8188, aged 7 in 1998), and the Millennium Cohort Study (MCS: N = 13192, aged 7 in 2008). Mental health problems at age 7 were identified using the parent-reported Rutter A scale (NCDS) and Strengths and Difficulties Questionnaire (ALSPAC and MCS). Associated outcomes were compared across cohorts: age 11 social functioning, age 16 exam attainment and age 16 mental health. Results Child mental health problems were common in each cohort (boys: 7.0%-9.7%; girls: 5.4%-8.4%). Child mental health problems became more strongly associated with social functioning problems (boys: NCDS OR = 1.95 (1.50, 2.53), MCS OR = 3.77 (2.89, 4.92); interaction p < .001; girls: NCDS OR = 1.69 (1.22, 2.33), MCS OR = 3.99 (3.04, 5.25), interaction p < .001), lower academic attainment for boys (NCDS OR = 0.49 (0.31, 0.78), ALSPAC OR = 0.30 (0.22, 0.41), interaction p = .009), and age 16 mental health problems (boys: NCDS d’ = 0.55 (0.38, 0.72), ALSAPC d’ = 0.95 (0.73, 1.16); interaction p = .004; girls: NCDS d’ = 0.50 (0.34, 0.65), ALSPAC d’ = 0.99 (0.78, 1.20); interaction p < .001). Conclusions Child mental health problems have become more strongly associated with negative social, educational and mental health outcomes in recent generations

Validation of the English Language Pain Sensitivity Questionnaire

Background and Objectives: The Pain Sensitivity Questionnaire (PSQ) is predictive of pain-related responses to experimental stimuli in German-speaking individuals. Here, we explored the validation of the English translation of the PSQ (PSQ-E). Methods: One hundred thirty-six patients scheduled to undergo a low back interventional procedure completed the PSQ-E and other questionnaires including the Brief Pain Inventory. Pain ratings on a visual analog scale (VAS) were obtained following 2 standardized injections of subcutaneous lidocaine (VAS 1, infiltration in hand; VAS 2, infiltration of procedural site). The VAS measures were compared with the PSQ-E data and other inventories using linear regression analysis with stepwise selection of variables. Results: The PSQ-E properties were in all respects similar to those of the original German PSQ. VAS 1 magnitude was predicted by PSQ-E-minor (r = 0.26, P < 0.01). VAS 2 magnitude was predicted by PSQ-E-minor (r = 0.34, P < 0.001), and the prediction was significantly enhanced by further inclusion of the Brief Pain Inventory interference score (total r = 0.40, P < 0.001). Conclusions: The study demonstrated that a significant correlation exists between the PSQ-E and clinically relevant pain ratings. This study validates the PSQ-E both in terms of measuring pain sensitivity and as possible means of recognizing patients with high pain sensitivity. Defining this subset of patients may have clinical utility in the future

Pathways to suicide-related behavior in offspring of mothers with depression: the role of offspring psychopathology

Objective Offspring of mothers with depression are a high-risk group for the development of suicide-related behavior. These offspring are therefore a priority for preventive interventions; however, pathways contributing to risk, including specific aspects of offspring psychopathology, remain unclear. The aim of this study was to examine whether offspring symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), disruptive behavior disorder (DBD), attention-deficit/hyperactivity disorder (ADHD), and alcohol abuse independently mediate the association between maternal depression and offspring suicide-related behavior. Method Data were used from a population-based birth cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC). Three distinct classes of depression symptoms across the mothers’ first 11 years of their child’s life were identified (minimal, moderate, chronic-severe). Offspring psychopathology was assessed at age 15 years and suicide-related behavior at age 16 years. Data were analyzed using structural equation modeling. Results There was evidence for increased risk of suicidal ideation in offspring of mothers with chronic-severe depression symptoms in comparison to offspring of mothers with minimal symptoms (odds ratio = 3.04, 95% CI = 2.19, 4.21). This association was independently mediated by offspring MDD, GAD, and DBD symptoms. The same mechanisms were found for offspring of mothers with moderate depression symptoms over time. Results were similar for offspring suicide attempt except for additional evidence of an indirect effect through offspring ADHD symptoms. Conclusion Findings highlight that suicide prevention efforts in offspring of mothers with depression should not only be targeted at offspring with MDD; it is also important to consider offspring with other forms of psychopathology