A meta-analysis of transdiagnostic cognitive behavioural therapy in the treatment of child and young person anxiety disorders

Background: Previous meta-analyses of cognitive-behavioural therapy (CBT) for children and young people with anxiety disorders have not considered the efficacy of transdiagnostic CBT for the remission of childhood anxiety. Aim: To provide a meta-analysis on the efficacy of transdiagnostic CBT for children and young people with anxiety disorders. Methods: The analysis included randomized controlled trials using transdiagnostic CBT for children and young people formally diagnosed with an anxiety disorder. An electronic search was conducted using the following databases: ASSIA, Cochrane Controlled Trials Register, Current Controlled Trials, Medline, PsycArticles, PsychInfo, and Web of Knowledge. The search terms included “anxiety disorder(s)”, “anxi∗”, “cognitive behavio∗, “CBT”, “child∗”, “children”, “paediatric”, “adolescent(s)”, “adolescence”, “youth” and “young pe∗”. The studies identified from this search were screened against the inclusion and exclusion criteria, and 20 studies were identified as appropriate for inclusion in the current meta-analysis. Pre- and posttreatment (or control period) data were used for analysis. Results: Findings indicated significantly greater odds of anxiety remission from pre- to posttreatment for those engaged in the transdiagnostic CBT intervention compared with those in the control group, with children in the treatment condition 9.15 times more likely to recover from their anxiety diagnosis than children in the control group. Risk of bias was not correlated with study effect sizes. Conclusions: Transdiagnostic CBT seems effective in reducing symptoms of anxiety in children and young people. Further research is required to investigate the efficacy of CBT for children under the age of 6

Long-term influences of parental divorce on offspring affective disorders: a systematic review and meta-analysis

Background: The prevalence of divorce in Western countries has increased in recent decades. However, there is no recent systematic review and/or meta-analysis of studies testing for long-term effects of parental divorce on offspring affective disorders. The present study conducted a systematic review and meta-analysis of studies published since 1980 testing for the association between parental divorce and offspring depression and anxiety in adulthood. Method: PUBMED, Science Direct, Medline, PsychInfo, and PsychArticles databases were searched for eligible studies. Random-effect meta-analyses were used to synthesize effect sizes and to test whether associations of parental divorce with offspring affective disorders differed among three publication periods (i.e., before 1996, 1996–2005, 2006–2015). Results: In total, 29 studies were eligible for the systematic review, and 18 studies were included in the meta-analyses (depression: n=21,581; anxiety: n=2472). There was significant association between parental divorce and offspring depression (OR=1.56; 95%CI [1.31, 1.86]), but not anxiety (OR=1.16; 95%CI [0.98, 1.38]). The effect of parental divorce on offspring depression was not weaker in the reports published in more recent decades. Limitations: There is limited research in relation to offspring anxiety in adulthood. Conclusions: Parental divorce is associated with an increased risk of adult offspring depression, with no indication of the effect being weaker in recent publications

Affective symptoms across the life course and the role of adverse childhood experiences

The primary aim of this thesis is to investigate the effects of single and cumulative family-related adverse childhood experiences (ACEs) on affective problems (disorders and symptoms) across the life course. Chapter 1 represents a general introduction into the prevalence, development and stability of affective problems across the life course, outlines key theories and approaches that address the development of affective problems, and highlights the role of early life risk factors in the onset and stability of these problems. Chapter 2 focuses on systematically reviewing the evidence from prospective studies for the role of single (e.g. parental divorce, parental psychopathology, childhood maltreatment unspecified, sexual abuse and family conflict) and cumulative ACEs in adult affective problems. Through synthesising effect sizes from 42 eligible studies, findings revealed that ACEs were associated with an increased risk of affective symptoms in adulthood. However the strength of the association varied, with sexual abuse, followed by cumulative adversities, being the strongest predictors of affective symptoms in adulthood. These findings show that ACEs pose risk for affective problems beyond childhood and adolescence, and that this risk may vary depending on the type and number of ACEs. Chapter 3 builds upon this work through exploring the effects of cumulative ACEs on adult affective problems by synthesising the evidence from studies that use various designs (cross-sectional, case-control, and prospective), as well as critically evaluating methodological strengths and limitations of the existing studies, and suggesting new directions for future research. Future studies would benefit from more systematic assessments of ACEs using prospective multi-informant reports, and from utilisation of a developmentally sensitive life course approach to affective symptoms. Chapter 4 and Chapter 5 extend existing research by utilising longitudinal prospectively collected data from the Medical Research Council (MRC) National Survey of Health and Development (NSHD). These two empirical studies make a novel contribution to the research field by modelling life course profiles of affective symptoms across a period of more than 50 years (from age 13 through 69), and by investigating the effects of single and cumulative ACEs on affective symptoms across the lifespan. As demonstrated in Chapter 4, a higher cumulative ACE score was associated with affective symptom severity in late adulthood (i.e., at ages 60-64 and 69), but not at earlier ages (i.e., at ages 13, 15, 36, 43, 53). This unexpected finding indicates that the risk of affective symptoms in those who experienced multiple ACEs persists beyond childhood and adolescence, up to late adulthood. Further research is encouraged to explore the effect of cumulative ACEs on affective symptoms across the lifespan using person-centred approaches and to explore risk and resilience mechanisms underlying the association. In Chapter 5, advanced modelling techniques – latent class analysis (LCA) – were employed to derive life course profiles of affective symptoms, and the effects of 24 single ACEs and their accumulation, in relation to these life course profiles, were investigated. Four life course profiles of affective symptoms were identified: no symptoms, adolescent symptoms only, adult symptoms only, and adolescent and adult symptoms. Four ACEs were significantly associated with affective symptom trajectories, with small effect sizes observed: childhood chronic illness was associated with adult symptoms only; whereas growing up in an overcrowded house and parental poor perceived health were associated with symptoms in adolescence and adulthood. However, no associations were found for twenty of the ACEs tested. The thesis concludes with the Discussion, which aims to synthesise and summarise the evidence from each study, discuss their key findings and implications, before acknowledging the strengths and limitations of the research area in general, along with providing some suggestions for future research

Childhood chronic physical illness and adult emotional health: a systematic review and meta-analysis

Background: Childhood chronic physical illness is associated with a greater vulnerability for emotional problems (i.e., depression and anxiety) in childhood. However, little is known about life-long effects of childhood chronic physical illness on mental health. The present study aims to systematically review evidence for associations between eight chronic physical illnesses with childhood onset (arthritis, asthma, cancer, chronic renal failure, congenital heart disease, cystic fibrosis, type 1 diabetes, and epilepsy) and adult emotional problems. Methods: A database search of MEDLINE, PsycARTICLES, PsycINFO, and ScienceDirect was undertaken, and random effects meta-analyses were used to synthesize evidence from eligible studies. Results: In total, 37 studies were eligible for the systematic review (n = 45,733) and of these, 34 studies were included into the meta-analyses (n = 45,358). There were overall associations between childhood chronic physical illness and adult depression (OR = 1.31; 95% CI [1.12, 1.54]) and anxiety (OR = 1.47; 95% CI [1.13, 1.92]). Separate meta-analyses for childhood asthma, type 1 diabetes and cancer were also conducted, with cancer being significantly associated with adult depression (OR = 1.19; 95% CI [1.00, 1.42]). Conclusions: The effects of childhood chronic physical illness on the risk of emotional problems persist beyond childhood and adolescence. Mental health prevention and intervention strategies targeting children with chronic physical illnesses can have long-term benefits

Life course trajectories of affective symptoms and their early life predictors

BACKGROUND: Life course trajectories of affective symptoms (depression and anxiety) are heterogenous. However, few studies have investigated the role of early life risk factors in the development of these trajectories. The present study aimed to: (1) derive latent trajectories of affective symptoms over a period of more than 50 years (ages 13–69), and (2) examine early life risk factors for associations with specific life course trajectories of affective symptoms. METHOD: Participants are from the MRC National Survey of Health and Development (NSHD) (n = 5,362). Affective symptoms were measured prospectively at ages 13, 15, 36, 43, 53, 60–64 and 69. A latent variable modelling framework was implemented to model longitudinal profiles of affective symptoms. Twenty-four prospectively measured early life predictors were tested for associations with different symptom profiles using multinomial logistic regression. RESULTS: Four life course profiles of affective symptoms were identified: (1) absence of symptoms (66.6% of the sample); (2) adolescent symptoms with good adult outcome (15.2%); (3) adult symptoms only (with no symptoms in adolescence and late life) (12.9%); (4) symptoms in adolescence and mid adulthood (5.2%). Of the 24 early life predictors observed, only four were associated with life course trajectories, with small effect sizes observed. CONCLUSIONS: People differ in their life course trajectories of anxiety and depression symptoms and that these differences are not largely influenced by early life factors tested in this study

How do Changes in Family Role Status Impact Employees? An empirical investigation

Purpose – Despite the proliferation of work–family research, a thorough understanding of family role status changes (e.g. the gaining of elder or child caregiving responsibilities) remain under-theorized and under-examined. The purpose of this paper is to conceptualize various forms of family role status changes and examine the ways in which these changes influence various employee outcomes. Design/methodology/approach – Data were collected as part of the work–family health study. Using a longitudinal, three-wave study with two-time lags of 6 months (n = 151 family role status changes; n = 392 individuals with family role stability), this study uses one-way analysis of variance to compare mean differences across groups and multilevel modeling to examine the predictive effects of family role status changes. Findings Overall, experiences of employees undergoing a family role status change did not differ significantly from employees whose family role status remained stable over the same 12-month period. Separation/divorce predicted higher levels of family-to-work conflict. Originality/value The work raises important considerations for organizational science and human resource policy research to better understand the substantive effects of family role status changes on employee well-being

Atmospheric circulation and cyclone frequency variations linked to the primary modes of Greenland snow accumulation

Data from 34 Greenland firn cores, extending from 1982 to 1996, are used to identify spatial accumulation variability patterns and their associated atmospheric circulation and cyclone frequencies. The first principal component, representing west-central Greenland accumulation, is correlated to NAO variability, having increased southwesterly (northeasterly) flow over that area during high (low) accumulation winters. The flow is linked to a relative increase in cyclone activity on the west central region of the ice sheet during high accumulation periods. The second principal component represents accumulation over southeastern Greenland where strong westerly flow leads to high accumulation and an increase in lee cyclones on the east and southeast coast. The study provides evidence that increased cyclone activity occurs over, or immediately adjacent to, areas experiencing anomalously high accumulation and it is important to distinguish lee cyclones from ‘‘Icelandic’’ cyclones, as they produce opposite precipitation effects over the ice sheet

The relationship between weight-related indicators and depressive symptoms during adolescence and adulthood: results from two twin studies

Background: The association between weight and depressive symptoms is well established, but the direction of effects remains unclear. Most studies rely on body mass index (BMI) as the sole weight indicator, with few examining the aetiology of the association between weight indicators and depressive symptoms. // Methods: We analysed data from the Twins Early Development Study (TEDS) and UK Adult Twin Registry (TwinsUK) (7658 and 2775 twin pairs, respectively). A phenotypic cross-lagged panel model assessed the directionality between BMI and depressive symptoms at ages 12, 16, and 21 years in TEDS. Bivariate correlations tested the phenotypic association between a range of weight indicators and depressive symptoms in TwinsUK. In both samples, structural equation modelling of twin data investigated genetic and environmental influences between weight indicators and depression. Sensitivity analyses included two-wave phenotypic cross-lagged panel models and the exclusion of those with a BMI <18.5. // Results: Within TEDS, the relationship between BMI and depression was bidirectional between ages 12 and 16 with a stronger influence of earlier BMI on later depression. The associations were unidirectional thereafter with depression at 16 influencing BMI at 21. Small genetic correlations were found between BMI and depression at ages 16 and 21, but not at 12. Within TwinsUK, depression was weakly correlated with weight indicators; therefore, it was not possible to generate precise estimates of genetic or environmental correlations. // Conclusions: The directionality of the relationship between BMI and depression appears to be developmentally sensitive. Further research with larger genetically informative samples is needed to estimate the aetiological influence on these associations