Jack Pollard, Tessa Reardon, Chloe Williams, Cathy Creswell, Tamsin Ford, Alastair Gray, Nia Roberts, Paul Stallard, Obioha C. Ukoumunne, Mara Violato
Background
Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs.
Methods
A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual-, family- or societal-level outcome or cost. All studies were synthesised narratively. For longitudinal studies, ‘effect direction’ was used as a common metric, with random effects meta-analysis undertaken where possible.
Results
Eighty-three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta-analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self-harm, eating, relationship, educational, health care, employment, and financial outcomes. ‘Effect direction’ was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow-up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP).
Conclusions
Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost-effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long-term, economic-related, consequences of childhood anxiety problems.
{"title":"The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta-analysis","authors":"Jack Pollard, Tessa Reardon, Chloe Williams, Cathy Creswell, Tamsin Ford, Alastair Gray, Nia Roberts, Paul Stallard, Obioha C. Ukoumunne, Mara Violato","doi":"10.1002/jcv2.12149","DOIUrl":"10.1002/jcv2.12149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual-, family- or societal-level outcome or cost. All studies were synthesised narratively. For longitudinal studies, ‘effect direction’ was used as a common metric, with random effects meta-analysis undertaken where possible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta-analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self-harm, eating, relationship, educational, health care, employment, and financial outcomes. ‘Effect direction’ was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow-up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost-effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long-term, economic-related, consequences of childhood anxiety problems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10652909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter J. Lawrence, Simona Skripkauskaite, Adrienne Shum, Polly Waite, Helen Dodd
Background
The COVID-19 pandemic caused significant disruption to the lives of children and their families. Pre-school children may have been particularly vulnerable to the effects of the pandemic, with the closure of childcare facilities, playgrounds, playcentres and parent and toddler groups limiting their opportunities for social interaction at a crucial stage of development. Additionally, for parents working from home, caring for pre-school aged children who require high levels of support and care, was likely challenging. We conducted an intensive longitudinal, but not nationally representative, study to examine trajectories of pre-schoolers’ mental symptoms in the United Kingdom during the first year of the COVID-19 pandemic.
Methods
UK-based parents and carers (n = 1520) of pre-school-aged children (2–4 years) completed monthly online surveys about their pre-schoolers’ mental health between April 2020 and March 2021. The survey examined changes in children's emotional symptoms, conduct problems and hyperactivity/inattention.
Results
In our final mixed-effects models, our predictors (fixed effects) accounted for 5% of the variance in each of conduct problems, emotional symptoms and hyperactivity/inattention symptoms scores, and the combined random and fixed effects accounted for between 64% and 73% of the variance. Pre-schoolers’ emotional problems and hyperactivity/inattention symptoms declined from April through summer 2020 and then increased again during the autumn and winter 2020/2021 as lockdowns were re-introduced. Pre-schoolers who attended childcare showed greater decline in symptom severity than those who did not. Older children, compared to younger, showed greater lability of emotion symptom severity. Attending childcare predicted lower symptom severity across all three domains of conduct problems, emotional symptoms, and hyperactivity/inattention, while the opposite pattern was observed for children whose parent had a mental health problem.
Conclusions
Our findings reinforce the importance of examining pre-schoolers’ mental health in the context of micro and macro-level factors. Interventions focussing on family factors such as parent mental health, as well as continued provision of childcare, may have most potential to mitigate the impact of COVID-19 on young children's mental health.
{"title":"Changes in UK pre-schooler's mental health symptoms over the first year of the COVID-19 pandemic: Data from Co-SPYCE study","authors":"Peter J. Lawrence, Simona Skripkauskaite, Adrienne Shum, Polly Waite, Helen Dodd","doi":"10.1002/jcv2.12163","DOIUrl":"10.1002/jcv2.12163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic caused significant disruption to the lives of children and their families. Pre-school children may have been particularly vulnerable to the effects of the pandemic, with the closure of childcare facilities, playgrounds, playcentres and parent and toddler groups limiting their opportunities for social interaction at a crucial stage of development. Additionally, for parents working from home, caring for pre-school aged children who require high levels of support and care, was likely challenging. We conducted an intensive longitudinal, but not nationally representative, study to examine trajectories of pre-schoolers’ mental symptoms in the United Kingdom during the first year of the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>UK-based parents and carers (<i>n</i> = 1520) of pre-school-aged children (2–4 years) completed monthly online surveys about their pre-schoolers’ mental health between April 2020 and March 2021. The survey examined changes in children's emotional symptoms, conduct problems and hyperactivity/inattention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In our final mixed-effects models, our predictors (fixed effects) accounted for 5% of the variance in each of conduct problems, emotional symptoms and hyperactivity/inattention symptoms scores, and the combined random and fixed effects accounted for between 64% and 73% of the variance. Pre-schoolers’ emotional problems and hyperactivity/inattention symptoms declined from April through summer 2020 and then increased again during the autumn and winter 2020/2021 as lockdowns were re-introduced. Pre-schoolers who attended childcare showed greater decline in symptom severity than those who did not. Older children, compared to younger, showed greater lability of emotion symptom severity. Attending childcare predicted lower symptom severity across all three domains of conduct problems, emotional symptoms, and hyperactivity/inattention, while the opposite pattern was observed for children whose parent had a mental health problem.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings reinforce the importance of examining pre-schoolers’ mental health in the context of micro and macro-level factors. Interventions focussing on family factors such as parent mental health, as well as continued provision of childcare, may have most potential to mitigate the impact of COVID-19 on young children's mental health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lin Li, Honghui Yao, Le Zhang, Miguel Garcia-Argibay, Ebba Du Rietz, Isabell Brikell, Marco Solmi, Samuele Cortese, J. Antoni Ramos-Quiroga, Marta Ribasés, Zheng Chang, Henrik Larsson
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with other psychiatric and physical diseases. However, available evidence on associations between ADHD and cardiovascular diseases (CVDs) is mixed. To systematically review, quantitatively synthesize, and appraise available evidence on the link between ADHD with CVDs, we searched relevant articles in PubMed, Embase, PsycINFO, and Web of Science from inception to May 1, 2022. Study quality was assessed by using the Newcastle-Ottawa Scale, and random-effects model meta-analyses were performed. A total of 18,391,169 (ADHD: n = 421,224) individuals from 11 studies were included in our systematic review and 8,196,648 (ADHD = 332,619) individuals from five studies were included in the main meta-analysis of adjusted estimates. Pooled estimates showed that ADHD was significantly associated with an increased risk of CVDs in analyses based on adjusted effect size (odds ratio (OR) = 1.96; 95% confidence interval (CI) = 1.19–2.23, Q = 140.74, PQ < 0.001, I2 = 97.2%). When restricted among adults, the heterogeneity declined to null (OR = 1.73; 95% CI = 1.14–2.62, Q = 6.28, PQ = 0.10, I2 = 6.28%), suggesting age might be the main source of heterogeneity. In subgroup analyses, we found increased risk of CVDs associated with ADHD across age groups, type of CVDs, and data sources. This systematic review and meta-analyses indicate that ADHD is associated with increased risk for CVDs, but further studies with various study designs are warranted to advance the understanding of the underlying mechanisms for the observed association between ADHD and CVDs. Additional research is also needed to resolve the role of ADHD medications which remains unclear due to the limited number of primary studies exploring this issue.
注意力缺陷/多动障碍（ADHD）经常与其他精神和身体疾病同时发生。然而，关于多动症和心血管疾病（CVD）之间关系的现有证据喜忧参半。为了系统地回顾、定量综合和评估ADHD与心血管疾病之间联系的现有证据，我们从成立到2022年5月1日在PubMed、Embase、PsycINFO和Web of Science上搜索了相关文章。使用Newcastle Ottawa量表评估研究质量，并进行随机效应模型荟萃分析。共有来自11项研究的18391169名（多动症：n=421224）个体被纳入我们的系统综述，来自5项研究的8196648名（多ADHD=332619）个体被包括在调整估计的主要荟萃分析中。汇总估计显示，在基于调整后的效应大小的分析中，ADHD与心血管疾病风险增加显著相关（比值比（OR）=1.96；95%可信区间（CI）=1.19-2.23，Q=140.74，P Q I 2=97.2%）。当限制在成年人中时，异质性降至零（OR=1.73；95%CI=1.14-2.62，Q=6.28，P Q=0.10，I 2=6.28%），表明年龄可能是异质性的主要来源。在亚组分析中，我们发现不同年龄组、心血管疾病类型和数据来源的心血管疾病与多动症相关的风险增加。这项系统综述和荟萃分析表明，多动症与心血管疾病风险增加有关，但有必要对各种研究设计进行进一步研究，以促进对所观察到的多动症和心血管疾病之间关联的潜在机制的理解。还需要进行更多的研究来解决多动症药物的作用，由于探索这一问题的初级研究数量有限，目前尚不清楚。
{"title":"Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: A systematic review and meta-analysis","authors":"Lin Li, Honghui Yao, Le Zhang, Miguel Garcia-Argibay, Ebba Du Rietz, Isabell Brikell, Marco Solmi, Samuele Cortese, J. Antoni Ramos-Quiroga, Marta Ribasés, Zheng Chang, Henrik Larsson","doi":"10.1002/jcv2.12158","DOIUrl":"10.1002/jcv2.12158","url":null,"abstract":"<p>Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with other psychiatric and physical diseases. However, available evidence on associations between ADHD and cardiovascular diseases (CVDs) is mixed. To systematically review, quantitatively synthesize, and appraise available evidence on the link between ADHD with CVDs, we searched relevant articles in PubMed, Embase, PsycINFO, and Web of Science from inception to May 1, 2022. Study quality was assessed by using the Newcastle-Ottawa Scale, and random-effects model meta-analyses were performed. A total of 18,391,169 (ADHD: <i>n</i> = 421,224) individuals from 11 studies were included in our systematic review and 8,196,648 (ADHD = 332,619) individuals from five studies were included in the main meta-analysis of adjusted estimates. Pooled estimates showed that ADHD was significantly associated with an increased risk of CVDs in analyses based on adjusted effect size (odds ratio (OR) = 1.96; 95% confidence interval (CI) = 1.19–2.23, <i>Q</i> = 140.74, <i>P</i><sub>Q</sub> < 0.001, <i>I</i><sup>2</sup> = 97.2%). When restricted among adults, the heterogeneity declined to null (OR = 1.73; 95% CI = 1.14–2.62, <i>Q</i> = 6.28, <i>P</i><sub>Q</sub> = 0.10, <i>I</i><sup>2</sup> = 6.28%), suggesting age might be the main source of heterogeneity. In subgroup analyses, we found increased risk of CVDs associated with ADHD across age groups, type of CVDs, and data sources. This systematic review and meta-analyses indicate that ADHD is associated with increased risk for CVDs, but further studies with various study designs are warranted to advance the understanding of the underlying mechanisms for the observed association between ADHD and CVDs. Additional research is also needed to resolve the role of ADHD medications which remains unclear due to the limited number of primary studies exploring this issue.</p>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10652910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ARFID (avoidant restrictive food intake disorder) is a relatively new diagnostic term covering a number of well-recognised, clinically significant disturbances in eating behaviour unrelated to body weight/shape concerns. Its phenotypic heterogeneity combined with much about the condition remaining unknown, can contribute to uncertainties about best practice. While other reviews of the evidence base for ARFID exist, few specifically target health care professionals and implications for clinical practice.
Methods
A narrative review was conducted to synthesise the findings of ARFID papers in scientific journals focussing on four key areas relevant to clinical practice: prevalence, assessment and characterisation of clinical presentations, treatment, and service delivery. Freely available online databases were searched for case studies and series, research reports, review articles, and meta-analyses. Findings were reviewed and practice implications considered, resulting in proposed clinical recommendations and future research directions.
Results
We discuss what is currently known about the four key areas included in this review. Based on available evidence as well as gaps identified in the literature, recommendations for clinical practice are derived and practice-related research priorities are proposed for each of the four of the areas explored.
Conclusion
Prevalence studies highlight the need for referral and care pathways to be embedded across a range of health care services. While research into ARFID is increasing, further studies across all areas of ARFID are required and there remains a pressing need for guidance on systematic assessment, evidence-based management, and optimal service delivery models. Informed clinical practice is currently predominantly reliant on expert consensus and small-scale studies, with ongoing routine clinical data capture, robust treatment trials and evaluation of clinical pathways all required. Despite this, a number a positive practice points emerge.
{"title":"Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions","authors":"Tanith Archibald, Rachel Bryant-Waugh","doi":"10.1002/jcv2.12160","DOIUrl":"10.1002/jcv2.12160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>ARFID (avoidant restrictive food intake disorder) is a relatively new diagnostic term covering a number of well-recognised, clinically significant disturbances in eating behaviour unrelated to body weight/shape concerns. Its phenotypic heterogeneity combined with much about the condition remaining unknown, can contribute to uncertainties about best practice. While other reviews of the evidence base for ARFID exist, few specifically target health care professionals and implications for clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative review was conducted to synthesise the findings of ARFID papers in scientific journals focussing on four key areas relevant to clinical practice: prevalence, assessment and characterisation of clinical presentations, treatment, and service delivery. Freely available online databases were searched for case studies and series, research reports, review articles, and meta-analyses. Findings were reviewed and practice implications considered, resulting in proposed clinical recommendations and future research directions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We discuss what is currently known about the four key areas included in this review. Based on available evidence as well as gaps identified in the literature, recommendations for clinical practice are derived and practice-related research priorities are proposed for each of the four of the areas explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Prevalence studies highlight the need for referral and care pathways to be embedded across a range of health care services. While research into ARFID is increasing, further studies across all areas of ARFID are required and there remains a pressing need for guidance on systematic assessment, evidence-based management, and optimal service delivery models. Informed clinical practice is currently predominantly reliant on expert consensus and small-scale studies, with ongoing routine clinical data capture, robust treatment trials and evaluation of clinical pathways all required. Despite this, a number a positive practice points emerge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simona Skripkauskaite, Cathy Creswell, Adrienne Shum, Samantha Pearcey, Pete Lawrence, Helen Dodd, Polly Waite
Background
The threats to health, associated restrictions and economic consequences of the COVID-19 pandemic have been linked to increases in mental health difficulties for many. Parents, in particular, have experienced many challenges such as having to combine work with home-schooling their children and other caring responsibilities. Yet, it remains unclear how parental mental health has changed throughout the pandemic or what factors may have mitigated or compounded the impact of the pandemic on parents' mental health.
Methods
We examined monthly survey data from two linked UK-based longitudinal studies: COVID-19: Supporting Parents, Adolescents and Children during Epidemics' (Co-SPACE) and COVID-19: Supporting Parents and Young Children during Epidemics' (Co-SPYCE). Data from 5576 parents/carers of 2–17-year-old children collected between April 2020 and January 2021 was analysed using mixed-effect modelling and latent class growth (mixture) modelling.
Results
Parental stress and depression, but not anxiety, were higher during the periods of restrictions. This pattern was most pronounced for parents with primary-school-aged children, those that worked at home or had other adults in the household. Being younger, reporting secondary or below education, working out of home, having secondary-school-aged children or children with special education needs (SEN)/neurodevelopmental disorders (ND) further moderated whether, how and when parental mental health symptoms changed. Although around three quarters of parents reported consistently low mental health symptoms, a substantial minority reported consistently high or increasing symptoms of anxiety, stress and depression. The latter were more likely to be parents who were younger than average, were a single adult in the household, had a pre-existing mental health diagnosis or had a child with special educational needs or a ND.
Conclusions
These findings emphasise how different personal circumstances and pre-existing inequalities shaped how parents were affected by this unprecedented global pandemic and highlight the need for support and consideration to meet the needs of families in the future.
{"title":"Changes in UK parental mental health symptoms over 10 months of the COVID-19 pandemic","authors":"Simona Skripkauskaite, Cathy Creswell, Adrienne Shum, Samantha Pearcey, Pete Lawrence, Helen Dodd, Polly Waite","doi":"10.1002/jcv2.12139","DOIUrl":"10.1002/jcv2.12139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The threats to health, associated restrictions and economic consequences of the COVID-19 pandemic have been linked to increases in mental health difficulties for many. Parents, in particular, have experienced many challenges such as having to combine work with home-schooling their children and other caring responsibilities. Yet, it remains unclear how parental mental health has changed throughout the pandemic or what factors may have mitigated or compounded the impact of the pandemic on parents' mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined monthly survey data from two linked UK-based longitudinal studies: COVID-19: Supporting Parents, Adolescents and Children during Epidemics' (Co-SPACE) and COVID-19: Supporting Parents and Young Children during Epidemics' (Co-SPYCE). Data from 5576 parents/carers of 2–17-year-old children collected between April 2020 and January 2021 was analysed using mixed-effect modelling and latent class growth (mixture) modelling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Parental stress and depression, but not anxiety, were higher during the periods of restrictions. This pattern was most pronounced for parents with primary-school-aged children, those that worked at home or had other adults in the household. Being younger, reporting secondary or below education, working out of home, having secondary-school-aged children or children with special education needs (SEN)/neurodevelopmental disorders (ND) further moderated whether, how and when parental mental health symptoms changed. Although around three quarters of parents reported consistently low mental health symptoms, a substantial minority reported consistently high or increasing symptoms of anxiety, stress and depression. The latter were more likely to be parents who were younger than average, were a single adult in the household, had a pre-existing mental health diagnosis or had a child with special educational needs or a ND.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings emphasise how different personal circumstances and pre-existing inequalities shaped how parents were affected by this unprecedented global pandemic and highlight the need for support and consideration to meet the needs of families in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Josjan Zijlmans, Jacintha M. Tieskens, Hedy A. van Oers, Hekmat Alrouh, Michiel A. J. Luijten, Rowdy de Groot, Daniël van der Doelen, Helen Klip, Rikkert M. van der Lans, Ronald de Meyer, Malindi van der Mheen, I. Hyun Ruisch, Germie van den Berg, Hilgo Bruining, Jan Buitelaar, Rachel van der Rijken, Pieter J. Hoekstra, Marloes Kleinjan, Ramón J. L. Lindauer, Kim J. Oostrom, Wouter Staal, Robert Vermeiren, Ronald Cornet, Lotte Haverman, Arne Popma, Meike Bartels, Tinca J. C. Polderman
Background
The COVID-19 pandemic has had an acute impact on child mental and social health, but long-term effects are still unclear. We examined how child mental health has developed since the start of the COVID-19 pandemic up to 2 years into the pandemic (April 2022).
Methods
We included children (age 8–18) from two general population samples (N = 222–1333 per measurement and N = 2401–13,362 for pre-covid data) and one clinical sample receiving psychiatric care (N = 334–748). Behavioral questionnaire data were assessed five times from April 2020 till April 2022 and pre-pandemic data were available for both general population samples. We collected parent-reported data on internalizing and externalizing problems with the Brief Problem Monitor and self-reported data on Anxiety, Depressive symptoms, Sleep-related impairments, Anger, Global health, and Peer relations with the Patient-Reported Outcomes Measurement Information System (PROMIS®).
Results
In all samples, parents reported overall increased internalizing problems, but no increases in externalizing problems, in their children. Children from the general population self-reported increased mental health problems from before to during the pandemic on all six PROMIS domains, with generally worst scores in April 2021, and scores improving toward April 2022 but not to pre-pandemic norms. Children from the clinical sample reported increased mental health problems throughout the pandemic, with generally worst scores in April 2021 or April 2022 and no improvement. We found evidence of minor age effects and no sex effects.
Conclusions
Child mental health in the general population has deteriorated during the first phase of the COVID-19 pandemic, has improved since April 2021, but has not yet returned to pre-pandemic levels. Children in psychiatric care show worsening of mental health problems during the pandemic, which has not improved since. Changes in child mental health should be monitored comprehensively to inform health care and policy.
背景：新冠肺炎大流行对儿童心理和社会健康产生了严重影响，但其长期影响尚不清楚。我们研究了自新冠肺炎大流行开始至大流行2年（2022年4月）以来儿童心理健康的发展情况。方法：我们包括来自两个普通人群样本（每次测量N=222-1333，新冠疫情前数据N=2401-13362）和一个接受精神病治疗的临床样本（N=334-748）的儿童（8-18岁）。从2020年4月到2022年4月，对行为问卷数据进行了五次评估，两个普通人群样本都有疫情前的数据。我们使用Brief Problem Monitor收集了家长报告的关于内化和外化问题的数据，并使用患者报告结果测量信息系统（PROMIS®）收集了关于焦虑、抑郁症状、睡眠相关障碍、愤怒、全球健康和同伴关系的自报数据。结果：在所有样本中，家长报告的内化问题总体增加，但他们的孩子的外化问题没有增加。来自普通人群的儿童自我报告，从疫情前到疫情期间，所有六个PROMIS领域的心理健康问题都有所增加，2021年4月的得分通常最差，到2022年4月，得分有所提高，但没有达到疫情前的标准。来自临床样本的儿童报告称，在整个疫情期间，他们的心理健康问题有所增加，2021年4月或2022年4月的得分通常最差，没有改善。我们发现了轻微的年龄影响和没有性别影响的证据。结论：在新冠肺炎大流行的第一阶段，普通人群的儿童心理健康状况恶化，自2021年4月以来有所改善，但尚未恢复到大流行前的水平。在疫情期间，接受精神病治疗的儿童的心理健康问题不断恶化，此后一直没有改善。应全面监测儿童心理健康的变化，为卫生保健和政策提供信息。
{"title":"The effects of COVID-19 on child mental health: Biannual assessments up to April 2022 in a clinical and two general population samples","authors":"Josjan Zijlmans, Jacintha M. Tieskens, Hedy A. van Oers, Hekmat Alrouh, Michiel A. J. Luijten, Rowdy de Groot, Daniël van der Doelen, Helen Klip, Rikkert M. van der Lans, Ronald de Meyer, Malindi van der Mheen, I. Hyun Ruisch, Germie van den Berg, Hilgo Bruining, Jan Buitelaar, Rachel van der Rijken, Pieter J. Hoekstra, Marloes Kleinjan, Ramón J. L. Lindauer, Kim J. Oostrom, Wouter Staal, Robert Vermeiren, Ronald Cornet, Lotte Haverman, Arne Popma, Meike Bartels, Tinca J. C. Polderman","doi":"10.1002/jcv2.12150","DOIUrl":"10.1002/jcv2.12150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic has had an acute impact on child mental and social health, but long-term effects are still unclear. We examined how child mental health has developed since the start of the COVID-19 pandemic up to 2 years into the pandemic (April 2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included children (age 8–18) from two general population samples (<i>N</i> = 222–1333 per measurement and <i>N</i> = 2401–13,362 for pre-covid data) and one clinical sample receiving psychiatric care (<i>N</i> = 334–748). Behavioral questionnaire data were assessed five times from April 2020 till April 2022 and pre-pandemic data were available for both general population samples. We collected parent-reported data on internalizing and externalizing problems with the Brief Problem Monitor and self-reported data on Anxiety, Depressive symptoms, Sleep-related impairments, Anger, Global health, and Peer relations with the Patient-Reported Outcomes Measurement Information System (PROMIS®).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all samples, parents reported overall increased internalizing problems, but no increases in externalizing problems, in their children. Children from the general population self-reported increased mental health problems from before to during the pandemic on all six PROMIS domains, with generally worst scores in April 2021, and scores improving toward April 2022 but not to pre-pandemic norms. Children from the clinical sample reported increased mental health problems throughout the pandemic, with generally worst scores in April 2021 or April 2022 and no improvement. We found evidence of minor age effects and no sex effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Child mental health in the general population has deteriorated during the first phase of the COVID-19 pandemic, has improved since April 2021, but has not yet returned to pre-pandemic levels. Children in psychiatric care show worsening of mental health problems during the pandemic, which has not improved since. Changes in child mental health should be monitored comprehensively to inform health care and policy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Celestine Lockhart, Joanna Bright, Yasmin Ahmadzadeh, Gerome Breen, Shannon Bristow, Andy Boyd, Johnny Downs, Matthew Hotopf, Elisavet Palaiologou, Kaili Rimfeld, Jessye Maxwell, Margherita Malanchini, Tom A. McAdams, Andrew McMillan, Robert Plomin, Thalia C. Eley
The Twins Early Development Study (TEDS) is a longitudinal study following a cohort of twins born 1994–1996 in England and Wales. Of the 13,759 families who originally consented to take part, over 10,000 families remain enrolled in the study. The current focus of TEDS is on mental health in the mid-twenties. Making use of over 25 years of genetically sensitive data, TEDS is uniquely placed to explore the longitudinal genetic and environmental influences on common mental health disorders in early adulthood. This paper outlines recent data collection efforts supporting this work, including a cohort-wide mental health assessment at age 26 and a multi-phase Covid-19 study. It will also provide an update on data linkage efforts and the Children of TEDS (CoTEDS) project.
{"title":"Twins Early Development Study (TEDS): A genetically sensitive investigation of mental health outcomes in the mid-twenties","authors":"Celestine Lockhart, Joanna Bright, Yasmin Ahmadzadeh, Gerome Breen, Shannon Bristow, Andy Boyd, Johnny Downs, Matthew Hotopf, Elisavet Palaiologou, Kaili Rimfeld, Jessye Maxwell, Margherita Malanchini, Tom A. McAdams, Andrew McMillan, Robert Plomin, Thalia C. Eley","doi":"10.1002/jcv2.12154","DOIUrl":"10.1002/jcv2.12154","url":null,"abstract":"<p>The Twins Early Development Study (TEDS) is a longitudinal study following a cohort of twins born 1994–1996 in England and Wales. Of the 13,759 families who originally consented to take part, over 10,000 families remain enrolled in the study. The current focus of TEDS is on mental health in the mid-twenties. Making use of over 25 years of genetically sensitive data, TEDS is uniquely placed to explore the longitudinal genetic and environmental influences on common mental health disorders in early adulthood. This paper outlines recent data collection efforts supporting this work, including a cohort-wide mental health assessment at age 26 and a multi-phase Covid-19 study. It will also provide an update on data linkage efforts and the Children of TEDS (CoTEDS) project.</p>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41144136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alice R. Phillips, Sarah L. Halligan, Megan Denne, Catherine Hamilton-Giachritsis, John A. A. MacLeod, David Wilkins, Rachel M. Hiller
Background
Young people in care are much more likely to experience mental health difficulties than the general population, yet little is known about the provision of mental health support for this group in the United Kingdom.
Methods
Using routinely collected social care data, we explored the provision of mental health support for 112 young people in care in the UK. We identified young people experiencing elevated internalising or externalising difficulties in their first year in care (based on strengths and difficulties questionnaire scores) and extracted data on mental health referrals and provision. We generated descriptive statistics relating to provision of mental health support and used regressions to examine predictors of mental health provision, and associations between support and mental health outcomes one and 2 years later.
Results
Eighty-one percent of the children (n = 79) were referred to mental health services in their first year of being in care. Referrals were usually for emotional or conduct problems. Those with higher externalising symptoms were more likely to be referred than those with higher internalising symptoms (OR = 1.2, (95% confidence interval (CI): 1.01, 1.38)). Females were more likely to access support than males (OR = 3.82 (95% CI: 1.2, 13.3)). Sixty-eight percent of children (n = 66) accessed mental health services in their first year of being in care. Of those who accessed services, support ended prematurely for 29 (44%) of them, often due to placement instability or disengagement. Accessing support in the first year of care was not associated with changes in mental health 1 year (OR: 2.14 (95% CI: 0.62,7.29)), or 2 years after entering care (OR: 0.72–8.57, (95% CI: 0.72, 8.57)), although methodological limitations are noted.
Conclusions
Mental health difficulties for children in care are recognised quickly, but mental health support may be difficult to access, with issues evident in retention and engagement.
{"title":"Secondary data analysis of social care records to examine the provision of mental health support for young people in care","authors":"Alice R. Phillips, Sarah L. Halligan, Megan Denne, Catherine Hamilton-Giachritsis, John A. A. MacLeod, David Wilkins, Rachel M. Hiller","doi":"10.1002/jcv2.12161","DOIUrl":"10.1002/jcv2.12161","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Young people in care are much more likely to experience mental health difficulties than the general population, yet little is known about the provision of mental health support for this group in the United Kingdom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using routinely collected social care data, we explored the provision of mental health support for 112 young people in care in the UK. We identified young people experiencing elevated internalising or externalising difficulties in their first year in care (based on strengths and difficulties questionnaire scores) and extracted data on mental health referrals and provision. We generated descriptive statistics relating to provision of mental health support and used regressions to examine predictors of mental health provision, and associations between support and mental health outcomes one and 2 years later.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-one percent of the children (<i>n</i> = 79) were referred to mental health services in their first year of being in care. Referrals were usually for emotional or conduct problems. Those with higher externalising symptoms were more likely to be referred than those with higher internalising symptoms (<i>OR</i> = 1.2, (95% confidence interval (CI): 1.01, 1.38)). Females were more likely to access support than males (<i>OR</i> = 3.82 (95% CI: 1.2, 13.3)). Sixty-eight percent of children (<i>n</i> = 66) accessed mental health services in their first year of being in care. Of those who accessed services, support ended prematurely for 29 (44%) of them, often due to placement instability or disengagement. Accessing support in the first year of care was not associated with changes in mental health 1 year (<i>OR</i>: 2.14 (95% CI: 0.62,7.29)), or 2 years after entering care (<i>OR</i>: 0.72–8.57, (95% CI: 0.72, 8.57)), although methodological limitations are noted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mental health difficulties for children in care are recognised quickly, but mental health support may be difficult to access, with issues evident in retention and engagement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessio Bellato, Muskaan Aleeza Admani, Camila Deak, Luis Carlos Farhat, Maria Carolina Fontana Antunes de Oliveira, Rebeca Vasconcelos, Margherita Malanchini, Elizabeth Shephard, Giorgia Michelini
Background
Self-injurious thoughts and behaviours (SITBs) have been associated with dysfunction of the Autonomic Nervous System (ANS) in children and young people, suggesting that objective ANS measures may aid assessment of suicide risk, but a systematic synthesis of this literature is currently lacking.
Methods
Following a pre-registered protocol (PROSPERO CRD42022327605), we conducted a systematic search of PubMed, Medline, Embase, PsycINFO, and Web of Science, for empirical studies published until 10th May 2022 that compared indices of ANS functioning in individuals aged 0–25 years with versus without SITBs, or reported continuous associations between ANS measures and SITBs. Study quality was assessed with the Newcastle-Ottawa Scales. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models.
Results
Twenty studies (1979 participants) were included in our systematic review, with 16 included in meta-analyses. Results suggested that SITBs were associated with altered cardiac indices of arousal (g = −0.328, p < 0.001), which was driven by lower heart rate variability in individuals with SITBs (g = −0.375, p = 0.025). Overall results for electrodermal activity were not significant (g = 0.026, p = 0.857), but subgroup analyses showed increased activity in studies of individuals who engaged specifically in non-suicidal self-harm (g = 0.249, p = 0.014) but decreased activity in the remaining studies (g = −0.567, p = 0.004).
Conclusions
Our systematic review and meta-analysis found evidence of reduced parasympathetic regulation as well as more tentative evidence of altered electrodermal activity in children and young people displaying SITBs. Future longitudinal studies should test the clinical utility of these markers for detecting and monitoring suicide risk.
背景：儿童和年轻人的自残思想和行为（SITB）与自主神经系统（ANS）功能障碍有关，这表明客观的自主神经系统测量可能有助于评估自杀风险，但目前缺乏对该文献的系统综合。方法：根据预先注册的方案（PROSPERO CRD42022327605），我们在PubMed、Medline、Embase、PsycINFO和Web of Science上进行了系统搜索，以查找截至2022年5月10日发表的实证研究，这些研究比较了0-25岁有SITB和没有SITB的个体的ANS功能指数，或报告了ANS测量和SITB之间的持续关联。研究质量采用纽卡斯尔-渥太华量表进行评估。使用随机效应元分析模型估计汇集效应大小（Hedge's g）。结果：20项研究（1979名参与者）被纳入我们的系统综述，其中16项被纳入荟萃分析。结果表明SITBs与心脏唤醒指数的改变有关（g=-0.328，p g=-0.375，p=0.025）。皮肤电活动的总体结果不显著（g=0.026，p=0.857），但亚组分析显示，在专门从事非自杀性自残的个体的研究中，活动增加（g=0.249，p=0.014），但在其余研究中活动减少（g=0.567，p=0.004）儿童和年轻人展示SITB的活动。未来的纵向研究应该测试这些标志物在检测和监测自杀风险方面的临床效用。
{"title":"Autonomic dysregulation and self-injurious thoughts and behaviours in children and young people: A systematic review and meta-analysis","authors":"Alessio Bellato, Muskaan Aleeza Admani, Camila Deak, Luis Carlos Farhat, Maria Carolina Fontana Antunes de Oliveira, Rebeca Vasconcelos, Margherita Malanchini, Elizabeth Shephard, Giorgia Michelini","doi":"10.1002/jcv2.12148","DOIUrl":"10.1002/jcv2.12148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Self-injurious thoughts and behaviours (SITBs) have been associated with dysfunction of the Autonomic Nervous System (ANS) in children and young people, suggesting that objective ANS measures may aid assessment of suicide risk, but a systematic synthesis of this literature is currently lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following a pre-registered protocol (PROSPERO CRD42022327605), we conducted a systematic search of PubMed, Medline, Embase, PsycINFO, and Web of Science, for empirical studies published until 10th May 2022 that compared indices of ANS functioning in individuals aged 0–25 years with versus without SITBs, or reported continuous associations between ANS measures and SITBs. Study quality was assessed with the Newcastle-Ottawa Scales. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty studies (1979 participants) were included in our systematic review, with 16 included in meta-analyses. Results suggested that SITBs were associated with altered cardiac indices of arousal (<i>g</i> = −0.328, <i>p</i> < 0.001), which was driven by lower heart rate variability in individuals with SITBs (<i>g</i> = −0.375, <i>p</i> = 0.025). Overall results for electrodermal activity were not significant (<i>g</i> = 0.026, <i>p</i> = 0.857), but subgroup analyses showed increased activity in studies of individuals who engaged specifically in non-suicidal self-harm (<i>g</i> = 0.249, <i>p</i> = 0.014) but decreased activity in the remaining studies (<i>g</i> = −0.567, <i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our systematic review and meta-analysis found evidence of reduced parasympathetic regulation as well as more tentative evidence of altered electrodermal activity in children and young people displaying SITBs. Future longitudinal studies should test the clinical utility of these markers for detecting and monitoring suicide risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Increasing research efforts have focused on understanding why some individuals develop severe psychopathology after exposure to adverse childhood experiences (ACEs). Sleep disturbances (insomnia, nightmares, and sleep disorders) are prevalent sequelae of ACEs and associated with psychopathology; however, there is no meta-analytic evidence on whether sleep disturbance functions as a transdiagnostic mediator in the relationship between ACEs and psychopathology (internalizing/externalizing disorders and psychosis) in children and adolescents.
Methods
Systematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 98 articles (N = 402,718; age range 1–17 years) and the present study used a novel two-stage meta-analytic structural equation model to investigate whether ACEs predict psychopathology through sleep disturbance. Subgroup analyses determined potential biases due to study design (cross-sectional vs. longitudinal) and geographical differences (Western vs. non-Western countries). Sensitivity analyses evaluated the influence of early childhood (<5 years old) and overlapping symptoms (i.e., nightmares and trauma symptoms) on model stability.
Results
The pooled correlations among ACEs, sleep disturbance, and psychopathology were significant; the effect sizes ranged from moderate to high (r = 0.21 to r = 0.29). The indirect effect from ACEs via sleep disturbance to psychopathology was significant (β = 0.05, 95% CI [0.04, 0.06]). The direct effect of ACEs on psychopathology was significant (β = 0.18, 95% CI 0.13–0.24). Subgroup analyses revealed larger effects for cross-sectional studies than longitudinal studies (Δ χ2 (3) = 9.71, p = 0.021). Sensitivity analyses revealed stable and consistent results.
Conclusions
The present meta-analytic results indicate that sleep disturbance is a transdiagnostic mediator in the relationship between ACEs and psychopathology among children and adolescents. Further research is required to determine the synergistic effects between sleep disturbance and other risk mechanisms, and elucidate the complex pathways that lead to disorder in the aftermath of childhood adversities.
背景：越来越多的研究工作集中在理解为什么一些人在暴露于不良童年经历（ACE）后会发展成严重的精神病理学。睡眠障碍（失眠、噩梦和睡眠障碍）是ACE的常见后遗症，与精神病理学有关；然而，没有荟萃分析证据表明睡眠障碍是否在儿童和青少年的ACE与精神病理学（内化/外化障碍和精神病）之间的关系中起到了跨诊断中介的作用。方法：在PubMed、PsycINFO和Web of Science三个数据库中进行系统搜索，共发现98篇文章（N=402718；年龄范围1-17岁），本研究使用一个新的两阶段元分析结构方程模型来研究ACE是否通过睡眠障碍预测精神病理学。亚组分析确定了研究设计（横截面与纵向）和地理差异（西方国家与非西方国家）造成的潜在偏差。敏感性分析评估了儿童早期的影响（结果：ACE、睡眠障碍和精神病理学之间的合并相关性显著；影响大小从中等到高不等（r=0.21到r=0.29）。ACE通过睡眠障碍对精神病理学的间接影响显著（β=0.05，95%CI[0.040.06]）精神病理学显著（β=0.18，95%CI 0.13-0.24）。亚组分析显示，横断面研究的影响大于纵向研究（Δχ2（3）=9.71，p=0.021）。敏感性分析显示结果稳定一致。结论：目前的荟萃分析结果表明，睡眠障碍是儿童和青少年ACE与精神病理学关系的一个跨诊断中介。需要进一步的研究来确定睡眠障碍和其他风险机制之间的协同作用，并阐明儿童逆境后导致障碍的复杂途径。
{"title":"Sleep disturbance as transdiagnostic mediator between adverse childhood experiences and psychopathology in children and adolescents: A structural equation modeling meta-analysis","authors":"Jianlin Liu, Wen Lin Teh, Rachel Hsiao Shen Tan, Yoke Boon Tan, Charmaine Tang, Nisha Chandwani, Mythily Subramaniam","doi":"10.1002/jcv2.12156","DOIUrl":"10.1002/jcv2.12156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Increasing research efforts have focused on understanding why some individuals develop severe psychopathology after exposure to adverse childhood experiences (ACEs). Sleep disturbances (insomnia, nightmares, and sleep disorders) are prevalent sequelae of ACEs and associated with psychopathology; however, there is no meta-analytic evidence on whether sleep disturbance functions as a transdiagnostic mediator in the relationship between ACEs and psychopathology (internalizing/externalizing disorders and psychosis) in children and adolescents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Systematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 98 articles (<i>N</i> = 402,718; age range 1–17 years) and the present study used a novel two-stage meta-analytic structural equation model to investigate whether ACEs predict psychopathology through sleep disturbance. Subgroup analyses determined potential biases due to study design (cross-sectional vs. longitudinal) and geographical differences (Western vs. non-Western countries). Sensitivity analyses evaluated the influence of early childhood (<5 years old) and overlapping symptoms (i.e., nightmares and trauma symptoms) on model stability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The pooled correlations among ACEs, sleep disturbance, and psychopathology were significant; the effect sizes ranged from moderate to high (<i>r</i> = 0.21 to <i>r</i> = 0.29). The indirect effect from ACEs via sleep disturbance to psychopathology was significant (<i>β</i> = 0.05, 95% CI [0.04, 0.06]). The direct effect of ACEs on psychopathology was significant (<i>β</i> = 0.18, 95% CI 0.13–0.24). Subgroup analyses revealed larger effects for cross-sectional studies than longitudinal studies (Δ χ<sup>2</sup> (3) = 9.71, <i>p</i> = 0.021). Sensitivity analyses revealed stable and consistent results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The present meta-analytic results indicate that sleep disturbance is a transdiagnostic mediator in the relationship between ACEs and psychopathology among children and adolescents. Further research is required to determine the synergistic effects between sleep disturbance and other risk mechanisms, and elucidate the complex pathways that lead to disorder in the aftermath of childhood adversities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10652904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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