JCPP advances最新文献_第7页

Cognitive bias modification of interpretations for anxiety and depression in children and adolescents: A meta-analysis 对儿童和青少年焦虑症和抑郁症解释的认知偏差修正：荟萃分析

JCPP advances

Pub Date : 2023-11-16 DOI: 10.1002/jcv2.12207

Gemma Sicouri, Emily K. Daniel, Michael J. Spoelma, Elske Salemink, Emma A. McDermott, Jennifer L. Hudson

Background

Evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in modifying interpretation biases and has a small effect on reducing anxiety in children and adolescents. However, most evidence to date is based on studies which report anxiety or general distress using ad-hoc Likert-type or Visual Analogue Scales, which are useful but do not reliably index symptoms of clinical importance. This meta-analysis aimed to establish the effects of CBM-I for children and adolescents on both anxiety and depression using psychometrically validated symptom measures, as well as state negative affect and negative and positive interpretation bias.

Methods

We identified studies through a systematic search. To be eligible for inclusion, studies needed to target interpretation biases, not combine CBM-I with another intervention, randomly allocate participants to CBM-I or a control condition, assess a mental health outcome (i.e., anxiety or depression symptoms using validated measures or state measures of negative affect) and/or interpretation bias and have a mean age less than 18 years.

Results

We identified 36 studies for inclusion in the meta-analysis. CBM-I had a small and non-significant unadjusted effect on anxiety symptoms (g = 0.16), no effect on depression symptoms (g = −0.03), and small and non-significant unadjusted effects on state negative affect both at post-training (g = 0.16) and following a stressor task (g = 0.23). In line with previous findings, CBM-I had moderate to large unadjusted effects on negative and positive interpretations (g = 0.78 and g = 0.52). No significant moderators were identified.

Conclusions

CBM-I is effective at modifying interpretation bias, however there were no effects on mental health outcomes. The substantial variability across studies and paucity of studies using validated symptom measures highlight the need to establish randomized controlled trial protocols that evaluate CBM-I in clinical youth samples to determine its future as a clinical intervention.

有证据表明，解释认知偏差修正法（CBM-I）可以有效地修正解释偏差，并对减轻儿童和青少年的焦虑有一定的效果。然而，迄今为止的大多数证据都是基于使用临时李克特量表或视觉模拟量表来报告焦虑或一般困扰的研究，这些量表虽然有用，但并不能可靠地反映具有临床重要性的症状。本荟萃分析旨在通过使用经心理测量学验证的症状测量方法，以及状态负性情绪、负性和正性解释偏差，确定 CBM-I 对儿童和青少年焦虑和抑郁的影响。要符合纳入条件，研究必须针对解释偏差、不将CBM-I与其他干预措施相结合、将参与者随机分配到CBM-I或对照条件下、评估心理健康结果（即使用有效测量方法或消极情绪状态测量方法评估焦虑或抑郁症状）和/或解释偏差，并且平均年龄小于18岁。CBM-I 对焦虑症状（g = 0.16）有微小且不显著的未调整影响，对抑郁症状（g = -0.03）无影响，对训练后（g = 0.16）和压力任务后（g = 0.23）的状态负性情绪有微小且不显著的未调整影响。与之前的研究结果一致，CBM-I 对消极和积极解释（g = 0.78 和 g = 0.52）具有中等至较大的未调整效应。CBM-I能有效改变解释偏差，但对心理健康结果没有影响。不同研究之间存在很大差异，而且使用有效症状测量方法的研究很少，这突出表明有必要制定随机对照试验方案，在临床青年样本中评估 CBM-I，以确定其作为临床干预措施的前景。

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引用次数: 0

Antipsychotic prescribing patterns in children and adolescents attending Australian general practice in 2011 and 2017 2011 年和 2017 年在澳大利亚全科诊所就诊的儿童和青少年的抗精神病药物处方模式

JCPP advances

Pub Date : 2023-11-10 DOI: 10.1002/jcv2.12208

Julie Klau, David Gonzalez-Chica, Melissa Raven, Jon Jureidini

Background

Antipsychotics are increasingly prescribed to children and adolescents worldwide, but little is known about reasons for prescribing. We aimed to examine patterns of paediatric antipsychotic prescribing in Australian primary care services in 2011 and 2017, including diagnoses, sociodemographic characteristics, off-label prescribing, and psychotropic co-prescribing.

Methods

Retrospective analysis of electronic health records (EHRs) using a large Australian general practice database (MedicineInsight). Diagnoses of mental disorders were extracted from EHRs and associated with antipsychotic prescriptions within the same calendar year for three age-groups: 0–9, 10–14, and 15–18-year-olds.

Results

In 2017, children/adolescents with mental health diagnoses were more likely to be prescribed antipsychotics (2.9% of 27,412 patients) than in 2011 (2.0% of 8418 patients; absolute difference +0.9, 95% CI + 0.5, +1.4). The likelihood was greater for patients with bipolar disorders (21.6% vs. 41.5%), eating disorders (1.1% vs. 7.2%), and autism without behavioural problems (3.7% vs. 6.1%). Depression/anxiety (adjusted 26.8% of patients 2011; 30.8% 2017) was the most common diagnosis associated with antipsychotics in both years. Most antipsychotics were prescribed off-label (69.8% 2011; 79.7% 2017; absolute difference +9.8, 95% CI + 1.54, +18.4). Off-label prescribing increased most among those aged 15–18-years, females, and patients living in outer regional/remote/very remote communities and the most disadvantaged areas. The three most frequently prescribed antipsychotics in both years were risperidone, quetiapine, and olanzapine. Psychotropic co-prescribing among patients receiving antipsychotic prescriptions was approximately 69% in both years.

Conclusions

Prescribing antipsychotics for mental health diagnoses to children/adolescents attending Australian general practices was more frequent in 2017 than 2011, and most commonly associated with depression/anxiety diagnoses. In both years, most prescribing was off-label. The majority of patients were co-prescribed other classes of psychotropics along with antipsychotics.

背景全世界越来越多的儿童和青少年服用抗精神病药物，但对处方原因却知之甚少。我们旨在研究 2011 年至 2017 年澳大利亚初级医疗服务中儿科抗精神病药物处方的模式，包括诊断、社会人口特征、标签外处方和精神药物联合处方。方法使用大型澳大利亚全科数据库（MedicineInsight）对电子健康记录（EHR）进行回顾性分析。从电子健康记录中提取精神障碍诊断，并将其与同一日历年内的抗精神病药物处方联系起来，涉及三个年龄组：0-9 岁、10-14 岁和 15-18 岁。结果 2017 年，与 2011 年（8418 名患者中的 2.0%；绝对差异 +0.9，95% CI +0.5，+1.4）相比，有精神健康诊断的儿童/青少年更有可能被开具抗精神病药物处方（27412 名患者中的 2.9%）。双相情感障碍（21.6% 对 41.5%）、进食障碍（1.1% 对 7.2%）和无行为问题的自闭症（3.7% 对 6.1%）患者使用药物的可能性更大。抑郁/焦虑（2011年调整后为26.8%；2017年为30.8%）是这两年与抗精神病药物相关的最常见诊断。大多数抗精神病药物都是标签外处方（2011 年为 69.8%；2017 年为 79.7%；绝对差异为 +9.8，95% CI +1.54，+18.4）。标签外处方在15-18岁人群、女性和居住在外围地区/偏远/非常偏远社区以及最贫困地区的患者中增幅最大。这两年最常处方的三种抗精神病药物是利培酮、喹硫平和奥氮平。在这两年中，接受抗精神病药物处方的患者中约有69%的人同时服用精神药物。结论 2017年，澳大利亚全科医生为就诊儿童/青少年的精神健康诊断开具抗精神病药物处方的频率高于2011年，最常见的是与抑郁/焦虑诊断相关的处方。在这两年中，大多数处方都是标示外处方。大多数患者在服用抗精神病药物的同时，还同时服用了其他类别的精神药物。

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引用次数: 0

Identifying characteristics of adolescents with persistent loneliness during COVID-19: A multi-country eight-wave longitudinal study 在 COVID-19 期间识别持续孤独青少年的特征：多国八波纵向研究

JCPP advances

Pub Date : 2023-11-08 DOI: 10.1002/jcv2.12206

Laura Riddleston, Meenakshi Shukla, Iris Lavi, Eloise Saglio, Delia Fuhrmann, Rakesh Pandey, Tushar Singh, Pamela Qualter, Jennifer Y. F. Lau

Background

Elevated loneliness experiences characterise young people. While loneliness at this developmental juncture may emerge from age-typical upheaval in social relationships, there is little data on the extent to which young people experience high and persistent levels of loneliness, and importantly, who is most vulnerable to these experiences. Using the widespread social restrictions associated with the COVID-19 pandemic, which precipitated loneliness in many, we aimed to examine adolescents' loneliness profiles across time and the demographic predictors (age, sex, and country) of more severe trajectories.

Methods

Participants aged 12–18 years, recruited into a multi-wave study (N = 1039) across three sites (UK, Israel, and India) completed a 3-item loneliness measure fortnightly across 8 timepoints during the pandemic.

Results

Latent class growth analysis suggested 5 distinct trajectories: (1) low stable (33%), (2) low increasing (19%), (3) moderate decreasing (17%), (4) moderate stable (23%), and (5) high increasing (8%). Females and older adolescents were more likely to experience persistently high loneliness.

Conclusions

These findings indicate a need for interventions to reduce loneliness in adolescents as we emerge from the pandemic, particularly for those groups identified as being at highest risk.

背景年轻人的孤独感很强。虽然这一成长阶段的孤独感可能源于社会关系中的典型年龄动荡，但关于青少年在多大程度上经历过高度和持续的孤独感，以及重要的是，哪些人最容易经历这些孤独感的数据却很少。COVID-19 大流行造成了广泛的社会限制，这加剧了许多人的孤独感，因此我们旨在研究青少年在不同时期的孤独感特征，以及更严重的孤独感轨迹的人口学预测因素（年龄、性别和国家）。方法我们在三个研究地点（英国、以色列和印度）进行了一项多波研究，招募了 12-18 岁的参与者（人数 = 1039），他们在大流行期间的 8 个时间点每两周完成一次 3 个项目的孤独感测量。结果潜在类增长分析显示出 5 种不同的轨迹：(1) 低度稳定（33%），(2) 低度增长（19%），(3) 中度下降（17%），(4) 中度稳定（23%），(5) 高度增长（8%）。女性和年龄较大的青少年更有可能经历持续的高度孤独感。结论这些研究结果表明，在大流行病肆虐之后，有必要采取干预措施来减少青少年的孤独感，尤其是那些被认为是高危人群的青少年。

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引用次数: 0

A systematic review of the association between parent-child communication and adolescent mental health 亲子沟通与青少年心理健康关系的系统回顾

JCPP advances

Pub Date : 2023-11-04 DOI: 10.1002/jcv2.12205

Holger Zapf, Johannes Boettcher, Yngvild Haukeland, Stian Orm, Sarah Coslar, Krister Fjermestad

Background

This systematic review addresses how adolescent-rated parent-child communication (PCC) quality is related to adolescent mental health.

Methods

We performed a systematic literature search in Medline and APA PsycInfo, including peer-reviewed quantitative studies examining associations between adolescent-rated dyadic PCC quality and general as well as specific measures of adolescent mental health. Qualitative and case studies were excluded, as were studies reporting only parent-rated communication quality or instruments assessing other constructs than dyadic PCC. We screened 5314 articles, of which 37 were included in the review. We assessed study quality with the Mixed Methods Appraisal Tool.

Results

We synthesized the findings in a table and narratively, reporting the main outcomes organized according to mental health constructs. The included studies were mainly cross-sectional. The results showed that adolescent-rated PCC quality is negatively associated with mental health constructs, demonstrating small to large effects across different mental health constructs and populations. The associations were found for general mental health and specific domains, including depression, anxiety, psychosis, suicidal ideation, post-traumatic stress symptoms, and addictive internet use/gaming.

Conclusions

The findings demonstrate that PCC is a relevant variable to consider in assessing adolescent mental health and preventive efforts. Limitations include the exclusive focus on adolescent-reported PCC questionnaires since parent- and observer-rated instruments may lead to different results. Also, PCC is related to other constructs, such as dyadic relationships, that were not included in this review. We conclude that PCC is a relevant variable to consider in mental health research. Our findings suggest that PCC may be considered in mental health practice, both in terms of assessing its quality and potentially by tailoring interventions to enhance PCC. These may represent a mean to promote adolescent mental health.

背景本系统综述探讨了青少年评价的亲子沟通（PCC）质量与青少年心理健康之间的关系。方法我们在 Medline 和 APA PsycInfo 上进行了系统性文献检索，其中包括经同行评审的定量研究，这些研究考察了青少年评定的父子沟通质量与青少年心理健康的一般和特定测量指标之间的关系。定性研究和案例研究被排除在外，仅报告父母评定的沟通质量或评估除双向 PCC 以外的其他结构的工具的研究也被排除在外。我们筛选了 5314 篇文章，其中 37 篇被纳入综述。我们使用混合方法评估工具对研究质量进行了评估。结果我们以表格和叙述的形式对研究结果进行了综合，并根据心理健康的构建因素对主要结果进行了报告。纳入的研究主要是横断面研究。结果表明，青少年评价的 PCC 质量与心理健康结构呈负相关，在不同的心理健康结构和人群中显示出小到大的影响。在一般心理健康和特定领域（包括抑郁症、焦虑症、精神病、自杀倾向、创伤后应激症状和成瘾性网络使用/游戏）中都发现了相关性。结论研究结果表明，PCC 是评估青少年心理健康和预防工作时需要考虑的一个相关变量。研究的局限性包括只关注青少年报告的 PCC 问卷，因为家长和观察者评分的工具可能会导致不同的结果。此外，PCC 还与其他结构相关，例如本综述未包括的双亲关系。我们的结论是，PCC 是心理健康研究中需要考虑的一个相关变量。我们的研究结果表明，在心理健康实践中可以考虑 PCC，既可以评估其质量，也可以通过定制干预措施来增强 PCC。这可能是促进青少年心理健康的一种手段。

{"title":"A systematic review of the association between parent-child communication and adolescent mental health","authors":"Holger Zapf, Johannes Boettcher, Yngvild Haukeland, Stian Orm, Sarah Coslar, Krister Fjermestad","doi":"10.1002/jcv2.12205","DOIUrl":"10.1002/jcv2.12205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This systematic review addresses how adolescent-rated parent-child communication (PCC) quality is related to adolescent mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic literature search in Medline and APA PsycInfo, including peer-reviewed quantitative studies examining associations between adolescent-rated dyadic PCC quality and general as well as specific measures of adolescent mental health. Qualitative and case studies were excluded, as were studies reporting only parent-rated communication quality or instruments assessing other constructs than dyadic PCC. We screened 5314 articles, of which 37 were included in the review. We assessed study quality with the Mixed Methods Appraisal Tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We synthesized the findings in a table and narratively, reporting the main outcomes organized according to mental health constructs. The included studies were mainly cross-sectional. The results showed that adolescent-rated PCC quality is negatively associated with mental health constructs, demonstrating small to large effects across different mental health constructs and populations. The associations were found for general mental health and specific domains, including depression, anxiety, psychosis, suicidal ideation, post-traumatic stress symptoms, and addictive internet use/gaming.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings demonstrate that PCC is a relevant variable to consider in assessing adolescent mental health and preventive efforts. Limitations include the exclusive focus on adolescent-reported PCC questionnaires since parent- and observer-rated instruments may lead to different results. Also, PCC is related to other constructs, such as dyadic relationships, that were not included in this review. We conclude that PCC is a relevant variable to consider in mental health research. Our findings suggest that PCC may be considered in mental health practice, both in terms of assessing its quality and potentially by tailoring interventions to enhance PCC. These may represent a mean to promote adolescent mental health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135774505","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}

引用次数: 0

Are restricted and repetitive behaviours in two- and six-year-olds associated with emotional and behavioural difficulties? 两岁和六岁儿童的受限和重复行为是否与情绪和行为障碍有关？

JCPP advances

Pub Date : 2023-11-03 DOI: 10.1002/jcv2.12209

Sarah J. Carrington, Mirko Uljarević, Elizabeth Meins, Charles Fernyhough, Helen McConachie, Ann Le Couteur, Susan R. Leekam

Background

Restricted and repetitive patterns of behaviour (RRBs) serve an adaptive role in development. Elevated levels of RRBs beyond the early years, however, are associated with poorer outcome in language, cognition, and wellbeing, and are seen across a range of neurodevelopmental conditions. This study aimed to characterize the association of distinct RRB subtypes at two and six years of age, with internalising and externalising difficulties in a community sample of children.

Methods

485 parents reported on their child's insistence on sameness (IS) and repetitive sensory and motor (RSM) RRBs at two and six years of age using the Repetitive Behaviour Questionnaire (RBQ-2). Emotional and behavioural difficulties were measured using the Strengths and Difficulties Questionnaire (SDQ) at age six.

Results

Consistent with previous research, RRBs later in development better predicted emotional and behavioural difficulties at age six than RRBs earlier in development. Moreover, IS RRBs were selectively associated with internalising behaviours and RSM RRBs with externalising behaviours. Importantly, these selective associations depended on when RRBs were measured. Only IS RRBs at age six were significantly associated with internalising behaviour. By contrast, while more RSM RRBs at age six were associated with higher rates of externalising behaviours, higher rates of RSM RRBs at age two were associated with fewer externalising behaviours, adding further support to the previously reported adaptive role of RRBs in early behaviour regulation.

Conclusion

Although there is a need for further research to provide a detailed profile of the adaptive periods for IS and RSM RRBs, the present findings support the potential utility of elevated RRBs as a signal for emotional and behavioural difficulties at age six.

背景局限性和重复性行为模式（RRB）在发育过程中起着适应作用。然而，幼年期以后，RRB 水平的升高与语言、认知和幸福感方面的较差结果相关联，并且在一系列神经发育状况中均可见到。本研究的目的是在社区儿童样本中，描述两岁和六岁时不同的 RRB 亚型与内化和外化困难之间的关系。方法 485 名家长使用重复行为问卷（RBQ-2）报告了他们的孩子在两岁和六岁时的坚持同一性（IS）和重复性感觉和运动（RSM）RRB。六岁时的情绪和行为障碍通过优势和困难问卷（SDQ）进行测量。结果与先前的研究一致，发育后期的 RRB 比发育早期的 RRB 更能预测六岁时的情绪和行为障碍。此外，IS RRB 与内化行为有选择性关联，RSM RRB 与外化行为有选择性关联。重要的是，这些选择性关联取决于 RRB 的测量时间。只有六岁时的 IS RRB 与内化行为有明显的关联。相比之下，虽然六岁时较多的 RSM RRB 与较高的外部化行为发生率有关，但两岁时较多的 RSM RRB 与较少的外部化行为有关，这进一步支持了之前报道的 RRB 在早期行为调节中的适应性作用。结论虽然还需要进一步的研究来提供 IS 和 RSM RRB 适应期的详细情况，但目前的研究结果支持了 RRB 升高作为六岁儿童情绪和行为困难信号的潜在作用。

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引用次数: 0

The relationship between cognitive and affective control and adolescent mental health 认知和情感控制与青少年心理健康的关系

JCPP advances

Pub Date : 2023-11-03 DOI: 10.1002/jcv2.12204

Savannah Minihan, Levi Kumle, Kate Maston, Debopriyo Bal, Aliza Werner-Seidler, Helen Christensen, Susanne Schweizer

Background

Cognitive control problems have been implicated in the etiology and maintenance of mental health problems, including depression, in adults. Studies in adolescents have been more equivocal, with some showing changes in cognitive control in adolescents with mental health problems, whereas others fail to show an association. This study examines whether adolescent mental health is associated with affective control, the application of cognitive control in affective contexts, which shows more protracted development than cognitive control.

Methods

The present study investigated the association of cognitive and affective control with depressive symptomatology and self-reported diagnostic history of mental health problems in adolescents. The study included 1929 participants (M_age = 13.89) from the Future Proofing Study (N = 6,388, 11–16 years), who completed affective (incl., affective stimuli) and/or cognitive (incl., neutral stimuli) versions of a working memory (backward digit-span) and/or shifting (card-sorting) task at least once within 3 weeks of assessing mental health.

Results

Poorer working memory was associated with greater depressive symptomatology in adolescents (β = −0.06, p = .004), similarly across cognitive and affective control conditions (β = −0.02, p = .269). Adolescents with self-reported diagnostic history of mental health problems had significantly poorer shifting ability in affective compared to cognitive control conditions (b = 0.05, p = .010), whereas for adolescents with no self-reported diagnoses, shifting ability did not differ between conditions (b = −0.00, p = .649).

Conclusions

The present analyses suggest that working memory difficulties, in particular, may be associated with the experience of current depressed mood in adolescents. Problems with affective shifting may be implicated in a range of mental health problems in adolescents. Given the ubiquitous need for efficient cognitive functioning in daily life, enhancing cognitive and affective control in adolescents may be a promising means of improving functioning across a range of domains, including affective functioning, and by extension, adolescent mental health.

背景认知控制问题已被认为与包括抑郁症在内的成人精神健康问题的病因和维持有关。对青少年的研究则比较模糊，有些研究显示，有心理健康问题的青少年的认知控制能力会发生变化，而另一些研究则未能显示出两者之间的联系。本研究探讨了青少年的心理健康是否与情感控制有关。情感控制是认知控制在情感情境中的应用，与认知控制相比，情感控制的发展更为持久。方法本研究调查了认知控制和情感控制与青少年抑郁症状和自我报告的心理健康问题诊断史之间的关系。研究对象包括 "面向未来研究"（N = 6,388, 11-16 岁）中的 1929 名参与者（Mage = 13.89），他们在心理健康评估后的 3 周内至少完成了一次情感（包括情感刺激）和/或认知（包括中性刺激）版本的工作记忆（向后数字跨度）和/或移位（卡片分类）任务。结果青少年较差的工作记忆与较严重的抑郁症状有关（β = -0.06，p = .004），在认知和情感控制条件下也是如此（β = -0.02，p = .269）。与认知控制条件相比，自我报告有心理健康问题诊断史的青少年在情感控制条件下的移位能力明显较差（b = 0.05，p = .010），而对于没有自我报告诊断史的青少年，移位能力在不同条件下没有差异（b = -0.00，p = .649）。结论本分析表明，工作记忆困难尤其可能与青少年当前的抑郁情绪体验有关。情绪转移问题可能与青少年的一系列心理健康问题有关。鉴于日常生活中无处不在地需要高效的认知功能，加强青少年的认知和情感控制可能是改善包括情感功能在内的一系列领域的功能，并进而改善青少年心理健康的一种有前途的方法。

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引用次数: 0

Diagnostic certainty during in-person and telehealth autism evaluations 面对面和远程医疗自闭症评估中的诊断确定性

JCPP advances

Pub Date : 2023-10-28 DOI: 10.1002/jcv2.12201

Natasha N. Ludwig, Calliope Holingue, Ji Su Hong, Luther G. Kalb, Danika Pfeiffer, Rachel Reetzke, Deepa Menon, Rebecca Landa

Background

Many diagnostic evaluations abruptly shifted to telehealth during the COVID-19 pandemic; however, little is known about the impact on diagnosis patterns for children evaluated for autism spectrum disorder (ASD). The purpose of this clinical research study was to examine (1) the frequency of diagnoses evaluated beyond ASD; (2) the frequency of diagnoses made, including ASD; and (3) clinician diagnostic certainty for all diagnoses evaluated for children who received an evaluation due to primary concerns about ASD via telehealth during the pandemic compared to those evaluated in person before the pandemic at an ASD specialty clinic.

Methods

The sample included 2192 children, 1–17 years (M = 6.5 years; SD = 3.9), evaluated by a physician/psychologist at an ASD specialty center. A total of 649 children were evaluated in-person September 1, 2019–March 13, 2020 (pre-pandemic) and 1543 were evaluated via telehealth March 14, 2020–July 26, 2021 (during pandemic). Upon completion of each evaluation, clinicians provided a final diagnostic determination (i.e., “Yes,” “No,” “Possible,” or “Not Assessed”) for the following DSM-5 conditions: ASD, attention-deficit/hyperactivity disorder (ADHD), intellectual developmental disorder (IDD), anxiety (ANX), depression (DEP), and behavioral disorder (BD). “Possible” indicated lower certainty and the diagnosis was not provided. “Not Assessed” indicated the disorder was not evaluated.

Results

Diagnostic certainty for ASD and ADHD was lower and clinicians evaluated for and made diagnoses of IDD less often during evaluations that occurred via telehealth during the pandemic versus in person before the pandemic. DEP and BD were diagnosed more frequently, diagnostic certainty of DEP was lower, and no differences in the frequency of ANX diagnoses emerged during evaluations conducted via telehealth during the pandemic compared to those conducted in person before the pandemic.

Conclusions

Differences emerged in the frequency of diagnoses evaluated and made and diagnostic certainty for evaluations conducted via telehealth during the pandemic compared to in person before the pandemic, which likely impacted patients and reflect real-word challenges. Future work should examine whether these patterns are generalizable and the mechanisms that contribute to these differences.

背景在 COVID-19 大流行期间，许多诊断评估突然转向远程医疗；然而，人们对自闭症谱系障碍 (ASD) 评估对儿童诊断模式的影响知之甚少。这项临床研究的目的是检查 (1) 除 ASD 以外的诊断频率；(2) 包括 ASD 在内的诊断频率；(3) 与大流行前在 ASD 专科门诊亲自接受评估的儿童相比，大流行期间通过远程医疗接受评估的因主要关注 ASD 而接受评估的儿童的所有诊断的临床医生诊断确定性。方法样本包括 2192 名 1-17 岁的儿童（中位数 = 6.5 岁；标准差 = 3.9），由 ASD 专科中心的医生/心理学家进行评估。共有 649 名儿童于 2019 年 9 月 1 日至 2020 年 3 月 13 日（大流行前）接受了现场评估，1543 名儿童于 2020 年 3 月 14 日至 2021 年 7 月 26 日（大流行期间）接受了远程医疗评估。每次评估完成后，临床医生都会针对以下 DSM-5 病症给出最终诊断结果（即 "是"、"否"、"可能 "或 "未评估"）：ASD、注意力缺陷/多动障碍 (ADHD)、智力发育障碍 (IDD)、焦虑 (ANX)、抑郁 (DEP) 和行为障碍 (BD)。"可能 "表示确定性较低，未提供诊断结果。"未评估 "表示未对该疾病进行评估。结果在大流行期间通过远程医疗进行的评估中，ASD 和 ADHD 的诊断确定性较低，临床医生对 IDD 的评估和诊断也较少。在大流行期间通过远程医疗进行的评估中，DEP 和 BD 的诊断频率较高，DEP 的诊断确定性较低，而 ANX 的诊断频率与大流行前亲自进行的评估相比没有出现差异。结论大流行期间通过远程医疗进行评估的诊断频率和诊断确定性与大流行前亲自进行评估的诊断频率和诊断确定性出现了差异，这可能会对患者产生影响，并反映出实际的挑战。未来的工作应研究这些模式是否具有普遍性，以及造成这些差异的机制。

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引用次数: 0

Comparing findings from the random-intercept cross-lagged panel model and the monozygotic twin difference cross-lagged panel model: Maladaptive parenting and offspring emotional and behavioural problems 比较随机截距交叉滞后面板模型和单卵双生差异交叉滞后面板模型的研究结果：适应不良的养育方式与后代的情绪和行为问题

JCPP advances

Pub Date : 2023-10-28 DOI: 10.1002/jcv2.12203

Marie-Louise J. Kullberg, Charlotte C. Van Schie, Andrea G. Allegrini, Yasmin Ahmadzadeh, Daniel L. Wechsler, Bernet M. Elzinga, Tom A. McAdams

Background

In this study we compare results obtained when applying the monozygotic twin difference cross-lagged panel model (MZD-CLPM) and a random intercept cross-lagged panel model (RI-CLPM) to the same data. Each of these models is designed to strengthen researchers' ability to draw causal inference from cross-lagged associations. We explore differences and similarities in how each model does this, and in the results each model produces. Specifically, we examine associations between maladaptive parenting and child emotional and behavioural problems in identical twins aged 9, 12 and 16.

Method

Child reports of 5698 identical twins from the Twins Early Development Study (TEDS) were analysed. We ran a regular CLPM to anchor our findings within the current literature, then applied the MZD-CLPM and the RI-CLPM.

Results

The RI-CLPM and MZD-CLPM each enable researchers to evaluate the direction of effects between correlated variables, after accounting for unmeasured sources of potential confounding. Our interpretation of these models therefore focusses primarily on the magnitude and significance of cross-lagged associations. In both the MZD-CLPM and the RI-CLPM behavioural problems at age 9 resulted in higher levels of maladaptive parenting at age 12. Other effects were not consistently significant across the two models, although the majority of estimates pointed in the same direction.

Conclusion

In light of the triangulated methods, differences in the results obtained using the MZD-CLPM and the RI-CLPM underline the importance of careful consideration of what sources of unmeasured confounding different models control for and that nuance is required when interpreting findings using such models. We provide an overview of what the CLPM, RI-CLPM and MZD-CLPM can and cannot control for in this respect and the conclusions that can be drawn from each model.

背景在本研究中，我们比较了对相同数据应用单卵双生子差分交叉滞后面板模型（MZD-CLPM）和随机截距交叉滞后面板模型（RI-CLPM）所得到的结果。这两种模型都旨在加强研究人员从交叉滞后关联中得出因果推论的能力。我们将探讨每个模型在实现这一目标方面的异同，以及每个模型产生的结果。具体来说，我们研究了 9 岁、12 岁和 16 岁同卵双胞胎的不良养育方式与儿童情绪和行为问题之间的关联。方法我们对双胞胎早期发展研究（TEDS）中 5698 个同卵双胞胎的儿童报告进行了分析。我们进行了常规的CLPM，以便将我们的研究结果与当前的文献结合起来，然后应用了MZD-CLPM和RI-CLPM。结果 RI-CLPM 和 MZD-CLPM 都能让研究人员在考虑未测量的潜在混杂因素后，评估相关变量之间的影响方向。因此，我们对这些模型的解释主要集中在交叉滞后关联的程度和重要性上。在 MZD-CLPM 和 RI-CLPM 中，9 岁时的行为问题会导致 12 岁时更高水平的适应不良型养育。其他影响在两个模型中的显著性并不一致，尽管大多数估计值都指向同一方向。结论根据三角测量方法，使用 MZD-CLPM 和 RI-CLPM 得出的结果存在差异，这突出表明了仔细考虑不同模型控制哪些未测量混杂因素来源的重要性，以及在解释使用此类模型得出的结果时需要细微差别。我们概述了 CLPM、RI-CLPM 和 MZD-CLPM 在这方面能控制和不能控制的因素，以及从每个模型中可以得出的结论。

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引用次数: 0

The relationship between dissociation and panic symptoms in adolescence and the exploration of potential mediators 青春期解离症与恐慌症状之间的关系及潜在中介因素探讨

JCPP advances

Pub Date : 2023-10-11 DOI: 10.1002/jcv2.12202

Lottie Shipp, Alisa Musatova, Emma Černis, Polly Waite

Background

Dissociative experiences have been linked to panic symptoms in adolescents, yet the nature of the association remains unclear.

Methods

In the present study, we investigated the longitudinal relationship between dissociative experiences (focusing on the felt sense of anomaly subtype) and panic, as well as the potential mediating roles of emotion regulation strategies (expressive suppression and cognitive reappraisal), alexithymia, and cognitive appraisals of dissociation. Four thousand five hundred one adolescents aged 13–18 years were recruited via social media advertising to take part in an online survey at two timepoints, 1 month apart.

Results

Analysis of 421 datasets found a significant positive relationship between initial dissociative experiences and panic symptoms reported 1 month later. This was mediated by the emotion regulation strategy of cognitive reappraisal, and cognitive appraisals of dissociation. These two variables were no longer significant mediators when controlling for panic symptoms at the first time point, likely due to the stability of panic symptoms across both assessments. Neither alexithymia nor expressive suppression were significant mediators.

Conclusions

Thus, dissociative experiences that are persistently misinterpreted in a catastrophic manner may lead to escalating anxiety and panic symptoms, which could in turn heighten and maintain the feared dissociation sensation. These results indicate that dissociative experiences are associated with panic symptoms in adolescence, with cognitive appraisals of dissociation and cognitive reappraisal playing a role in this relationship.

背景解离体验与青少年的恐慌症状有关，但这种关联的性质仍不清楚。方法在本研究中，我们调查了解离体验（侧重于感觉异常亚型）与恐慌之间的纵向关系，以及情绪调节策略（表达性抑制和认知再评价）、情感障碍和对解离的认知评价的潜在中介作用。研究人员通过社交媒体广告招募了 451 名 13-18 岁的青少年，让他们在两个时间点（相隔 1 个月）参与在线调查。结果对 421 个数据集进行分析后发现，最初的解离体验与一个月后报告的恐慌症状之间存在显著的正相关关系。认知再评价的情绪调节策略和对分离的认知评价对此有中介作用。在控制了第一个时间点的恐慌症状后，这两个变量不再是重要的中介变量，这可能是由于两次评估中恐慌症状的稳定性。自闭症和表达性抑制都不是重要的中介变量。结论因此，持续被误解为灾难性的解离体验可能会导致焦虑和恐慌症状的升级，这反过来又会增强和维持令人恐惧的解离感。这些结果表明，解离体验与青少年的恐慌症状有关，解离的认知评价和认知再评价在这种关系中发挥了作用。

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引用次数: 0

Pathways from maternal depression to child resilience: Socioeconomic, family, and individual factors in the 2004 Pelotas (Brazil) birth cohort 从母亲抑郁到儿童适应力的途径:2004年Pelotas(巴西)出生队列的社会经济、家庭和个人因素

JCPP advances

Pub Date : 2023-10-03 DOI: 10.1002/jcv2.12188

Jessica Mayumi Maruyama, Andreas Bauer, Gemma Hammerton, Sarah L. Halligan, Ina S. Santos, Tiago N. Munhoz, Aluísio J. D. Barros, Fernando C. Barros, Graeme Fairchild, Alicia Matijasevich

Background

The negative impacts of maternal depression on child mental health outcomes are well-documented. However, some children show adaptive functioning following exposure to maternal depression, demonstrating resilience. In a large birth cohort from Brazil, a middle-income country, we examined direct and indirect pathways, considering socioeconomic, family, and individual factors, contributing to the development of resilience.

Methods

Using data from the 2004 Pelotas Birth Cohort (N = 4231), we restricted the sample to those exposed to maternal depression up to age 6 years (depression present at ≥2 out of 5 assessment waves; n = 1132; 50% boys). Resilience was defined as scoring below or equal to the mean of the unexposed group on all four problem subscales of the parent-report Strengths and Difficulties Questionnaire at age 11 years. We examined pathways from socioeconomic status (SES; measured at birth) to resilience via cognitive stimulation (CS) (at 24 and 48 months) and Intelligence quotient (IQ) (at 6 years), and from CS to resilience via IQ, using counterfactual mediation.

Results

A minority of children exposed to maternal depression showed resilience (12.4%). There was evidence of indirect pathways from SES to resilience via CS (odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.02–3.38) and IQ (OR = 1.19, 95% CI 1.01–1.42), such that higher SES was associated with resilience via both higher levels of CS and higher IQ, which, in turn, were each positively associated with resilience. Furthermore, there was evidence of a direct (OR = 1.86, 95% CI 1.01–3.76) and total effect (OR = 1.94, 95% CI 1.05–3.89) of CS on resilience, even after controlling for SES. However, these effects varied depending on how persistent and severe depression was defined.

Conclusions

These findings suggest that CS in early childhood may represent a modifiable protective factor for children exposed to maternal depression and a promising intervention target to promote child resilience in the context of maternal depression exposure.

背景母亲抑郁对儿童心理健康结果的负面影响是有据可查的。然而，一些儿童在暴露于母亲抑郁后表现出适应功能，表现出适应力。在中等收入国家巴西的一个大型出生队列中，我们研究了直接和间接的途径，考虑了社会经济、家庭和个人因素，这些因素有助于恢复力的发展。方法使用2004年Pelotas出生队列(N = 4231)的数据，我们将样本限制在6岁前暴露于母亲抑郁的人群中(5个评估波中抑郁≥2个;n = 1132;50%的男孩)。弹性被定义为低于或等于未暴露组在11岁时父母报告的优势和困难问卷的所有四个问题分量表的平均值。我们从社会经济地位(SES;通过认知刺激(CS)(24个月和48个月)和智商(IQ)(6岁)从CS到弹性，并使用反事实中介，通过智商从CS到弹性。结果少数暴露于母亲抑郁的儿童表现出恢复力(12.4%)。有证据表明，社会地位通过社会地位(odds ratio, OR) = 1.76, 95%可信区间(CI) 1.02-3.38)和智商(OR = 1.19, 95%可信区间(CI) 1.01-1.42)间接影响了心理弹性，因此，较高的社会地位通过较高的社会地位和较高的智商与心理弹性相关，而这两者又分别与心理弹性呈正相关。此外，有证据表明，即使在控制了SES之后，CS对恢复力也有直接影响(OR = 1.86, 95% CI 1.01-3.76)和总影响(OR = 1.94, 95% CI 1.05-3.89)。然而，这些影响取决于如何定义持续和严重的抑郁症。结论儿童早期心理适应可能是母亲抑郁环境下儿童心理适应的一个可改变的保护因素，是提高母亲抑郁环境下儿童心理适应能力的一个有希望的干预目标。

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引用次数: 1