Chronic illness in childhood linked to higher rates of mental illness
May 4, 2020
Science Daily/Queen Mary University of London
Children with long-term health conditions may be more likely to experience mental illness in early adolescence than healthy children, according to new research from Queen Mary University of London.
In the study, published in Development and Psychopathology, children reported to have chronic health problems showed higher rates of mental illness at 10 years, and those health problems continued to be associated with poor mental health at the ages of 13 and 15.
To carry out the study, researchers reviewed a sample of approximately 7000 children to investigate the occurrence of mental health disorders, including anxiety or depression, and chronic illness. The measure of chronic illness was based on mothers assessing their child's health at 10 and 13. Since chronic conditions are defined as those that cannot be cured but can be controlled by medication and other therapies, and may have little disease activity, this measure included children presenting with minor health problems.
The researchers found that children with chronic health conditions were approximately twice as likely at 10 and at 13 to present with a mental health disorder than the control group (children reported by their mothers to be 'healthy, no problems'). At age 15, children with chronic health problems were 60% more likely to present with such disorders.
Study author, Dr Ann Marie Brady from Queen Mary University of London, said: "Although the link between chronic health conditions and mental health problems in childhood has been made before, this study provides the strongest evidence of it to date in the years of late childhood and early adolescence. The difference chronic conditions make to mental health are concerning, and the first impact can be seen even before adolescence, in late childhood."
To investigate this pattern further, the researchers looked at a subset of the children with chronic illness: those who had been diagnosed with asthma. Asthma symptoms are generally mild and well-controlled. Nevertheless, researchers found that asthmatic children showed a similar pattern, having a higher rate of mental illness at 10, 13 and 15 than healthy children.
The study also reviewed what additional factors might account for the link between chronic conditions and mental illness. The sample was taken from the Children of the 90s study, which also contains information from parents and children about other issues including family functioning, friendships, children's activity levels, bullying and health-related absenteeism from school. Researchers analysed which of these might contribute to mental illness rates among children with chronic illness.
They found that bullying and health-related school absenteeism emerged as the most significant additional factors for children with mental health issues. Health-related school absenteeism was identified as the most consistent factor predicting mental health problems over time.
Dr Brady said: "Chronic illness disrupts children's normal lives, and this can affect their development and wellbeing. Even children with asthma, a generally treatable and less debilitating chronic condition, had higher rates of mental illness than the healthy children in our study. If children with chronic conditions are more likely to miss school, or experience bullying, that can make the situation worse. Keeping an eye on school attendance and looking out for evidence of bullying amongst children with chronic illness may help to identify those who are most at risk."
https://www.sciencedaily.com/releases/2020/05/200504114117.htm
Young adults exposed to incarceration as children prone to depression
Anxiety high among this population
September 4, 2019
Science Daily/Ann & Robert H. Lurie Children's Hospital of Chicago
Young adults with childhood history of both parental incarceration and juvenile justice involvement were nearly three times more likely to have depression or post-traumatic stress disorder (PTSD) compared to peers without any experience with the criminal justice system, according to a study published in JAMA Network Open. They also were nearly twice as likely to have anxiety compared to young adults without childhood exposure to incarceration.
"This is a particularly vulnerable and understudied population. Incarceration impacts families across generations, and youth who had a parent in jail or prison more often find themselves in the juvenile justice system," says lead author Nia Heard-Garris, MD, MSc, a pediatrician at Ann & Robert H. Lurie Children's Hospital of Chicago and Instructor of Pediatrics at Northwestern University Feinberg School of Medicine. "Young adults with histories of both juvenile incarceration and parental incarceration as children had a strong association with poor mental health outcomes in young adulthood."
Five million U.S. children have had a parent incarcerated, and those children are estimated to be involved in the juvenile justice system at three times the rate of their peers without a history of parental incarceration.
To examine the association between childhood history of incarceration (parental incarceration plus juvenile justice involvement) and mental health outcomes, Dr. Heard-Garris and co-lead author, Kaitlyn Sacotte, MD, a former medical student at Northwestern University Feinberg School of Medicine and current pediatric resident physician at Oregon Health Science University, and colleagues, used data from the National Longitudinal Study of Adolescent Health to Adult Health.
Out of 13,083 participants, 1,247 (9 percent) had childhood history of parental incarceration, 492 (4.5 percent) had juvenile justice involvement, and 141 (1 percent) had a childhood history of both parental incarceration and juvenile justice involvement. Black individuals accounted for over 33 percent of participants who reported both parental incarceration and juvenile justice involvement, and Latinx participants accounted for over 17 percent.
"Our analyses highlight that a history of both parental incarceration and juvenile justice involvement occurs for 1 out of every 100 U.S. children overall and is disproportionally more common among youth of color," says Dr. Heard-Garris.
Although Black and Latinx individuals were more highly represented, researchers found that the group with dual incarceration exposure had higher odds of poor mental health outcomes that are independent of other factors, such as race or ethnicity, age, family structure, parental education, receipt of public assistance, and residence in the city, suburbs or rural areas.
The researchers additionally found that a history parental incarceration or juvenile justice involvement alone was also associated with worse mental health outcomes compared to peers without incarceration exposure.
"Currently parental incarceration is considered an adverse childhood experience, but juvenile justice involvement is not," says Dr. Heard-Garris. "Given the increased risk for poor mental health outcomes we found in our study, perhaps we should also consider juvenile justice involvement an adverse childhood experience and start screening youth for any incarceration exposure during typical healthcare visits. This would allow us to further support vulnerable patients by connecting them with appropriate resources."
https://www.sciencedaily.com/releases/2019/09/190904113208.htm
Some children are more likely to suffer depression long after being bullied
July 1, 2019
Science Daily/University of Bristol
Some young adults who were bullied as a child could have a greater risk of ongoing depression due to a mix of genetic and environmental factors according to a new study from the University of Bristol.
Researchers wanted to find out what factors influenced depression in young adults between the ages of 10 and 24 and why some people responded differently to risk factors such as bullying, maternal postnatal depression, early childhood anxiety and domestic violence.
Using detailed mood and feelings questionnaires and genetic information from 3,325 teenagers who are part of Bristol's Children of the 90s study, alongside evidence of these risk factors at nine points in time they found that childhood bullying was strongly associated with trajectories of depression that rise at an early age. Children who continued to show high depression into adulthood were also more likely to have genetic liability for depression and a mother with postnatal depression. However, Children who were bullied but did not have any genetic liability for depression showed much lower depressive symptoms as they become young adults.
University of Bristol PhD student Alex Kwong commented: "Although we know that depression can strike first during the teenage years we didn't know how risk factors influenced change over time. Thanks to the Children of the 90s study, we were able to examine at multiple time points the relationships between the strongest risk factors such as bullying and maternal depression, as well as factors such as genetic liability.
"It's important that we know if some children are more at risk of depression long after any childhood bullying has occurred. Our study found that young adults who were bullied as children were eight times more likely to experience depression that was limited to childhood. However, some children who were bullied showed greater patterns of depression that continued into adulthood and this group of children also showed genetic liability and family risk.
"However, just because an individual has genetic liability to depression does not mean they are destined to go on and have depression. There are a number of complex pathways that we still don't fully understand and need to investigate further.
"The next steps should continue to look at both genetic and environmental risk factors to help untangle this complex relationship that would eventually help influence prevention and coping strategies for our health and education services."
Lecturer in Psychiatric Epidemiology at the University of Bristol Dr Rebecca Pearson added: "The results can help us to identify which groups of children are most likely to suffer ongoing symptoms of depression into adulthood and which children will recover across adolescence. For example, the results suggest that children with multiple risk factors (including family history and bullying) should be targeted for early intervention but that when risk factors such as bullying occur insolation, symptoms of depression may be less likely to persist"
Karen Black, Chief Executive Officer for Bristol's Off the Record added: "At Off The Record we see a diverse mix of young people presenting with a range of needs, often depression and anxiety. Understanding some of the factors that influence this will further help us to shape services and our offer for young people. I would also hope that studies such as these will help change policy direction and spending so that we start to get upstream of the issues that we know affect mental health including education and family, prevention rather than cure ideally."
https://www.sciencedaily.com/releases/2019/07/190701144454.htm
Parent-child bond predicts depression, anxiety in teens attending high-achieving schools
October 25, 2018
Science Daily/Arizona State University
Researchers have found the quality of the parent-child relationship steadily declined starting in grade 6, and levels of alienation, trust and communication in middle school predicted depressive symptoms and anxiety in grade 12.
What causes some adolescents to thrive while other teenagers struggle with substance abuse and mental health? Through years of research, the scientists who study development and the clinicians who treat troubled teenagers have developed a list of risk factors that predict the problems faced by adolescents.
The Robert Wood Johnson Foundation, an influential philanthropic organization that focuses on health, recently published a report on adolescent wellness that prioritized risk factors for adolescents. The top three -- poverty, racism and discrimination -- have been on the list for many years, but the 2018 report included a new factor: ongoing pressures to excel that occur in high-achieving schools in mostly affluent communities.
Although attending a high-achieving school might not seem as risky as living in poverty or facing racism or discrimination, decades of research has shown that in fact it is.
"Teens in high achieving schools face different kinds of pressure, but it is substantial pressure nonetheless," said Arizona State University psychology graduate student Ashley Ebbert.
Ebbert has worked with Frank Infurna and Suniya Luthar in the ASU Department of Psychology to examine how the quality of the parent-child relationship influenced the mental health of adolescents who attend high-achieving schools. She is first author on an upcoming paper in Development and Psychopathology that will be published on October 25.
A long-term predictive study of adolescence
The researchers used data from the New England Study of Suburban Youth (NESSY), a long-term study of adolescents led by Luthar, Foundation Professor of Psychology at ASU and co-author on the paper. Participating students came mostly from two-parent families where the parents were white-collar professionals and well-educated. Each school year the NESSY participants completed questionnaires that included measures of their mental health and assess the quality of their relationships with others. The ASU researchers used assessments of the mental health and quality of parent relationships from 262 children.
"Parent-child relationships continue to serve as instrumental sources of support throughout adolescence," Ebbert said. "The quality of these connections can have ripple effects on adjustment and mental health outcomes."
The researchers used data from seven years -- sixth grade through senior year of high school -- to look at how the children's feelings about the parent-child relationship affected their mental health as seniors in high school. The yearly assessments evaluated feelings of alienation from each parent, how much trust the child felt with each parent and how well the child and parents communicated.
"We wanted the child's perspective on the relationship with their parents because ultimately it doesn't matter much how parents think they are doing," Luthar said. "It's what the children experience that is far more important in terms of effects on their mental health."
During the senior year of high school, the participants' mental health was assessed with surveys that measured depressive symptoms and anxiety levels.
The interplay of alienation, trust and communication
Starting in the sixth grade, the children reported growing disconnect with their parents. During the middle school years, the participants indicated increases in feelings of alienation from both parents as the levels of trust and quality of communication decreased.
"Kids pulling away from parents is a well-known phenomenon of adolescence, but we found that it really begins in early middle school," Luthar said.
The pulling away from parents associated with adolescence happens as the teenagers, or even pre-teenagers, begin to explore self-sufficiency and independence. Ebbert said a natural inclination of parents is to give their child space to navigate independence, but she added that if this response is seen as disengagement by kids, it can lead to problems like the ones the researchers found in the NESSY participants.
"We wanted to understand how the changes in the children's feelings of alienation, trust and communication with both parents affected their development, so we examined whether the reported changes could predict depressive symptoms or anxiety by the end of high school," said Infurna, associate professor of psychology and co-author on the paper.
Increases in alienation from both parents and decreasing less trust between children and their mothers were related to higher levels of anxiety in grade 12. Depressive symptoms in grade 12 were also predicted by increasing alienation and decreasing trust with mothers during the high school years.
The researchers found gender differences, in both the student participants and in the effect of parents. Middle school girls reported experiencing greater increases in alienation from both parents and greater decreases in trust with their mothers. Symptom levels at age 18 also differed, with girls experiencing higher levels of anxiety than boys during the senior year.
There were differences in the average quality of the relationship with mothers and fathers. Overall, the participants reported feeling closer to their mothers, which the researchers suggested might explain why the changes in alienation, trust and communication were greater between children and their mothers.
"Our findings emphasize the importance of parents constantly working on close and supportive relationships with their children, even if the teenager or pre-teen is pulling away," Ebbert said. "The teen might be pulling away as part of the natural process of developing into an individual separate from their parents, but parents remain a primary influence and the primary source of support for the teen."
https://www.sciencedaily.com/releases/2018/10/181025141007.htm
Parent-child therapy helps young children with depression
Early intervention supports kids in processing emotions
June 20, 2018
Science Daily/Washington University School of Medicine
New research demonstrates that an interactive therapy involving parents and their depressed preschoolers can reduce rates of depression and lower the severity of children's symptoms.
Children as young as 3 can be clinically depressed, and often that depression recurs as kids get older and go to school. It also can reappear during adolescence and throughout life.
But new research from Washington University School of Medicine in St. Louis demonstrates that an interactive therapy involving parents and their depressed children can reduce rates of depression and lower the severity of children's symptoms.
"By identifying depression as early as possible and then helping children try to change the way they process their emotions, we believe it may be possible to change the trajectory of depression and perhaps reduce or prevent recurrent bouts of the disorder later in life," said principal investigator Joan L. Luby, MD, director of the university's Early Emotional Development Program.
The findings are published June 20 in The American Journal of Psychiatry.
Luby's team adapted a treatment known as Parent-Child Interaction Therapy (PCIT) that was developed in the 1970s to correct disruptive behavior in preschoolers. The adaptation involved adding a series of sessions focused on emotions.
"We consider depression to be an impairment of the ability to experience and regulate emotions," said Luby, the Samuel and Mae S. Ludwig Professor of Psychiatry.
The 18-week, 20-session therapy program begins with a truncated version of the traditional PCIT program, then focuses more on enhancing emotional development.
"For example, we coach parents how to manage a child's emotional responses to stressful situations," Luby said.
Among the ways of doing so is an activity in which researchers place a package for a child in a room and then make the child wait to open it. The parent wears an earpiece and is coached by a therapist observing through a one-way mirror. The idea is to give children tools to keep their emotions under control, and to train parents to help their children reinforce those tools.
Luby's team studied 229 parent-child pairs. Children in the study were 3 to 7 years old and had been diagnosed with depression. Half received the adapted therapy, called PCIT-ED.
Compared with children who were placed on a wait list before starting the therapy, those who received the intervention right away had lower rates of depression after 18 weeks and less impairment overall. If depression continued after the treatment, it tended to be less severe than that seen in the kids who had not yet received therapy.
Luby said children in the study will be followed to see how long the effects of the therapy last. Her team is analyzing data gathered three months after treatment ended to see whether improvements were maintained or whether any depression symptoms had returned by that point. The researchers hope to follow the children into adolescence to see whether intervention in early childhood provides sustained benefits.
They also are conducting brain-imaging as part of the study. In previous research, Luby and her colleagues found that brain changes linked to depression can alter the brain's structure and function, making the children potentially vulnerable to future problems. Now they want to learn whether this interactive therapy might prevent or reverse those previously identified brain changes.
Interestingly, the researchers also found that symptoms of clinical depression improved in the parents who worked with their children during the study.
"Even without targeting the parent directly, if a parent has been depressed, his or her depression improves," Luby said. "It previously had been demonstrated that if you treat a parent's depression, a child's depression improves, but this is powerful new data suggesting that the reverse also is true."
Luby added that the therapy program doesn't require a psychiatrist and can be delivered by master's degree-level clinicians.
"This is a therapy that could be widely disseminated," she said. "Since it only takes 18 weeks and doesn't require a child psychologist or psychiatrist, we think it would be highly feasible to deliver in community clinics from a practical standpoint and in terms of cost."
https://www.sciencedaily.com/releases/2018/06/180620094812.htm
Sleep Patterns In Children And Teenagers Could Indicate Risk For Depression
August 14, 2009
Science Daily/UT Southwestern Medical Center
Sleep patterns can help predict which adolescents might be at greatest risk for developing depression, a researcher at UT Southwestern Medical Center has found in a five-year study.
Sleep is a biological factor known to be associated with adult depression. Depressed adults experience rapid-eye-movement (REM) sleep earlier in the sleep cycle than people who are not depressed. Until this study, available online and in the July edition of Neuropsychopharmacology, it had been unclear whether this relationship held true in adolescents.
At the start of the study involving 96 adolescents with no evidence of depression or other psychiatric disorders, researchers monitored the sleep cycles of participants for three days and collected saliva and urine samples to record cortisol levels. The teens were then monitored for up to five years.
In addition to the sleep finding, researchers found that at the end of the five-year study period, adolescents with higher cortisol levels were more likely than others to develop depression.
"Depression is not mediated by sleep alone," Dr. Rao said. "If we can identify factors such as sleep and cortisol and their role, we could start the prevention process before the disease leads children and teenagers down a path well behind their peers educationally and socially."
http://www.sciencedaily.com/releases/2009/08/090813083335.htm