Amanda Bunn

Concordance between mother and offspring retrospective reports of childhood adversity

Obtaining accurate accounts of adverse experiences that occur during childhood remains a major issue for researchers examining lifespan models of psychiatric disorder. Documented evidence of abuse and neglect is rarely available as the vast majority of exposed children never come to the attention of the relevant authorities (Ammerman, 1998). Consequently, research into the psychological and physical effects of childhood adversity tends to rely on reports provided by the individual themselves or their close family members. An individual’s own retrospective self-report of adverse childhood experiences can potentially present problems in terms of reliability and validity as the person’s current mental state, repression of the traumatic events, general processes of forgetting, subsequent events and embarrassment may affect both the likelihood of disclosure and the accuracy of the information provided (Briere & Conte, 1993; Lysaker, Beattie, Strasburger & Davis, 2005; Maughan & Rutter, 1997). However, the weight of evidence suggests that personal accounts of early experience are relatively accurate (see Brewin, Andrews & Gotlib, 1993). One strategy that has been employed to validate such accounts is to obtain corroboration from a relative of the individual’s childhood experiences. For instance, siblings who grew up in the same household have been demonstrated to provide both concordant and corroborating retrospective accounts of the family environment and abuse exposure (Bifulco et al., 1997; Brown, Craig, Harris, Handley & Harvey,_2007). However, other types of corroboration are often required, for example where siblings were separated in childhood, or where they are difficult to track down for assessment, or when they are unaware of some aspects of family adversity (e.g., hidden parental discord or secretive sexual abuse to only one child) or for example if they were very young at the time of the experience (Brown et al., 1997; Platt, 1980). Therefore, obtaining alternative corroborative accounts from older family members who were present for the majority of the target person’s childhood would be an advantage in producing valid data. Indeed, mothers are often ideal candidates for corroboration as they are usually present during their offspring’s childhood and can also provide details of other useful aspects of the individual’s early experiences (e.g., obstetric complications, pre- and post-natal development), thus potentially saving the researcher both time and money. However, obtaining two sets of accounts can be costly in large studies and sometimes it is not possible to obtain information directly from the individual themselves. For instance, studies based on longitudinal birth cohorts regularly rely on mothers’ accounts of young children’s exposure to adversity as it can be difficult, and perhaps even unethical to question the children directly (Bifulco, Brown, Lillie & Jarvis, 1997; Kinard, 1995). Mothers’ accounts of the early childhood environment are also utilised in studies of adults with psychiatric disorders (Cannon et al., 1997). However, it is unknown whether mothers are able to provide retrospectively a reasonably reliable and accurate account of their children’s exposure to a range of adverse experiences. Clearly it is quite possible they may under-report or minimise their own abusive and neglectful behaviour towards the child to present a more socially desirable picture of themselves or their partners, due to their style of communicating with others, or because they lack insight into their own past parenting behaviour (Bifulco et al., 1997). This requires investigation to inform the design of future studies in this area. Therefore, as part of a larger investigation of intergenerational transmission of risk for depression, this study aimed to explore whether maternal retrospective reports of childhood adversity were concordant with those provided directly by their offspring. Examination of this issue is important to investigate whether maternal reports could be used (i) instead of self-reported adversity (e.g., where the individual is mentally unfit, unavailable or too young to be interviewed); and (ii) to corroborate individual’s reports of adversity and provide additional information. Concordance of mother-offspring reports has previously been explored in relation to physical abuse, revealing moderate agreement (Tajima, Herrenkohi, Huang & Whitney, 2004), but not other forms of childhood adversity; hence this analysis is intended to further advance the field by exploring concordance for a wider range of adverse childhood experiences. Moreover, this study employed a standardised comprehensive interview measure of childhood adversity that utilises concrete examples and interviewer-based scoring procedures (Bifulco, Brown & Harris, 1994). This should provide a more robust test of concordance than brief self-report questionnaires which are often prone to bias as they rely on respondents’ subjective perceptions of their past experiences (Brown & Rutter, 1966).

Measuring Life Events and Their Association With Clinical Disorder: A Protocol for Development of an Online Approach

Background Severe life events are acknowledged as important etiological factors in the development of clinical disorders, including major depression. Interview methods capable of assessing context and meaning of events have demonstrated superior validity compared with checklist questionnaire methods and arguments for interview approaches have resurfaced because choosing the appropriate assessment tool provides clarity of information about gene-environment interactions in depression. Such approaches also have greater potential for understanding and treating clinical cases or for use in interventions. Objective (1) To argue that life events need sophisticated measurement not satisfactorily captured in checklist approaches. (2) To review life-events measures and key findings related to disorder, exemplifying depression. (3) To describe an ongoing study with a new online measure and to assess its psychometric properties and the association of life events in relation to disorder and educational outcomes. Methods The Computerised Life Events Assessment Record (CLEAR) is under development as a tool for online assessment of adult life events. Based on the Life Events and Difficulties Schedule interview, CLEAR seeks to assess life events to self and close others, link these to other events and difficulties, and utilize calendar-based timing, to improve upon checklist approaches. Results The CLEAR study is in the preliminary stages and its results are expected to be made available by the end of 2015. Conclusions There is currently no sophisticated technological application of social risk factor assessment, such as life events and difficulties. CLEAR is designed to gather reliable and valid life-event data while combating the limitations of interviews (eg, time consuming and costly) and life-event checklists (eg, inability to accurately measure severity and independence of life events). The advantages of using such innovative methodology for research, clinical practice, and interventions are discussed.

Solutions on Stress (SOS): programmes, packages and products for helping teenagers

Purpose – Recent research and media attention has highlighted soaring levels of stress among young people. As part of a programme of research based across a number of universities in London and the South‐West of the UK (called WestFocus) a team of psychologists, social scientists and complementary practitioners have started to investigate this issue with the aim of introducing stress management interventions into the school environment. This paper aims to examine their findings.Design/methodology/approach – This paper summarises the set up, progress, results and implications of a six‐week stress management intervention piloted and evaluated with teenagers at school. The intervention aimed to provide a holistic approach to stress management teaching students both psychological techniques (such as cognitive behavioural therapy) and complementary therapy approaches (such as Indian head massage and aromatherapy).Findings – Structured assessments and qualitative feedback taken at the beginning and end of the p...

Setting up a youth violence prevention project in a London hospital emergency department

Purpose – Youth violence victimisation impacts on health, mental health and future risk trajectories. A London hospital emergency department (ED) outreach youth service provides a unique intervention opportunity to support adolescents involved in violence. The purpose of this paper is to describe the set‐up of the service.Design/methodology/approach – Young people (YP) targeted were aged 12‐18, from two London boroughs and attended ED with injuries from a violent incident. They were referred to Oasis youth workers for a mentoring/youth work intervention. Lifestyle and symptom scales were used to assess risk profile. Hospital staff questionnaires determined service awareness in the first six months, and interviews/focus group identified potential barriers to service uptake.Findings – By 12 months, the service was operating smoothly. Of the first 505 YP attending ED, a third were referred, a third ineligible and a third non‐contactable/refused. Detailed analysis of the first 30 attending found most were mal...

Improving mental health and lifestyle outcomes in a hospital emergency department based youth violence intervention

Purpose Current government policy aims to tackle youth anti-social behaviour and its psychological and social impacts. Given an increased likelihood that young victims of crime are also likely to engage in aggressive or deviant behaviour and to have psychological and social difficulties, interventions are needed which access vulnerable youth with adverse lifestyles to increase well-being and reduce offending. The current project utilised a hospital emergency department (ED) as an appropriate location to identify and interact with youth victims of violent crime; to support key lifestyle risk and mental health difficulties; and build resilience. The purpose of this paper is to use a youth work paradigm, to target vulnerable youth in a health setting at a crisis point where intervention may have a higher chance of uptake. Design/methodology/approach The study applied a quasi-experimental, longitudinal design. Using the strengths and difficulties questionnaire and the “What Do You Think” component of the ASSET risk assessment, data were collected from 120 youth aged 12-20, at baseline with 66 youth who successfully completed the programme with assessments at baseline and follow-up, at an average of 14 weeks. Findings There was significant reduction in both psychological problems and lifestyle risk at follow-up. Research limitations/implications These findings support the government initiative to intervene in youth violence in healthcare settings. Challenges revolve around increasing participation and greater formalisation of the intervention. Originality/value The youth work led violence intervention in the ED is successfully tackling psychological problems and lifestyle risk following injury.