David G. Rosenthal

Paternal Depressive Symptoms and Child Behavioral or Emotional Problems in the United States

BACKGROUND: The negative effects of maternal mental health problems on child health are well documented. In contrast, there is a profound paucity of information about paternal mental healths association with child health. OBJECTIVE: To investigate the association of paternal mental health problems and depressive symptoms and childrens emotional or behavioral problems. METHODS: We analyzed Medical Expenditure Panel Survey data, which included a representative sample of US children (N = 21 993) aged 5 to 17 years and their mothers and fathers. The main outcome measure was child emotional or behavioral problems assessed by using the Columbia Impairment Scale. RESULTS: Paternal depressive symptoms, as assessed using the Patient Health Questionnaire–2, and mental health problems, more generally, assessed by using the Short-Form 12 Scale, were independently associated with increased rates of child emotional or behavioral problems even after controlling for numerous potential confounders including maternal depressive symptoms and other mental health problems. The adjusted odds ratio (aOR) for emotional or behavioral problems among children of fathers with depressive symptoms was 1.72 (95% confidence interval [CI]: 1.33–2.23) and the aOR associated with abnormal paternal scores on the mental component scale of the Short-Form 12 was 1.33 (95% CI: 1.10–1.62) for those within 1 SD below average and 1.48 (95% CI: 1.20–1.84) for those >1 SD below average. CONCLUSIONS: To the best of our knowledge, this is the first study to use a representative US sample to demonstrate that living with fathers with depressive symptoms and other mental health problems is independently associated with increased rates of emotional or behavioral problems of children.

Physical, behavioral, and cognitive effects of prenatal tobacco and postnatal secondhand smoke exposure.

The purpose of this review is to examine the rapidly expanding literature regarding the effects of prenatal tobacco and postnatal secondhand smoke (SHS) exposure on child health and development. Mechanisms of SHS exposure are reviewed, including critical periods during which exposure to tobacco products appears to be particularly harmful to the developing fetus and child. The biological, biochemical, and neurologic effects of the small fraction of identified components of SHS are described. Research describing these adverse effects of both in utero and childhood exposure is reviewed, including findings from both animal models and humans. The following adverse physical outcomes are discussed: sudden infant death syndrome, low birth weight, decreased head circumference, respiratory infections, otitis media, asthma, childhood cancer, hearing loss, dental caries, and the metabolic syndrome. In addition, the association between the following adverse cognitive and behavioral outcomes and such exposures is described: conduct disorder, attention-deficit/hyperactivity disorder, poor academic achievement, and cognitive impairment. The evidence supporting the adverse effects of SHS exposure is extensive yet rapidly expanding due to improving technology and increased awareness of this profound public health problem. The growing use of alternative tobacco products, such as hookahs (a.k.a. waterpipes), and the scant literature on possible effects from prenatal and secondhand smoke exposure from these products are also discussed. A review of the current knowledge of this important subject has implications for future research as well as public policy and clinical practice.

Housing and Child Health

The connection between housing and health is well established. Physical, chemical, and biological aspects of the childs home, such as cleanliness, moisture, pests, noise, accessibility, injury risks, and other forms of housing environmental quality, all have the potential to influence multiple aspects of the health and development of children. Basic sanitation, reduced household crowding, other improvements in housing and expanded, and improved housing regulations have led to advances in childrens health. For example, lead poisoning prevention policies have profoundly reduced childhood lead exposure in the United States. This and many other successes highlight the health benefits for families, particularly children, by targeting interventions that reduce or eliminate harmful exposures in the home. Additionally, parental mental health problems, food insecurity, domestic violence, and the presence of guns in childrens homes all are largely experienced by children in their homes, which are not as yet considered part of the Healthy Homes agenda. There is a large movement and now a regulatory structure being put in place for healthy housing, which is becoming closely wedded with environmental health, public health, and the practice of pediatrics. The importance of homes in childrens lives, history of healthy homes, asthma, and exposures to lead, carbon monoxide, secondhand/thirdhand smoke, radon, allergy triggers is discussed, as well as how changes in ambient temperature, increased humidity, poor ventilation, water quality, infectious diseases, housing structure, guns, electronic media, family structure, and domestic violence all affect childrens health.

Three Adoption Studies of Heredity in the Schizophrenic Disorders

Research in the genetics of human behavioral disorders* confronts a complex of problems from the moment of its inception. First of all, how does one go about doing this genetic research when one obviously has no leverage on the implicated genes per se? One cannot engage in the traditional forms of experimental breeding, so that one has no control at all over the breeding of his sample population; and that is as it should be. No matter which behavioral disorder one studies, it is apparent from the outsetand always has beenthat its distribution in families follows no Mendelian pattern. What are we talking about, then, when we talk about the genetics of such disorders? The truth is that much of psychiatric genetics has been devoted to explaining awaynot explainingthe non-Mendelian distributions found. Initially, there was a predilection for positing such factors as reduced penetrance and varying manifestation in homozygotes and heterozygotes, depending on whether ones own preference was for a theory of dominance or recessiveness. Such theories? are based, in turn, on empirical statistical distributions that are fallibly determined and that vary appreciably from sample to sample and from study to study. In more recent times, the tendency has been to turn away from such theorizing and either to postulate a simple, additive, polygenic system to explain away the non-Mendelian distributions or to speculate that such disorders are genetically heterogeneous, i.e., that there are a number of different major single-genes at different loci that can lead to the same type of disorder. It is a simple matter for any investigator to choose to believe one kind of theory rather than another, and the fact is that the variety and abundance of genetic theories that have been proposed in the past fifty years constitute an eloquent testimonial to the fact that we have been offered articles of faith and fancy rather than hard substance on which to develop a genetic theory of human behavioral disorders.

Characteristics of Fathers with Depressive Symptoms

Extensive research shows maternal depression to be associated with poorer child outcomes, and characteristics of these mothers have been described. Recent research describes associations of paternal depressive symptoms and child behavioral and emotional outcomes, but characteristics of these fathers have not been investigated. This study describes characteristics of fathers with depressive symptoms in the USA. Utilizing data from 7,247 fathers and mothers living in households with children aged 5–17xa0years who participated in the Medical Expenditure Panel Survey 2004–2006, the Patient Health Questionnaire-2 was used to assess parental depressive symptoms, the Short Form-12 was used to examine paternal and maternal physical health, the Columbia Impairment Scale was used to measure child behavioral or emotional problems, and the Children with Special Health Care Needs Screener was used to identify children with special health care needs. In multivariate analyses, poverty (AOR 1.52; 95% CI 1.05–2.22), maternal depressive symptoms (AOR 5.77; 95% CI 4.18–7.95), living with a child with special health care needs (AOR 1.42, 95% CI 1.04–1.94), poor paternal physical health (AOR 3.31; 95% CI 2.50–4.38) and paternal unemployment (AOR 6.49; 95% CI 4.12–10.22) were independently associated with increased rates of paternal depressive symptoms. These are the first data that demonstrate that poverty, paternal physical health problems, having a child with special health care needs, maternal depressive symptoms, and paternal unemployment are independently associated with paternal depressive symptoms, with paternal unemployment associated with the highest rates of such problems.

Nicotine Addiction: Mechanisms and Consequences

David G. Rosenthal, B.A., is a medical student at the New York University School of Medicine. Michael Weitzman, M.D., is a professor of both pediatrics and psychiatry at the New York University School of Medicine. Neal L. Benowitz, M.D., is a professor of biopharmacological sciences at the University of California San Francisco Departments of Medicine, Bioengineering, and Therapeutic Sciences and Director of Drug Detoxification at the San Francisco General Hospital Medical Center Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service. None of the authors have any financial conflicts to disclose. International Journal of Mental Health vol. 40, no. 1, Spring 2011, pp. 22–38.

Examining the Effects of Intrauterine and Postnatal Exposure to Tobacco Smoke on Childhood Cognitive and Behavioral Development

David G. Rosenthal, B.A., is a medical student at the New York University School of Medicine. Michael Weitzman, M.D., is a professor of both pediatrics and psychiatry at the New York University School of Medicine. International Journal of Mental Health vol. 40, no. 1, Spring 2011, pp. 39–64.

Hemophagocytic Lymphohistiocytosis Secondary to Human Immunodeficiency Virus-Associated Histoplasmosis.

Hemophagocytic lymphohistiocytosis (HLH) in immunocompromised hosts is a fulminant syndrome of immune activation with high rates of mortality that may be triggered by infections or immunodeficiency. Rapid diagnosis and treatment of the underlying disorder is necessary to prevent progression to multiorgan failure and death. We report a case of HLH in a patient with human immunodeficiency virus, disseminated histoplasmosis, Mycobacterium avium complex, and Escherichia coli bacteremia. We discuss management of acutely ill patients with HLH and treatment of the underlying infection versus initiation of HLH-specific chemotherapy.

Dual-standard reference values of left ventricular volumetric parameters by multidetector CT angiography

BACKGROUNDnThe papillary and trabecular muscles constitute a significant percentage of left ventricular mass and volume. The influence of the papillary and trabecular muscles on left ventricular parameters has not been described with multidetector CT angiography.nnnOBJECTIVEnThe aims of this study are (1) to derive reference values for left ventricular volumetric parameters both including and excluding the papillary and trabecular muscles and (2) to establish the optimal segmentation method for measuring these values.nnnMETHODSnA total of 179 subjects (mean age, 55.4 ± 9 years; 102 women) without heart disease and at low risk of cardiovascular disease who underwent CT angiography were selected. Left ventricular volumes, myocardial volume, and ejection fraction were measured with epicardial and 2 endocardial trace methods, including and excluding trace for the papillary and trabecular muscles. Values of all parameters obtained by both endocardial trace methods were compared.nnnRESULTSnSignificant difference between both trace groups for all parameters on both sexes was found (P < .001). Significant differences in precision error of remeasurement were found in the including trace (3.6%) compared with the excluding trace (4.7%; P < .05) and in the epicardial trace (2.2%) compared with both endocardial traces (P < .001).nnnCONCLUSIONnThe left ventricular parameters measured by CT angiography were influenced significantly by the trace method by including or excluding the papillary and trabecular muscles. The dual-standard reference values of left ventricular parameters were established, and the optimal segmentation methods were definite in considering the heart size and image quality studied with retrospective and prospective CT angiography.

Characteristics of Mothers with Depressive Symptoms Outside the Postpartum Period

Numerous studies have investigated the deleterious effects of maternal depression on child outcomes. Knowledge of characteristics of these mothers is incomplete, as most studies utilize small samples or limit investigation to the postpartum period. Utilizing data from a nationally representative sample of 7,211 fathers and mothers living in households with children aged 5–17xa0years who participated in the Medical Expenditure Panel Survey (MEPS) 2004–2006, the Patient Health Questionnaire-2 (PHQ-2) was used to assess parental depressive symptoms, the Short Form-12 (SF-12) was used to examine paternal and maternal physical health, and the Columbia Impairment Scale was used to measure child behavioral or emotional problems. In multivariate analyses, maternal unemployment (AOR 1.76, 95xa0% CI 1.31–2.35); living with smokers (AOR 1.82, 95xa0% CI 1.12–2.94); poor maternal physical health (AOR 2.31; 95xa0% CI 1.81–2.94); living with children with behavioral or emotional problems (AOR 2.95, 95xa0% CI 2.30–3.96); and paternal depressive symptoms (AOR 5.11, 95xa0% CI 1.97–13.25) each were independently associated with increased rates of maternal depressive symptoms. This paper is the first we are aware of to use a nationally representative sample to investigate characteristics associated with maternal depressive symptoms and found that maternal unemployment, living with smokers, poor maternal physical health, having children with behavioral or emotional problems, and paternal depressive symptoms are each independently associated with maternal depressive symptoms. In these data, paternal depressive symptoms are associated with the greatest risk of mothers exhibiting depressive symptoms, a finding that we believe has never before been shown.