Kai von Klitzing

Depressive symptoms and psychosocial stress across the transition to parenthood: Associations with parental psychopathology and child difficulty

The transition to parenthood is often accompanied by depression and stress. Several studies have established risk factors for postpartum depression, e.g., antenatal depression. However, only a few studies have involved fathers. Moreover, most studies focus on the prevalence of depression instead of intraindividual changes over time. Our study investigated differential effects of parental psychopathology and child difficulty on the course of depressive symptoms and feelings of stress for first-time mothers and fathers. Seventy-four mothers and 58 fathers completed questionnaires on depressive symptoms (EPDS) and feelings of stress during pregnancy, and at 1, 3, 12, and 18 months postpartum. Parents rated childrens difficulty-fussiness at 3, 12, and 18 months postpartum (ICQ). Parental psychopathology was established during pregnancy using self-reports (SCL-90-R) and anamnestic data. In mentally healthy mothers and fathers depressive symptoms decreased from pregnancy to 18 months postpartum, whereas parents with psychopathology in pregnancy showed a tendency to prolonged depressive phases. In parents with psychopathology, feelings of stress peaked at 12 months postpartum. Child difficulty was associated with elevated levels of psychosocial stress, but only for some participants. Parental psychopathological symptoms during pregnancy should thus be considered as a risk factor for elevated and prolonged depression and elevated psychosocial stress in mothers and fathers across the transition to parenthood.

Gender-Specific Characteristics of 5-Year-Olds' Play Narratives and Associations With Behavior Ratings

OBJECTIVES To examine the content and structure of childrens play narratives in a large sample of 5-year-olds in order to replicate previous findings, explore the role of gender differences, and identify a pattern that can provide useful information about childrens behavior. METHOD The MacArthur Story Stem Battery and coding system was used to code content themes and coherence from play narratives of 652 twins in a nonclinical sample. To measure behavior problems, parents completed the Child Behavior Checklist when their children were aged 5 and 7 years; teachers completed the Teachers Report Form when the children were aged 7 years. RESULTS Girls told more coherent narratives with less aggression than boys. Aggressive themes were found to correlate with behavior problems as in previous studies. Upon further examination, this correlation held for girls but not boys. Children who told repeated aggressive/incoherent narratives had more behavior problems than those who did not show this narrative pattern. CONCLUSIONS The Story Stem methodology is useful for gaining access into the young childs inner world. The gender of the child, content of the story, and coherence of the story all provide useful information in identifying narratives that may indicate more risk for behavior problems.

Sleep actigraphy pattern and behavioral/emotional difficulties in kindergarten children : association with hypothalamic-pituitary-adrenocortical (HPA) activity

BACKGROUND Various studies of adult endocrinology and sleep show close connections between poor sleep quality, deterioration of the HPA axis and negative psychological characteristics. However, the extent to which these associations may have already emerged and developed in childhood remains unclear. METHODS A total of 82 preschoolers (age 4.91+/-0.48) underwent activity monitoring for seven consecutive days and nights, wearing a digital movement-measuring instrument. Additionally, on the first and on the last morning of sleep registration, the activity of the HPA axis was assessed via the amount of cortisol in the saliva. Psychological and behavioral assessments were also made. RESULTS Three sub-groups of good (22%), normal (58.5%) and poor (19.5%) sleepers were distinguished. Poor sleep patterns were associated with higher HPA activity and with behavioral/emotional difficulties. CONCLUSIONS The interplay between unfavorable sleep patterns, deterioration of the HPA axis and behavioral/emotional difficulties is already apparent in pre-school children.

Pathways of behavioural and emotional symptoms in kindergarten children: What is the role of pro-social behaviour?

The study investigated the predictive value of pro-social behaviour for developmental pathways of behavioural and emotional problems at kindergarten age. One hundred and sixty children participated in the study at the ages of 5 and 6. Teachers and parents completed the Strengths and Difficulties Questionnaire; children completed the Berkeley Puppet Interview at both assessment points. Single-informant data were aggregated to enhance the reliability and validity of data. Gender and parental educational status were controlled.Symptoms (conduct problems, hyperactivity and emotional symptoms) and pro-social behaviour were moderately stable over time. Compared to girls, boys showed higher levels and increases of conduct problems and hyperactivity and lower levels of pro-social behaviour. Lower parental educational level was associated with higher levels and increases in hyperactivity. Although pro-social behaviour was cross-sectionally associated with behavioural and emotional symptoms, pro-social behaviour did not predict changes in conduct problems or hyperactivity over time. However, children with above average emotional symptoms and above average pro-social behaviour at Age_5 showed the highest level of emotional symptoms at Age_6. The results indicate that low levels of pro-social behaviour are associated with children’s externalising behaviour problems, but that for children with high levels of emotional symptoms, higher levels of pro-social behaviour should also be considered as a risk factor.In sum, our results suggest mainly homotypic pathways of internalising and externalising symptoms across kindergarten age, but indicate that the assessment of pro-social behaviour yields additional information regarding the developmental pathways of emotional symptoms.

Psychological distress in cancer patients with underage children: gender-specific differences.

Findings on gender differences in the psychological distress of cancer patients have been inconsistent. The objectives of the current study were to examine whether being a parent differentially modulates anxiety and depression in men and women and to compare whether psychological distress differs in male and female patients with and without children.

In pre-school children, sleep objectively assessed via actigraphy remains stable over 12 months and is related to psychological functioning, but not to cortisol secretion

STUDY OBJECTIVES Cross-sectional studies provide evidence that in pre-schoolers poor sleep is by this age already associated with both poor psychological functioning and an increased cortisol secretion. However, long-term studies on the stability of sleep in pre-schoolers are scarce. The aim of the present study was therefore to investigate objectively assessed sleep in pre-schoolers longitudinally, and to predict sleep, psychological functioning and cortisol secretion prospectively as a function of sleep 12 months earlier. METHOD A total of 58 pre-schoolers (mean age: 5.43 years; 47% females) were re-assessed 12 months later (mean age: 6.4 years). Sleep-EEG recordings were performed, saliva cortisol was analysed, and parents and experts rated childrens psychological functioning. RESULTS Longitudinally, poor objective sleep at age 5.4 years was associated with poor objective sleep and psychological difficulties but not cortisol secretion 12 months later. At age 6.4 years, poor sleep was concurrently associated with greater psychological difficulties and increased cortisol secretion. CONCLUSION In pre-schoolers, poor sleep objectively assessed at the age of 5.4 years was associated with poor sleep and psychological difficulties one year later. Data indicate that in pre-schoolers, sleep remains stable over a 12-months-period. Pre-schoolers with poor sleep appear to be at risk for developing further psychological difficulties.

Story stem narratives of clinical and normal kindergarten children: Are content and performance associated with children's social competence?

Abstract This study examined whether content and performance in story stem narratives were associated with childrens social competence, and whether childrens symptom levels moderated these associations. Five-year-old children from a clinically enriched Swiss sample completed eight stories (N = 187). Teachers rated childrens social competence. Parents and teachers rated behavioral/emotional symptoms that were used to categorize children into clinical (n = 80), borderline (n = 31), and normal (n = 74). Controlling for gender and verbal competence, no differences were found in story responses between normal and clinical children. However, pro-social/moral and disciplinary themes, and coherence and quality of narration were significantly associated with childrens social competence. The associations between narratives and social competence were prominent in the clinical children, suggesting that narrative assessments may help to identify resources on which psychotherapeutic approaches can build.

Pre-schoolers suffering from psychiatric disorders show increased cortisol secretion and poor sleep compared to healthy controls

BACKGROUND Various studies of child cortisol secretion and sleep show a close association between poor sleep, deterioration of the HPA axis and unfavorable psychological functioning. However, there is little evidence as to whether these associations are clearly present in pre-school children suffering from psychiatric disorders. METHOD A total of 30 pre-schoolers suffering from psychiatric disorders (anxiety, adjustment disorders, emotional and attachment disorder; hyperactivity or oppositional disorder) and 35 healthy controls took part in the study. Saliva cortisol secretion was assessed both at baseline and under challenge conditions. Sleep was assessed via activity monitoring for seven consecutive days and nights, using a digital movement-measuring instrument. Parents and teachers completed questionnaires assessing childrens cognitive, emotional and social functioning. The Berkeley Puppet Interview provided child-based reports of cognitive-emotional processes. RESULTS Compared to healthy controls, children suffering from psychiatric disorders had much higher cortisol secretion both at baseline and under challenge conditions. Sleep was also more disturbed, and parents and teachers rated children suffering from psychiatric disorders as cognitively, emotionally and behaviorally more impaired, relative to healthy controls. Children with psychiatric disorders reported being more bullied and victimized. CONCLUSIONS In five-year old children the presence of psychiatric disorders is reflected not only at psychological, social and behavioral, but also at neuroendocrine and sleep-related levels. It is likely that these children remain at increased risk for suffering from psychiatric difficulties later in life.

Bright light treatment as mono-therapy of non-seasonal depression for 28 adolescents

Background. Bright light therapy, an effective therapeutic option for depressive adults, could provide safe, economic, and effective rapid recovery also in adolescents. Methods. Twenty-eight volunteers, between 14 and 17 years old and suffering from mild depressive disorder according to DSM-IV criteria, completed the study. This was a randomized cross-over trial, i.e. that 14 patients received first placebo (50 lux) for 1 h a day for 1 week and then bright light therapy (2,500 Lux) for 1 week. Fourteen patients received first bright light therapy and then placebo. For assessment of depressive symptoms, Becks depression inventory scales were administered 1 week before and 1 day before placebo treatment, on the day between placebo and verum treatment, on the day after verum treatment and 1 week after verum treatment. Saliva melatonin and cortisol samples were collected at 08:00 and 20:00 h, 1 week before and 1 day before placebo treatment, on the day between placebo and verum treatment, on the day after verum treatment and 1 week after verum treatment and assayed for melatonin and cortisol to observe any change in circadian timing. Results. BDI scores improved significantly. The assays of saliva showed significant differences between treatment and placebo. No significant adverse reactions were observed. Conclusion. Antidepressant response to bright light treatment in this age group was statistically superior to placebo.

Depressive comorbidity in preschool anxiety disorder

Background The threshold for clinical relevance of preschool anxiety has recently come under increasing scrutiny in view of large variations in prevalence estimates. We studied the impact of presence/absence of additional depressive comorbidity (symptoms and/or diagnosis) on preschoolers with anxiety disorders in relation to clinical phenomenology, family, and peer problems compared to healthy controls. Method A population of 1738 preschoolers were screened and oversampled for internalizing symptoms from community sites, yielding a sample of 236 children. Results Using a multi-informant approach (mother, father, teacher, child), we found evidence that children with anxiety disorders and depressive comorbidity display a greater internalizing symptom-load, more peer problems and live in families with more psychosocial impairment (poor family functioning, family adversity, maternal mental health problems). The pure anxiety group was merely dissociable from controls with regard to internalizing symptoms and family adversity. Conclusion The presence of depressive comorbidity in anxiety disorders may mark the transition to a more detrimental and impairing disorder at preschool age.