Pamela D. Pilkington

Parental factors associated with depression and anxiety in young people: A systematic review and meta-analysis

BACKGROUND There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in young people. However, there is hitherto no systematic review of this complex literature with a focus on the 12-18 years age range, when the first onset for these disorders peaks. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required. METHODS Employing the PRISMA method, we conducted a systematic review of parental factors associated with depression and anxiety disorders in young people which parents can potentially modify. RESULTS We identified 181 articles altogether, with 140 examining depression, 17 examining anxiety problems, and 24 examining both outcomes. Stouffers method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations between each parental factor and outcome. LIMITATIONS Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, not systematically reviewing moderators and mediators, the lack of generalizability across cultures and to younger or adult children, and the inability to conduct a meta-analysis on all included studies. CONCLUSIONS Parental factors with a sound evidence base indicating increased risk for both depression and anxiety include less warmth, more inter-parental conflict, over-involvement, and aversiveness; and for depression additionally, they include less autonomy granting and monitoring.

Risk and protective factors for depression that adolescents can modify: A systematic review and meta-analysis of longitudinal studies

BACKGROUND Adolescence is a peak time for the onset of depression, but little is known about what adolescents can do to reduce their own level of risk. To fill this gap, a review was carried out to identify risk and protective factors for depression during adolescence that are modifiable by the young person. METHODS Employing the PRISMA method, we conducted a systematic review and meta-analysis of longitudinal studies to identify risk and protective factors during the adolescent period (aged 12-18 years) that are potentially modifiable by the young person without professional intervention or assistance. Stouffer׳s method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations. RESULTS We identified 113 publications which met the inclusion criteria. Putative risk factors implicated in the development of depression for which there is a sound evidence base, and which are potentially modifiable during adolescence without professional intervention, are: substance use (alcohol, tobacco, cannabis, other illicit drugs, and polydrug use); dieting; negative coping strategies; and weight. Modifiable protective factors with a sound evidence base are healthy diet and sleep. LIMITATIONS Limitations include not systematically reviewing moderators and mediators, the lack of generalisability across cultures or to younger children or young adults, and the inability to conduct a meta-analysis on all included studies. CONCLUSIONS Findings from this review suggest that future health education campaigns or self-help prevention interventions targeting adolescent depression should aim to reduce substance use (alcohol, tobacco, cannabis, other illicit drugs, and polydrug use); dieting; and negative coping strategies; and promote healthy weight; diet; and sleep patterns.

Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis.

BACKGROUND Perinatal distress is a significant public health problem that adversely impacts the individual and their family. The primary objective of this systematic review and meta-analysis was to identify factors that partners can modify to protect each other from developing perinatal depression and anxiety. METHOD In accordance with the PRISMA statement, we reviewed the risk and protective factors associated with perinatal depression and anxiety symptoms that partners can potentially modify without professional assistance (PROSPERO reference CRD42014007524). Participants were new or expectant parents aged 16 years or older. The partner factors were sub-grouped into themes (e.g., instrumental support) based on a content analysis of the scale items and measure descriptions. A series of meta-analyses were conducted to estimate the pooled effect sizes of associations. RESULTS We included 120 publications, reporting 245 associations with depression and 44 with anxiety. Partner factors with sound evidence that they protect against both perinatal depression and anxiety are: emotional closeness and global support. Partner factors with a sound evidence base for depression only are communication, conflict, emotional and instrumental support, and relationship satisfaction. LIMITATIONS This review is limited by the lack of generalizability to single parents and the inability to systematically review moderators and mediators, or control for baseline symptoms. CONCLUSION The findings suggest that future prevention programs targeting perinatal depression and anxiety should aim to enhance relationship satisfaction, communication, and emotional closeness, facilitate instrumental and emotional support, and minimize conflict between partners.

Use of Twitter to monitor attitudes toward depression and schizophrenia: an exploratory study

Introduction. The paper reports on an exploratory study of the usefulness of Twitter for unobtrusive assessment of stigmatizing attitudes in the community. Materials and Methods. Tweets with the hashtags #depression or #schizophrenia posted on Twitter during a 7-day period were collected. Tweets were categorised based on their content and user information and also on the extent to which they indicated a stigmatising attitude towards depression or schizophrenia (stigmatising, personal experience of stigma, supportive, neutral, or anti-stigma). Tweets that indicated stigmatising attitudes or personal experiences of stigma were further grouped into the following subthemes: social distance, dangerousness, snap out of it, personal weakness, inaccurate beliefs, mocking or trivializing, and self-stigma. Results and Discussion. Tweets on depression mostly related to resources for consumers (34%), or advertised services or products for individuals with depression (20%). The majority of schizophrenia tweets aimed to increase awareness of schizophrenia (29%) or reported on research findings (22%). Tweets on depression were largely supportive (65%) or neutral (27%). A number of tweets were specifically anti-stigma (7%). Less than 1% of tweets reflected stigmatising attitudes (0.7%) or personal experience of stigma (0.1%). More than one third of the tweets which reflected stigmatising attitudes were mocking or trivialising towards individuals with depression (37%). The attitude that individuals with depression should “snap out of it” was evident in 30% of the stigmatising tweets. The majority of tweets relating to schizophrenia were categorised as supportive (42%) or neutral (43%). Almost 10% of tweets were explicitly anti-stigma. The percentage of tweets showing stigmatising attitudes was 5%, while less than 1% of tweets described personal experiences of stigmatising attitudes towards individuals with schizophrenia. Of the tweets that indicated stigmatising attitudes, most reflected inaccurate beliefs about schizophrenia being multiple personality disorder (52%) or mocked or trivialised individuals with schizophrenia (33%). Conclusions. The study supports the use of analysis of Twitter content to unobtrusively measure attitudes towards mental illness, both supportive and stigmatising. The results of the study may be useful in assisting mental health promotion and advocacy organisations to provide information about resources and support, raise awareness and counter common stigmatising attitudes.

Parenting strategies for reducing the risk of childhood depression and anxiety disorders: A Delphi consensus study

BACKGROUND Substantial evidence that some modifiable parental factors are associated with childhood depression and anxiety indicates that parents can play a crucial role in the prevention of these disorders in their children. However, more effective translation of research evidence is required. METHODS This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing depression or anxiety disorders in children aged 5-11 years. A literature search identified 289 recommendations for parents. These were presented to a panel of 44 international experts over three survey rounds, who rated their preventive importance. RESULTS 171 strategies were endorsed as important or essential for preventing childhood depression or anxiety disorders by ≥90% of the panel. These were written into a parenting guidelines document, with 11 subheadings: Establish and maintain a good relationship with your child, Be involved and support increasing autonomy, Encourage supportive relationships, Establish family rules and consequences, Encourage good health habits, Minimise conflict in the home, Help your child to manage emotions, Help your child to set goals and solve problems, Support your child when something is bothering them, Help your child to manage anxiety, and Encourage professional help seeking when needed. LIMITATIONS This study relied on experts from Western countries; hence the strategies identified may not be relevant for all ethnic groups. CONCLUSIONS This study produced new parenting guidelines that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their children from depression and anxiety disorders.

Partners to Parents: development of an online intervention for enhancing partner support and preventing perinatal depression and anxiety

ABSTRACT Objective: Couples-based interventions to prevent perinatal depression and anxiety are needed to optimise parental well-being and infant mental health. Current interventions are limited by their focus on maternal mental health, postnatal outcomes, and a reliance on professionals for their delivery. This article describes the development of Partners to Parents (http://www.partnerstoparents.org), an online intervention for preventing perinatal depression and anxiety focused on enhancing partner support. Method: Individual usability testing sessions were conducted with 12 parents in the perinatal period (7 women and 5 men) to assess the quality of the website. A deductive coding scheme was applied using NVivo 10 to identify comments relating to system and content quality of the website, as well as positive and negative comments. Results: The results of the usability testing yielded more than 250 comments on system and content quality, potential barriers to accessing the website, and suggestions for improvement. This feedback was used to update the design of the intervention. Discussion: The usability testing sessions suggested that the majority of the mothers and fathers involved perceived the website to be a useful new resource. Consultation with potential users of the website enabled refinement of the content and design of the Partners to Parents website.

Maternal crying and postpartum distress: the moderating role of partner support

Abstract Objective: This study aimed to investigate maternal crying as a signal of distress and request for support in the postpartum period. Background: The development of postpartum mental illness may be prevented if spouses can recognise their partner’s distress and respond supportively. Methods: A cross-sectional survey of primiparous mothers (N =137) was conducted to determine whether partner support moderates the association between maternal crying frequency and postpartum depression, anxiety and stress symptom severity. Results: Regression analyses indicated that, as hypothesised, women who reported more frequent crying and low partner support reported higher levels of depression. Conversely, women who reported frequent crying in the context of high partner support reported lower levels of depression symptoms. The expected moderation effect was not present in the analyses examining postpartum anxiety and stress symptoms as outcome variables. Conclusion: In keeping with the well-established finding that partner support is a protective factor for postpartum mood problems, the results indicated that the presence of a supportive partner moderates the association between crying and depression.

The prevalence and correlates of self-harm ideation trajectories in Australian women from pregnancy to 4-years postpartum

OBJECTIVES Women in the perinatal period are at increased risk of experiencing self-harm ideation. The current study longitudinally examines the prevalence, trajectories, and correlates of self-harm ideation in a population-based sample of Australian women from pregnancy through to the early years of parenting. METHODS Drawing on data from 1507 women participating in a prospective pregnancy cohort study, data were collected during pregnancy, at 3-, 6-, 12-, and 18-months postpartum, and 4-years postpartum. Longitudinal Latent Class Analysis was conducted to identify groups of women based on their responses to thoughts of self-harm at each time-point. Logistic regression analysis was used to identify factors associated with group membership. RESULTS Approximately 4-5% of women reported experiencing self-harm ideation at each time-point from pregnancy to 4-years postpartum. Cross-sectional analyses revealed that self-harm ideation was most frequently endorsed in the first 12-months postpartum (4.6%), and approximately 15% of women reported self-harm ideation at least once during the study period. Longitudinally, approximately 7% of women had an enduring pattern of self-harm ideation from pregnancy to 4-years postpartum. Women who had experienced a range of preconception and current social health issues and disadvantage were at increased risk of self-harm ideation over time. LIMITATIONS Limitations included use of brief measures, along with an underrepresentation of participants with particular socio-demographic characteristics. CONCLUSIONS A proportion of women are at increased risk of experiencing self-harm ideation during the perinatal period and in the early years of parenting, underscoring the need for early identification during pregnancy and early postpartum to facilitate timely early intervention.

“Getting Help for Yourself is a Way of Helping Your Baby:” Fathers’ Experiences of Support for Mental Health and Parenting in the Perinatal Period.

The need for services targeting fathers in the perinatal period is increasingly apparent. To maximize engagement, such interventions need to be father focused, but men’s experiences and needs around support have not been adequately examined. Therefore, the aims of this qualitative study were to explore men’s experiences of seeking support for their mental health and parenting in the perinatal period, and identify their specific support needs during this time. Australian fathers (N = 20) who were expecting or parenting an infant less than 2 years of age participated in individual semistructured face-to-face or telephone interviews. Thematic content analysis was used to analyze the data. Five broad themes were explored: experiences of support, support needs, barriers to support, facilitators to support, and timing of support. Several subthemes were identified within each category, illustrating a diverse range of issues that fathers experience across the perinatal period. The findings have implications for our understanding of fathers’ help-seeking behaviors, their perinatal support needs and for the development of resources, services, and interventions aiming to engage fathers in maternity health services.

Fathers’ Worries During Pregnancy: A Qualitative Content Analysis of Reddit

ABSTRACT Qualitative investigations into the emotional needs of expectant fathers have been limited by difficulties with recruitment. This study aimed to unobtrusively obtain insights into fathers’ worries during pregnancy by analyzing the content of posts on the Internet forum Reddit. The majority of worries related to infant well-being (50.8%), particularly the potential for perinatal loss (23.0%). Concerns relating to partner well-being and the couple relationship were also common, comprising 17.0% of posts. Several posts related to individual factors, such as apprehension about the father role (16.3%). Finally, situational factors such as work–family conflict accounted for 15.9% of posts. These findings contribute to the growing literature on fathers’ experiences of pregnancy and can inform the development of father-inclusive perinatal education.