Robyne Le Brocque

Maternal Depression, Parent–Child Relationships, and Resilient Outcomes in Adolescence

OBJECTIVE To examine the relationship between maternal depression, parent-child relations, and resilient outcomes in the context of risk in a cross-sectional study of 816 15-year-olds in Australia. METHOD Resilient outcomes were defined as the following: no current Axis I diagnosis, no history of depressive disorder diagnoses, no current internalizing problems, and no indication of current social functioning difficulties. Parent-child relationship qualities were measured using the Five-Minute Speech Sample, the Childrens Report of Parent Behavior Inventory, and a child report questionnaire concerning perceived maternal warmth and hostility. The role of the fathers psychiatric status in resilient outcomes was also assessed. RESULTS Results revealed that low levels of parental psychological control, high levels of maternal warmth, and low levels of maternal overinvolvement all interacted with maternal depression to predict resilient outcomes in youth. CONCLUSIONS Targeting maternal and paternal parenting qualities may be a useful method of increasing the likelihood of resilient outcomes in children of depressed mothers.

The Course of Posttraumatic Stress in Children: Examination of Recovery Trajectories Following Traumatic Injury

OBJECTIVE Group-based trajectory modeling was used to identify patterns of posttraumatic stress symptom (PTSS) in children 6-16 years following accidental injury. The aims were to: (a) identify probable groups of children following distinct trajectories, and (b) identify risk factors affecting the probability of group membership. METHOD Childrens Impact of Events Scale (n = 190) was used to assess PTSS up to 2 years post injury. Age, gender, type of injury, and preinjury behavior were assessed as risk factors. RESULTS Three distinct trajectory groups were identified: resilient (57%), elevated stress symptoms which recovered quickly (33%), and chronic (10%). Younger children were more likely to be in the recovery group. Those with serious injuries were more likely to be in the chronic group. Preinjury child behavior problems were predictive of recovery and high chronic symptoms. CONCLUSION Identification of distinct PTSS trajectory groups has implications for understanding the course and treatment of PTSS in children.

Information-provision intervention for children and their parents following pediatric accidental injury

ObjectiveThis study evaluated an early intervention for children and their parents following pediatric accidental injury.MethodInformation booklets provided to participants within 72 h of the initial trauma detailed common responses to trauma, the common time course of symptoms, and suggestions for minimizing any post-trauma distress. Following admission for traumatic injuries sustained in motor vehicle accidents, falls and sporting injuries a total of 103 children (aged 7–15) and their parents were evaluated at pre-intervention, 1 month, and 6 months post-trauma. The intervention (N = 33) was delivered to one of two hospitals, the second hospital was the control (N = 70).ResultsAnalyses indicated that the intervention reduced child anxiety symptoms at 1-month follow-up and parental posttraumatic intrusion symptoms and overall posttraumatic symptoms at the 6-month follow-up. No other differences between the intervention and control groups were found.ConclusionOverall, the information-based early intervention is simple, cost-effective method of reducing child and parent distress post-trauma.

Methodological Issues in the Effects of Attrition: Simple Solutions for Social Scientists:

Participant attrition from longitudinal research studies is a concern for social scientists because loss of certain subgroups of participants may result in subsequent data collection phases becoming increasingly biased. This article examines whether attrition has been given due consideration in selected reports of longitudinal research undertaken by social scientists. Results of a review of the literature found that less than one-quarter of the studies described how data were examined for patterns of attrition. On the other hand, those articles that described the treatment of attrition used solutions that were varied and often simple and effective. Recommendations for statistical and nonstatistical ways of dealing with sample attrition used by social scientists are provided.

Adaptive ability, behavior and quality of life pre and posttraumatic brain injury in childhood

Context: Traumatic brain injury (TBI) is a common, acquired childhood disability, which has been shown to have a significant impact on children’s cognitive and educational function. While behavioral problems are also noted, there is ongoing debate about the contribution of preinjury factors in this domain. Few studies have attempted to measure the impact of these preinjury functions on postinjury behavior. Objective: To compare pre and postinjury adaptive ability, behavior, executive function and quality of life (QOL) and to identify factors that contribute to outcomes in these domains including injury severity, socio-demographic and preinjury characteristics. Design: Consecutive recruitments to a prospective, longitudinal study, utilizing a between factor design, with injury severity as the independent variable. Participants and methods: Children admitted to hospital with a diagnosis of TBI aged between 6 and 14 years (n = 205) were divided according to injury severity (mild, moderate and severe). Adaptive behavior (Vineland Adaptive Behavior Scales), child behavior (Child Behavior Checklist), everyday executive functions (Behavior Rating Inventory of Executive Function) and QOL (Child Health Questionnaire) assessed at 6 months post-TBI. Results and conclusions: Severity by time interactions were identified across a range of outcome domains demonstrating that more severe injury is associated with a decrease in functional ability at 6 months post-TBI. This effect was most pronounced for everyday executive skills, social function and internalizing aspects of child behavior. Preinjury function was a consistent predictor of postinjury status. Injury severity contributed little to the prediction of functional outcomes once preinjury functioning was accounted for in the model. Age at injury and family cohesion were relevant to specific outcome domains only. Socio-economic status did not contribute significantly to outcome at 6 months. Preinjury functioning as reported by parents in the acute phase may be a useful predictive tool for identifying children who may be at risk of functioning difficulties 6 months post-TBI. Implications for Rehabilitation Childhood traumatic brain injury Priorities for intervention: (i) more severe injury; (ii) presence of pre-injury impairment; (iii) younger age at injury and (iv) evidence of family dysfunction. Level of functional impairment postinjury rarely meets criteria for a frank diagnosis (e.g. intellectual impairment and psychiatric disorder) and thus children are frequently ineligible for routine community supports. Reduced executive skills and social competence and elevated behavioral disturbances indicate that evidence-based interventions addressing these domains are a priority.

Youth depression and early childrearing: stress generation and intergenerational transmission of depression

OBJECTIVE Broadening the concept of stress generation beyond acute life events, the current study explores predictors of the creation of stressful environments-specifically, selection into early childrearing by age 20. It was predicted that youth with early onset depressive disorders would be at higher risk for early childrearing accompanied by greater depression and parenting maladjustment. Additional analyses tested hypotheses about the roles of interpersonal vulnerability and intergenerational transmission of depression and examined gender differences. METHOD A community sample of 706 adolescents and their mothers were studied at ages 15 and 20. The sample was originally selected to oversample families with depressed mothers. RESULTS Results confirmed the hypotheses for women but not men: Young women with depression by age 15 were at greater risk for interpersonal difficulties at age 15 and early childrearing, accompanied by further depression and parenting dysfunction at age 20. The effects of (grand)maternal depression were evident in predicting youth early onset depression and interpersonal difficulties, as well as higher rates of depression among their daughters who had children by age 20. CONCLUSIONS The study expands the definition of stress generation to include the role of past depression and other risk factors as predictors of selection into a stressful childrearing environment. The findings also describe aspects of the intergenerational transmission of depression. The results highlight potentially important targets for interventions in young women to prevent recurrence of major depression and parenting dysfunction.

Resilience to maternal depression in young adulthood.

Using a prospective longitudinal design, this study investigated factors associated with resilience in 20-year-old offspring of depressed mothers (n = 648). Resilient youth were operationally defined as those whose mothers were depressed but who themselves had no history of recurrent depression and currently evidenced adequate academic or work and romantic functioning, no Axis I psychopathology, and no clinically significant internalizing behavior problems. Low levels of perceived maternal psychological control (p = .02) and high child IQ (p < .01) acted as protective factors in the context of maternal depression. Low paternal psychological control (p = .02), high maternal warmth (p < .01), high self-esteem (p < .01), and healthy peer social functioning (p < .01) all acted as resource factors predicting high functioning outcomes for young adults, regardless of mother depression status. Notably, high child IQ acted as a protective factor predicting resilient outcomes that persisted from adolescence to adulthood (p < .01), and low maternal psychological control acted as a protective factor predicting resilient outcomes that emerged in early adulthood (p = .03). Interventions focused on these 2 protective factors might yield the strongest benefits for offspring of depressed mothers as they transition to early adulthood.

Older people - the reserve army of volunteers? An analysis of volunteerism among older Australians

In Australia, as in other Western countries, policy-makers are turning their attention to older people, particularly the early retired, as a rich potential source of volunteers. This study examines volunteer behavior in a sample of older Australians in either their immediate pre or post retirement phase. It involves a secondary analysis of data collected for a study on retirement, and seeks to examine the main social and demographic differences between those who volunteer and those who do not. The key concepts associated with volunteering are the availability of 1) time and 2) social and personal resources. Logistic regression analyses revealed that volunteers are significantly more likely to come from the higher occupational classes, are less likely to be self-employed, and are more likely to view their health positively. Implications of these results for social policy are discussed.

Parental Response to Child Injury: Examination of Parental Posttraumatic Stress Symptom Trajectories Following Child Accidental Injury

OBJECTIVE Trajectory analyses were used to empirically differentiate patterns of posttraumatic stress symptoms in parents following child accidental injury and explore the relationship between parent and child recovery patterns. METHOD Parent (n = 189) self-reported symptoms from acute to 2 years post accident were examined to (1) identify distinct parent symptom trajectories; (2) identify risk factors; and (3) explore the patterns of children and parents together. RESULTS Analysis revealed three distinct symptom trajectory groups for parents: resilient (78%); clinical level acute symptoms that declined to below clinical level by 6 months (recovery 8%); and chronic subclinical (14%). Children of resilient parents were most likely to be resilient. Half of the children of parents with chronic subclinical trajectories were likely to have chronic trajectories. CONCLUSION Clinicians cannot rely only on clinical level symptoms in parents to identify high risk families but include families where the parent has subclinical level symptoms.

The use of diaries in psychological recovery from intensive care

Intensive care patients frequently experience memory loss, nightmares, and delusional memories and some may develop symptoms of anxiety, depression, and post-traumatic stress. The use of diaries is emerging as a putative tool to ‘fill the memory gaps’ and promote psychological recovery. In this review, we critically analyze the available literature regarding the use and impact of diaries for intensive care patients specifically to examine the impact of diaries on intensive care patients’ recovery. Diversity of practice in regard to the structure, content, and process elements of diaries for intensive care patients exists and emphasizes the lack of an underpinning psychological conceptualization. The use of diaries as an intervention to aid psychological recovery in intensive care patients has been examined in 11 studies, including two randomized controlled trials. Inconsistencies exist in sample characteristics, study outcomes, study methods, and the diary intervention itself, limiting the amount of comparison that is possible between studies. Measurement of the impact of the diary intervention on patient outcomes has been limited in both scope and time frame. Furthermore, an underpinning conceptualization or rationale for diaries as an intervention has not been articulated or tested. Given these significant limitations, although findings tend to be positive, implementation as routine clinical practice should not occur until a body of evidence is developed to inform methodological considerations and confirm proposed benefits.