Background: Maternal history of abuse has been associated with their children’s behavior problems, but the role of the timing and chronicity of abuse is less understood. We used a structured life course modeling approach (SLCMA) to examine whether models of accumulation (i.e. cumulative exposure to abuse across periods) or sensitive periods (i.e. developmentally salient timing of abuse) best explained associations with children’s behavior outcomes. Methods: 949 mother-child pairs from the Pregnancy Outcomes, Maternal and Infant Study (PrOMIS), a prospective birth cohort in Peru, were analyzed. Women were recruited during pregnancy and followed up approximately 8 years postpartum. Maternal physical and sexual abuse history during childhood, one year preconception, and during pregnancy was assessed. Maternal report of child behavior problems was obtained using the Child Behavior Check List. Life course hypotheses were tested using SLCMA, and secondary analyses assessed the influence of abuse severity and current stressors. Findings: 65% of mothers reported lifetime experience of abuse, most often physical abuse. Among children, 20% had internalizing and 12% had externalizing behavior problems. The cumulative model of physical abuse and sensitive periods preconception and during pregnancy, most strongly predicted children’s behavior problems (r2 range 0.8% - 1.8%), particularly among girls (externalizing T-score =7.4, 95%CI=1.6, 12.5). Severe maternal physical abuse had the largest association with externalizing behaviors, and current food insecurity was an effect modifier. Interpretation: Maternal physical abuse experienced at critical developmental periods, explained sex-specific problems in child behaviors. Understanding the biological mechanisms behind this transgenerational risk may help design interventions to prevent childhood psychopathology.

BACKGROUND:Child internalizing and externalizing behavioral problems are highly prevalent psychiatric symptoms worldwide, for which maternal prenatal stress is a known risk factor. However, underlying neuroendocrine mechanisms remain largely unclear. We investigated whether maternal hair cortisol (HCC) and cortisone concentration (HCNC) are associated with offspring's internalizing and externalizing behavior problems in a prospective pre-birth cohort study from Perú. METHODS:N = 271 mother-child dyads were included in this analysis. Recruitment and data collection took place at the Instituto Nacional Materno Perinatal in Lima, Perú. HCC and HCHC were obtained from hair segments representing up to 3 months pre-pregnancy and first trimester, respectively, and were quantified via liquid chromatography tandem mass spectrometry. The Child Behavior Checklist was used to assess internalizing and externalizing behavioral problems of children (mean age at follow-up = 6.98 years (SD = 1.05)). Marginal structural models estimated population average associations between HCC, HCNC, and internalizing and externalizing problems, adjusting for established covariates. RESULTS:At pre-pregnancy, logHCNC was positively associated with offspring internalizing (β = 2.21, 95% CI: 0.46; 3.96, p = .013) and externalizing problems (β = 1.87, 95% CI: 0.34; 3.40, p = .016). At the first trimester, logHCNC was negatively associated with internalizing (β = -2.51, 95%CI: -4.37; -0.64, p = .008), and externalizing problems (β = -2.73, 95% CI: -4.18; -1.28, p < .001). Associations were stronger for females and not apparent for logHCC. CONCLUSIONS:We found time-dependent associations between stress-related prenatal hair glucocorticoid concentration and offspring behavioral problems. Modeling biomarker data time-dependently may prove critical to identifying the underlying mechanisms of transgenerational stress transmission.

OBJECTIVES:The prevailing belief is that during times of heightened collective stress, the adverse effects of experiences such as caregiving and living alone on mental health are exacerbated. Whether this is true and the extent to which modifiable contextual factors still buffer their negative effects remain underexplored. Women are often disproportionately affected by the burdens of caregiving, and older adults face added challenges due to age-related social and health vulnerabilities. We examined prospective associations of caregiving responsibilities and living alone with mental health in a cohort of older women and evaluated the role of caregiving-related stress and social support. METHODS:Longitudinal data were collected in a subsample of women from the Nurses' Health Study II (n = 27,646; mean age: 67), across seven time points during the COVID-19 pandemic. Participants self-reported caregiving responsibilities and living arrangements. Participants providing care also reported caregiving-related stress levels and social support levels. Seven mental health measures capturing psychological distress and positive psychological functioning were assessed 1-6 times over one year. Analyses accounted for multiple testing and key confounders. RESULTS:Compared to non-caregivers, caregivers not reporting stress had better mental health across measures (e.g., Odds Ratioanxiety = 0.8, 95% Confidence Interval = 0.75-0.85). Women living alone did not show worse mental health with adequate social support, relative to women living with others and adequately supported. DISCUSSION:Effects of caregiving responsibilities and living alone are not uniform, even during times of heightened stress. Caregiving stress and social support matter. Overlooking key contextual factors may lead to missed opportunities for prevention and intervention.

This qualitative study explored Thinking a Lot (TAL), a culturally patterned idiom of distress through which individuals describe and make sense of psychological and somatic suffering, among Vietnamese men who have sex with men (MSM). Between June and October 2018, 197 participants completed a verbally administered standardized questionnaire containing quantitative and qualitative questions about TAL. Qualitative responses were analyzed thematically to characterize its features and content. TAL was commonly described as persistent preoccupation with unresolved, often negative thoughts; emotional and mental distress; and difficulty focusing on the present. Concerns centered on professional challenges, societal expectations, family pressures, health, and romantic relationships. Work emerged as the most salient source of TAL, particularly in the context of limited legal protections for MSM in Vietnam. Participants also described pressures related to filial piety and societal norms that complicated efforts to balance employment, caregiving, and personal identity. These findings highlight the compounded stress experienced by MSM in a predominantly heteronormative society, where structural and cultural barriers constrain educational, occupational, and social opportunities. These findings suggest that TAL could provide a culturally salient, non-stigmatizing entry point for screening psychological distress and identifying and potentially intervening in the specific stressors underlying it among Vietnamese MSM.

During the COVID-19 pandemic, parents in low- and middle-income countries (LMICs) faced greater income loss, high fatality rates, and less accessible healthcare. Peru reported the highest COVID-19 mortality rate globally; yet no known study in Peru has examined the unique impact of COVID-related stressors on parents or their children’s behavioral health. Cross-sectional data were drawn from 672 mothers (mean age = 32.5) on COVID-related perceived stress, as part of a longitudinal birth cohort. Factor analyses of COVID-related perceived stress identified three domains which were used in multivariate logistic regression to examine associations with children’s (mean age = 7.6; 50.9

This study investigates the association between maternal trauma history (lifetime exposure to physical and sexual violence), maternal mental health and child behavior. Pregnant women attending the Instituto Nacional Materno Perinatal (INMP) in Lima, Peru, were recruited to join the study beginning in February 2012. Maternal trauma history and prenatal mental health were assessed at 16-weeks gestation and mothers completed the Child Behavior Checklist when children were four years old. We used causal mediation analysis to examine the association between maternal trauma history and child behavior. This study population included 631 mother-child dyads; 74% of mothers reported one or more lifetime episodes of intimate partner violence (IPV). We found that 32% of the association between maternal lifetime exposure to IPV and child internalizing behavior was mediated by prenatal anxiety. Our findings suggest that prevention and treatment of perinatal IPV and mental health disorders should be prioritized.

Sleep problems are common in the perinatal period. But the effects of sleep health on long-term postpartum depression and anxiety are underexamined. Using marginal structural models, we estimated the effect of sustained restful sleep quality, or adequate sleep quantity, or both, on clinically significant depression and anxiety at 23 and 32 weeks' gestation, and at 8 weeks, and 8, and 21 months postpartum. Women (n = 9211) in the Avon Longitudinal Study of Parents and Children cohort reported on sleep quality (difficulty falling asleep, early morning awakening), sleep quantity (<= or > 5 hours and perceived sleep adequacy), depression (Edinburgh Postnatal Depression Scale), and anxiety (Crown-Crisp Experiential Index). Analyses adjusted for fixed (maternal education, age, body mass index, parity, marital status, smoking) and time-varying (alcohol use, psychosocial adversities, depression, anxiety, or sleep problems at prior time periods) covariates. Descriptive analyses suggest that sleep alterations persist beyond the immediate postpartum period. Estimates of counterfactual prevalences of outcomes under restful sleep quality and adequate sleep suggest a reduction of the population burden of clinically significant depression between 2.4% and 5.9% and of anxiety by 3.4% to 8.0% for the time points assessed. Interventions for perinatal sleep problems may reduce clinically significant depression and anxiety. This article is part of a Special Collection on Mental Health.

A majority of adults in the United States report a range of stressful and potentially traumatic childhood experiences (e.g., physical or sexual abuse, witnessing violence, neglect). Such adversities are associated with a range of mental (e.g., anxiety, mood, and behavioral difficulties) and physical (e.g., cardiovascular illnesses, diabetes, asthma) health problems. Increasingly, precision medicine approaches seek to prevent and treat such multifinal downstream health problems by identifying common etiological pathways (e.g., inflammation and immune pathways) and candidate biomarkers to target interventions. In this context, we review the rationale for continued research to identify biomarkers of childhood adversity. Building on the bioecological theory, we emphasize that individual neurobiological profiles develop within multiple ecological levels (individual, family, neighborhood, macrosocial) that confer both risk and protective factors that can attenuate or amplify biological effects of childhood adversity. Given the limited data on adversity-associated biomarkers for children and adolescents, we discuss future recommendations for research, implications for clinical care, and ethical considerations. Preventing childhood adversity and supporting adversity- and trauma-informed systemic intervention approaches remains our primary recommendation. We highlight the continued need to consider both biomarkers of risk and protective factors across ecological levels in future research.

Sexual minorities face an increased risk of being exposed to trauma and developing Post-Traumatic Stress Disorder (PTSD). PTSD symptoms can be exacerbated by 'Thinking a Lot' (TAL). The purpose of this study was to explore TAL and its associations with childhood trauma exposure and PTSD among young men who have sex with men (MSM) in Hanoi, Vietnam. Between June and October 2018, 198 participants completed the TAL Questionnaire, Childhood Trauma Questionnaire, and PTSD Symptom Scale. The network of associations among TAL, childhood trauma, and PTSD symptoms was estimated using the Ising model with l1 regularization, and a clustering algorithm was applied. Results indicated that childhood emotional abuse was connected to adult hyperarousal symptoms, but not to TAL-induced distress or other PTSD symptom clusters. PTSD symptom clusters were highly interconnected, and hyperarousal and avoidance symptom clusters specifically linked childhood trauma exposure to TAL-induced insomnia, irritability, and somatic distress. These findings underscored the complex local understanding of TAL and its role in the connection between childhood trauma and PTSD among MSM.

BACKGROUND Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians. METHODS In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance. RESULTS Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12. CONCLUSIONS Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.

The authors sought to characterize adverse posttraumatic neuropsychiatric sequelae (APNS) symptom trajectories across ten symptom domains (pain, depression, sleep, nightmares, avoidance, re-experiencing, anxiety, hyperarousal, somatic, and mental/fatigue symptoms) in a large, diverse, understudied sample of motor vehicle collision (MVC) survivors. More than two thousand MVC survivors were enrolled in the emergency department (ED) and completed a rotating battery of brief smartphone-based surveys over a 2-month period. Measurement models developed from survey item responses were used in latent growth curve/mixture modeling to characterize homogeneous symptom trajectories. Associations between individual trajectories and pre-trauma and peritraumatic characteristics and traditional outcomes were compared, along with associations within and between trajectories. APNS across all ten symptom domains were common in the first two months after trauma. Many risk factors and associations with high symptom burden trajectories were shared across domains. Both across and within traditional diagnostic boundaries, APNS trajectory intercepts, and slopes were substantially correlated. Across all domains, symptom severity in the immediate aftermath of trauma (trajectory intercepts) had the greatest influence on the outcome. An interactive data visualization tool was developed to allow readers to explore relationships of interest between individual characteristics, symptom trajectories, and traditional outcomes ( http://itr.med.unc.edu/aurora/parcoord/ ). Individuals presenting to the ED after MVC commonly experience a broad constellation of adverse posttraumatic symptoms. Many risk factors for diverse APNS are shared. Individuals diagnosed with a single traditional outcome should be screened for others. The utility of multidimensional categorizations that characterize individuals across traditional diagnostic domains should be explored.

Families of children with mental health challenges may have been particularly vulnerable to emotional distress during the COVID-19 pandemic. This cross-sectional study surveyed 81 parents of children ages 6-17 years receiving mental health treatment in an outpatient clinic during the pandemic. We sought to characterize the impact of the pandemic on family relationships and parental well-being. Additionally, regression and ANCOVA models examined associations between four potentially protective factors-parents' psychological resilience, perceived social support, positive family experiences during the pandemic, and children's use of cognitive or behavioral coping strategies-with family relationships and parental well-being. Findings suggest that families of children with mental health conditions experienced remarkable challenges to family relationships, parental well-being, and parents' perceived capacity to support their children's mental health. Nearly 80% of parents reported a negative impact of the pandemic on their own well-being, and 60% reported reduced ability to support their children's mental health. Simultaneously, protective factors appeared to mitigate the negative impact of the pandemic. Particularly, support within the family (e.g., co-parenting) and from external sources (e.g., mental health services) were associated with better self-reported well-being for parents and their capacity to support their children. Children's use of coping tools, likely enhanced by mental health treatment, was also positively related to better family relationships and parental ability to support children with mental health challenges. Our findings highlight the need for enhancing supports for families at multiple levels including individual skill-building, family-based/parenting support, and community-based support.

The COVID-19 pandemic presents opportunities for transformative actions towards improving children's and young people's mental health, argues Archana Basu.

•In a survey of 3696 pregnant women during COVID-19 pandemic, one in three pregnant women reported elevated mental health distress, and about 30–45% women reported moderate to high impacts on health behaviors across sleep, fitness, and diet.•Greater impact in each health behavior domain (sleep, diet, fitness) was linked to increased mental health distress, even after accounting for impacts in the other domains.•Gratitude and sense of community may buffer the impact of sleep and other health behaviors on mental health distress, while loneliness may exacerbate risks.•Addressing sleep, diet, and fitness changes together may help identify and prevent mental health distress in pregnancy during a major stressor such as a global pandemic.

Objective To determine whether emotional and physical intimate partner violence (IPV) and financial adversity increase risk of incident homelessness in pregnancy and the post-partum period. Study design Data were drawn from the Avon Longitudinal Study of Parents and Children, which starting in 1990 mailed questionnaires to 14,735 mothers in the UK, over 7 years from pregnancy onwards. Marginal structural models and multiple imputation were used to address time-varying confounding of the primary variables, testing for interaction between concurrent emotional/physical IPV and financial adversity, and adjusted for baseline age, ethnicity, education, partner’s alcohol use, parity, depression, and social class. Results Emotional IPV (HR 1.44 (1.13,1.84)), physical IPV (HR 2.05 (1.21,3.49)), and financial adversity (HR 1.59 (1.44,1.77)) each predicted a multiplicative increase in the discrete-time hazard of incident homelessness. We identified joint effects for concurrent emotional IPV and financial adversity (HR 2.09 (1.35,3.22)) and concurrent physical IPV and financial adversity (HR 2.79 (1.21,6.44)). We further identified a temporary decline in self-reported physical IPV among mothers during pregnancy and up to 8 months post-partum. Conclusions Emotional and physical IPV and financial adversity independently and jointly increase the risk of incident homelessness. The effects of emotional and physical IPV are comparable to or greater than the risk of financial adversity. Homelessness prevention policies should consider IPV victims as high-risk, regardless of financial status. Furthermore, self-reported physical IPV declines temporarily during pregnancy and up to 8 months post-partum. Screening for IPV in this period may miss high-risk individuals.

Pregnant and postpartum women face unique challenges during the COVID-19 pandemic that may put them at elevated risk of mental health problems. However, few large-scale and no cross-national studies have been conducted to date that investigate modifiable pandemic-related behavioral or cognitive factors that may influence mental health in this vulnerable group. This international study sought to identify and measure the associations between pandemic-related information seeking, worries, and prevention behaviors on perinatal mental health during the COVID-19 pandemic. An anonymous, online, cross-sectional survey of pregnant and postpartum women was conducted in 64 countries between May 26, 2020 and June 13, 2020. The survey, available in twelve languages, was hosted on the Pregistry platform for COVID-19 studies ( https://corona.pregistry.com ) and advertised in social media channels and online parenting forums. Participants completed measures on demographics, COVID-19 exposure and worries, information seeking, COVID-19 prevention behaviors, and mental health symptoms including posttraumatic stress via the IES-6, anxiety/depression via the PHQ-4, and loneliness via the UCLA-3. Of the 6,894 participants, substantial proportions of women scored at or above the cut-offs for elevated posttraumatic stress (2,979 [43%]), anxiety/depression (2,138 [31%], and loneliness (3,691 [53%]). Information seeking from any source (e.g., social media, news, talking to others) five or more times per day was associated with more than twice the odds of elevated posttraumatic stress and anxiety/depression, in adjusted models. A majority of women (86%) reported being somewhat or very worried about COVID-19. The most commonly reported worries were related to pregnancy and delivery, including family being unable to visit after delivery (59%), the baby contracting COVID-19 (59%), lack of a support person during delivery (55%), and COVID-19 causing changes to the delivery plan (41%). Greater worries related to children (i.e., inadequate childcare, their infection risk) and missing medical appointments were associated with significantly higher odds of posttraumatic stress, anxiety/depression and loneliness. Engaging in hygiene-related COVID-19 prevention behaviors (face mask-wearing, washing hands, disinfecting surfaces) were not related to mental health symptoms or loneliness. Elevated posttraumatic stress, anxiety/depression, and loneliness are highly prevalent in pregnant and postpartum women across 64 countries during the COVID-19 pandemic. Excessive information seeking and worries related to children and medical care are associated with elevated symptoms, whereas engaging in hygiene-related preventive measures were not. In addition to screening and monitoring mental health symptoms, addressing excessive information seeking and women’s worries about access to medical care and their children’s well-being, and developing strategies to target loneliness (e.g., online support groups) should be part of intervention efforts for perinatal women. Public health campaigns and medical care systems need to explicitly address the impact of COVID-19 related stressors on mental health in perinatal women, as prevention of viral exposure itself does not mitigate the pandemic’s mental health impact.

Background Pregnant and postpartum women face unique challenges and concerns during the COVID-19 pandemic. Thus far, no studies have explored the factors associated with increased levels of worry in this population globally. The current study sought to assess the frequency and sources of worry during the COVID-19 pandemic in an international sample of pregnant and postpartum women. Methods We conducted an anonymous, online, cross-sectional survey in 64 countries between May and June 2020. The survey was available in 12 languages and hosted on the Pregistry platform for COVID-19 studies. Participants were sought mainly on social media platforms and online parenting forums. The survey included questions related to demographics, level of worry, support, stress, COVID-19 exposure, frequency of media usage, and mental health indicators. Results The study included 7561 participants. Eighty-three percent of all participants indicated that they were either 'somewhat' or 'very' worried. Women 13-28 weeks pregnant were significantly more likely to indicate that they were 'very worried' compared to those who were postpartum or at other stages of pregnancy. When compared with women living in Europe, those in Africa, Asia and Pacific, North America and South/Latin America were more likely to have increased levels of worry, as were those who more frequently interacted with social media. Different forms of support and stress also had an impact upon level of worry, while indicators of stress and anxiety were positively associated with worry level. Conclusion Pregnant and postpartum women are vulnerable to the changes in societal norms brought about by the COVID-19 pandemic. Understanding the factors associated with levels of worry within this population will enable society to address potential unmet needs and improve the current and future mental health of parents and children.

This commentary contextualizes potential mental health outcomes for children during and after the COVID-19 pandemic within the risk and resilience literature. Individual, familial, and community-level factors that may increase risk for mental health challenges for children as well as factors associated with positive adaptation in the face of adversity are considered. We highlight the value of considering children's resilience within a systemic perspective by considering family-centered approaches including both short-term and long-term evidence-informed mental health practices. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

BACKGROUND:Prospective population-based studies of psychiatric comorbidity following trauma and severe stress exposure in children are limited.AIMS:To examine incident psychiatric comorbidity following stress disorder diagnoses in Danish school-aged children using Danish national healthcare system registries.METHOD:Children (6-15 years of age) with a severe stress or adjustment disorder (ICD-10) between 1995 and 2011 (n = 11 292) were followed prospectively for an average of 5.8 years. Incident depressive, anxiety and behavioural disorder diagnoses were examined relative to an age- and gender-matched comparison cohort (n = 56 460) using Cox proportional hazards regression models. Effect modification by gender was examined through stratified analyses.RESULTS:All severe stress and adjustment disorder diagnoses were associated with increased rates for all incident outcome disorders relative to the comparison cohort. For instance, adjustment disorders were associated with higher rates of incident depressive (rate ratio RR = 6.8; 95% CI 6.0-7.7), anxiety (RR = 5.3; 95% CI 4.5-6.4), and behavioural disorders (RR = 7.9; 95% CI 6.6-9.3). Similarly, PTSD was also associated with higher rates of depressive (RR = 7.4; 95% CI 4.2-13), anxiety (RR = 7.1; 95% CI 3.5-14) and behavioural disorder (RR = 4.9; 95% CI 2.3-11) diagnoses. There was no evidence of gender-related differences.CONCLUSIONS:Stress disorders varying in symptom constellation and severity are associated with a range of incident psychiatric disorders in children. Transdiagnostic assessments within a longitudinal framework are needed to characterise the course of post-trauma or severe stressor psychopathology.