Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment.
Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area.
To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing.
In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies.
All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum.
Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models.
We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills.
There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
Jones KA
，Freijah I
，Brennan SE
，McKenzie JE
，Bright TM
，Fiolet R
，Kamitsis I
，Reid C
，Davis E
，Andrews S
，Muzik M
，Segal L
，Herrman H
，Chamberlain C
... -
《Cochrane Database of Systematic Reviews》
Potential Mechanisms Underlying Suicidality in Autistic People with Attention Deficit/Hyperactivity Disorder: Testing Hypotheses from the Interpersonal Theory of Suicide.
Autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) appear to be at heightened risk of suicide. To understand why, we explored two explanatory mechanisms from the interpersonal theory of suicide: first, that co-occurring ADHD might be associated with greater risk through greater thwarted belongingness and perceived burdensomeness and, secondly, that hyperactive/impulsive features might incur additional risk through their association with painful and provocative events, which are suggested to create "capability" for suicide.
Autistic adults (n = 314) completed an online survey including measures of thwarted belongingness, perceived burdensomeness, painful and provocative events, acquired capability for suicide, and ADHD features. Creating an overall index of likely ADHD, we examined associations between likely ADHD, suicide ideation, and lifetime suicide attempts through the parallel mediators of thwarted belongingness, perceived burdensomeness, anxiety, and depression. In several models, we then examined hyperactive, impulsive, and inattentive features as predictors of exposure to painful and provocative events and subsequent capability for suicide, and examined whether these two variables, sequentially or individually, mediated an association with lifetime suicide attempts.
Likely ADHD was associated with past-year suicide ideation through greater depression and perceived burdensomeness, which also mediated its association with more suicide attempts. Hyperactive and impulsive features were associated with exposure to painful and provocative events and through this acquired suicide capability. Both features were associated with more numerous suicide attempts through these two mediators sequentially, and through exposure to painful and provocative events alone.
These data suggest that suicidality in autistic people with ADHD may be partially related to perceived burdensomeness and to acquired suicide capability after exposure to painful and provocative events. However, as we observed a pathway to suicidality associated with painful and provocative events alone, it is likely that there are also other explanatory mechanisms for the influence of traumatic events on suicide risk.
Moseley RL
，Gregory NJ
，Smith P
，Allison C
，Cassidy S
，Baron-Cohen S
... -
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Nursing in the digital age: The role of nursing in addressing cyberbullying and adolescents mental health.
What is known on the subject? The study's findings are crucial for mental health nursing, as they highlight the significant impact of cyberbullying on adolescents' mental health in Egypt. What this paper adds to existing knowledge? By establishing a clear link between cyberbullying, family income, and mental health issues such as anxiety, stress, and depression, the research underscores the need for targeted interventions and support systems. What are the implications for practice? Mental health nurses can utilize this information to develop effective prevention and treatment strategies, advocate for policy changes, and educate families and communities. Addressing cyberbullying and its effects can lead to improved mental health outcomes, demonstrating the critical role of mental health nursing in supporting affected adolescents.
WHAT DOES THIS RESEARCH ADD TO EXISTING KNOWLEDGE OF CYBERBULLYING AMONG ADOLESCENTS?: This study brings attention to the widespread occurrence of cyberbullying among adolescents in Egypt and its substantial impact on their mental health. The research indicates that cyberbullying, along with family income, collectively explains more than 60% of the variation in mental health. These results underscore the importance of developing strategies to address cyberbullying and taking socioeconomic factors into account when addressing mental health issues in adolescents. WHAT ARE THE IMPLICATIONS OF THIS NEW KNOWLEDGE FOR NURSING CARE WITH ADOLESCENTS?: School nurses should be knowledgeable about the prevalence and effects of cyberbullying on the mental well-being of teenagers. They need to be equipped to recognize signs of cyberbullying and associated mental health issues, such as anxiety, depression, and stress. Educating adolescents, parents, and school staff about the dangers of cyberbullying and prevention methods is a crucial role that school nurses can play. This may involve teaching safe internet usage, promoting open communication about online experiences, and encouraging positive online behaviour. When evaluating mental health needs and planning care for adolescents, school nurses should consider their economic status. They should advocate for resources and assistance for low-income families to help alleviate the impact of financial stress on mental health. HOW COULD THE FINDINGS INFLUENCE POLICY, PRACTICE, RESEARCH, OR EDUCATION?: It is important to introduce policies that provide financial support to families with lower incomes, as the research has shown a strong connection between a family's monthly income and its members' mental well-being. Educational institutions, including schools, should introduce programs to prevent bullying, with a specific focus on cyberbullying. It would be beneficial for researchers to explore the effectiveness of various interventions in reducing cyberbullying and improving mental health outcomes. It is crucial to integrate education on cyberbullying into school curricula in order to raise awareness about this issue and to teach students how to respond if they or someone they know becomes a victim of cyberbullying. Educating parents and teachers about the indicators of cyberbullying and its potential impact on mental health is important so that they can offer support to adolescents who are experiencing cyberbullying. Further research is needed to address other covariates that could impact cyberbullying, such as addictive personality traits, impulsive seeking behaviours, and parenting styles.
BACKGROUND: Cyberbullying, a significant concern in today's digital age, has a profound impact on teenagers' mental health, leading to stress, depression, anxiety, low self-esteem, and, in severe cases, suicidal ideation. This study aimed to explore the effects of cyberbullying on adolescents' mental health.
The study employed a cross-sectional descriptive research design conducted at five public secondary schools in El-Beheira governorate, Egypt. A total of 500 students were selected through a multistage sampling technique, yielding a response rate of 96%. The instruments used for data collection were the European Cyberbullying Intervention Project Questionnaire and the Depression Anxiety Stress Scale-21.
The findings revealed that 27.4% and 32.0% of respondents reported high levels of victimization and cyberaggression, respectively. Furthermore, 72.2%, 44%, and 52.6% of students exhibited severe to extremely severe levels of anxiety, stress, and depression, respectively. The study also found that cyberbullying and family monthly income accounted for 61.6% of the variance in stress, anxiety, and depressive symptoms (adjusted R2 = .614).
The study concludes that cyberbullying is a prevalent issue among adolescents in Egypt, with a majority of students experiencing moderate to high levels of cybervictimization and aggression. This leads to varying degrees of anxiety, stress, and depression. The study also established a significant relationship between cyberbullying and mental health issues among adolescents. Moreover, both cyberbullying and family monthly income were found to significantly influence mental health, with higher levels of cyberbullying and lower income associated with increased stress, anxiety, and depressive symptoms.
No Patient or Public Contribution.
It is important for nurses working with adolescents to have an understanding of how common cyberbullying is and how it can affect mental health. They should receive training to be able to recognize signs of cyberbullying and mental health issues, such as anxiety, depression, and stress. Nurses can teach adolescents, parents, and school staff about its dangers and ways to prevent cyberbullying. This may involve educating adolescents on safe internet practices, promoting open communication about online experiences, and encouraging positive online behaviour. Lastly, considering the strong connection between income and mental health, nurses should also take into account the socioeconomic status of adolescents when assessing their mental health needs and planning care. They should work to secure resources and support for low-income families to help alleviate the impact of financial stress on mental health. Additionally, further research is needed to address other covariates that could impact cyberbullying, such as addictive personality traits, impulsive seeking behaviours, and parenting styles.
Amin SM
，Mohamed MAE
，Metwally El-Sayed M
，El-Ashry AM
... -
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ResearchGate
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钛学术
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