Publications by authors named "Anat Brunstein-Klomek"

62 Publications

Feeling Unsafe at School Among Adolescents in 13 Asian and European Countries: Occurrence and Associated Factors.

Front Psychiatry 2022 25;13:823609. Epub 2022 Apr 25.

Department of Child Psychiatry, University of Turku, Turku, Finland.

Background: Research on perceived school safety has been largely limited to studies conducted in Western countries and there has been a lack of large-scale cross-national studies on the topic.

Methods: The present study examined the occurrence of adolescents who felt unsafe at school and the associated factors of perceived school safety in 13 Asian and European countries. The data were based on 21,688 adolescents aged 13-15 (11,028 girls, 10,660 boys) who completed self-administered surveys between 2011 and 2017. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals.

Findings: The number of adolescents who felt unsafe at school varied widely across countries, with a mean occurrence of 31.4% for the total sample: 31.3% for girls, and 31.1% for boys. The findings revealed strong independent associations between feeling unsafe and individual and school-related factors, such as being bullied, emotional and behavioral problems and feeling that teachers did not care. The study also found large variations in perceived school safety between schools in many countries.

Conclusion: The findings emphasize the need to create safe educational environments for all students, based on positive relationships with teachers and peers. School-based interventions to prevent bullying and promote mental health should be a natural part of school safety promotion.
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http://dx.doi.org/10.3389/fpsyt.2022.823609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9082541PMC
April 2022

Bullying at 8 years and violent offenses by 31 years: the Finnish nationwide 1981 birth cohort study.

Eur Child Adolesc Psychiatry 2022 Apr 6. Epub 2022 Apr 6.

Department of Child Psychiatry, University of Turku, Turku University Hospital, Turku, Finland.

This study explored the associations between bullying perpetration and victimization at 8 years of age and violent offenses by the age of 31. Data were obtained for subjects enrolled in a population-based longitudinal birth cohort study. In 1989, 5813 8-year-old children (attrition 3.4%), and their parents and teachers, were surveyed about bullying. When 5405 subjects (attrition 10.2%) were 15-31 years of age, violent offenses were extracted from the Finnish National Police Register. We analyzed the data by sex and categorized bullying perpetration and victimization by frequency. Violent offenses were categorized by severity. Cox regression analyses estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs). When they were compared to males who had not been bullies at 8 years of age, frequent male bullies had an increased hazard for violent offenses (adjusted HR 3.01, 95% CI 2.11-4.33) and severe violent offenses (adjusted HR 2.86, 95% CI 1.07-7.59) as adults, even when the data were controlled for them being victims, parental education level, family structure and child psychopathology. Frequent female bullies also had an increased hazard for violent offenses, compared to those who had not bullied others (adjusted HR 5.27, 95% CI 1.51-18.40). Frequent male bullying was associated with higher odds for violent offenses compared to only bullying sometimes. Being a victim was not associated with violent offenses. Preventing childhood bullying could reduce violent offenses by both sexes.
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http://dx.doi.org/10.1007/s00787-022-01964-1DOI Listing
April 2022

Bullying at 8 years and violent offenses by 31 years: the Finnish nationwide 1981 birth cohort study.

Eur Child Adolesc Psychiatry 2022 Apr 6. Epub 2022 Apr 6.

Department of Child Psychiatry, University of Turku, Turku University Hospital, Turku, Finland.

This study explored the associations between bullying perpetration and victimization at 8 years of age and violent offenses by the age of 31. Data were obtained for subjects enrolled in a population-based longitudinal birth cohort study. In 1989, 5813 8-year-old children (attrition 3.4%), and their parents and teachers, were surveyed about bullying. When 5405 subjects (attrition 10.2%) were 15-31 years of age, violent offenses were extracted from the Finnish National Police Register. We analyzed the data by sex and categorized bullying perpetration and victimization by frequency. Violent offenses were categorized by severity. Cox regression analyses estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs). When they were compared to males who had not been bullies at 8 years of age, frequent male bullies had an increased hazard for violent offenses (adjusted HR 3.01, 95% CI 2.11-4.33) and severe violent offenses (adjusted HR 2.86, 95% CI 1.07-7.59) as adults, even when the data were controlled for them being victims, parental education level, family structure and child psychopathology. Frequent female bullies also had an increased hazard for violent offenses, compared to those who had not bullied others (adjusted HR 5.27, 95% CI 1.51-18.40). Frequent male bullying was associated with higher odds for violent offenses compared to only bullying sometimes. Being a victim was not associated with violent offenses. Preventing childhood bullying could reduce violent offenses by both sexes.
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http://dx.doi.org/10.1007/s00787-022-01964-1DOI Listing
April 2022

Bullying at 8 years and violent offenses by 31 years: the Finnish nationwide 1981 birth cohort study.

Eur Child Adolesc Psychiatry 2022 Apr 6. Epub 2022 Apr 6.

Department of Child Psychiatry, University of Turku, Turku University Hospital, Turku, Finland.

This study explored the associations between bullying perpetration and victimization at 8 years of age and violent offenses by the age of 31. Data were obtained for subjects enrolled in a population-based longitudinal birth cohort study. In 1989, 5813 8-year-old children (attrition 3.4%), and their parents and teachers, were surveyed about bullying. When 5405 subjects (attrition 10.2%) were 15-31 years of age, violent offenses were extracted from the Finnish National Police Register. We analyzed the data by sex and categorized bullying perpetration and victimization by frequency. Violent offenses were categorized by severity. Cox regression analyses estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs). When they were compared to males who had not been bullies at 8 years of age, frequent male bullies had an increased hazard for violent offenses (adjusted HR 3.01, 95% CI 2.11-4.33) and severe violent offenses (adjusted HR 2.86, 95% CI 1.07-7.59) as adults, even when the data were controlled for them being victims, parental education level, family structure and child psychopathology. Frequent female bullies also had an increased hazard for violent offenses, compared to those who had not bullied others (adjusted HR 5.27, 95% CI 1.51-18.40). Frequent male bullying was associated with higher odds for violent offenses compared to only bullying sometimes. Being a victim was not associated with violent offenses. Preventing childhood bullying could reduce violent offenses by both sexes.
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http://dx.doi.org/10.1007/s00787-022-01964-1DOI Listing
April 2022

Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries.

Eur Child Adolesc Psychiatry 2021 Apr 21. Epub 2021 Apr 21.

Department of Child Psychiatry, University of Turku, Turku, Finland.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.
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http://dx.doi.org/10.1007/s00787-021-01779-6DOI Listing
April 2021

Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries.

Eur Child Adolesc Psychiatry 2021 Apr 21. Epub 2021 Apr 21.

Department of Child Psychiatry, University of Turku, Turku, Finland.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.
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http://dx.doi.org/10.1007/s00787-021-01779-6DOI Listing
April 2021

Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries.

Eur Child Adolesc Psychiatry 2021 Apr 21. Epub 2021 Apr 21.

Department of Child Psychiatry, University of Turku, Turku, Finland.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.
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http://dx.doi.org/10.1007/s00787-021-01779-6DOI Listing
April 2021

Impact of a New Parent Behavioral-Schema Training on Children with ADHD: A Pragmatic Control Trial.

J Atten Disord 2021 12 30;25(14):2048-2059. Epub 2020 Sep 30.

Child and Adolescence Mental Health Clinic of Maccabi Health Services, Netanya, Israel.

Objectives: To examine whether adding schema therapy strategies to the conventional parent behavioral program prevents symptom relapse in children with attention deficit hyperactivity disorder (ADHD).

Method: The intervention was designed as an adaptive pragmatic control trial. The parent behavioral training and schema-enhanced parent behavior therapy (SPBT) protocols were delivered to the control group (40 parents of 23 children) and experimental group (97 parents of 54 children), respectively. Participants were assessed at baseline, mid-treatment, and termination. Parents and teachers indicated the severity of ADHD and comorbid symptoms through their responses to standardized questionnaires designed for this purpose.

Results: A nested growth curve analysis demonstrated that participants in the schema-enhanced intervention group had a lower risk of symptom relapse than the control group.

Conclusion: Participation in the SPBT program significantly reduced relapse rates by the end of the intervention. Future research may determine the long-term effects of the treatment.
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http://dx.doi.org/10.1177/1087054720959711DOI Listing
December 2021

Impact of a New Parent Behavioral-Schema Training on Children with ADHD: A Pragmatic Control Trial.

J Atten Disord 2021 12 30;25(14):2048-2059. Epub 2020 Sep 30.

Child and Adolescence Mental Health Clinic of Maccabi Health Services, Netanya, Israel.

Objectives: To examine whether adding schema therapy strategies to the conventional parent behavioral program prevents symptom relapse in children with attention deficit hyperactivity disorder (ADHD).

Method: The intervention was designed as an adaptive pragmatic control trial. The parent behavioral training and schema-enhanced parent behavior therapy (SPBT) protocols were delivered to the control group (40 parents of 23 children) and experimental group (97 parents of 54 children), respectively. Participants were assessed at baseline, mid-treatment, and termination. Parents and teachers indicated the severity of ADHD and comorbid symptoms through their responses to standardized questionnaires designed for this purpose.

Results: A nested growth curve analysis demonstrated that participants in the schema-enhanced intervention group had a lower risk of symptom relapse than the control group.

Conclusion: Participation in the SPBT program significantly reduced relapse rates by the end of the intervention. Future research may determine the long-term effects of the treatment.
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http://dx.doi.org/10.1177/1087054720959711DOI Listing
December 2021

Peer and parents' support are crucial protective factors against adolescent victimization by bullying.

EClinicalMedicine 2020 May 17;22:100328. Epub 2020 May 17.

Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel.

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http://dx.doi.org/10.1016/j.eclinm.2020.100328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264945PMC
May 2020

Peer and parents' support are crucial protective factors against adolescent victimization by bullying.

EClinicalMedicine 2020 May 17;22:100328. Epub 2020 May 17.

Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel.

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http://dx.doi.org/10.1016/j.eclinm.2020.100328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264945PMC
May 2020

Peer and parents' support are crucial protective factors against adolescent victimization by bullying.

EClinicalMedicine 2020 May 17;22:100328. Epub 2020 May 17.

Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel.

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http://dx.doi.org/10.1016/j.eclinm.2020.100328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264945PMC
May 2020

Peer and parents' support are crucial protective factors against adolescent victimization by bullying.

EClinicalMedicine 2020 May 17;22:100328. Epub 2020 May 17.

Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel.

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http://dx.doi.org/10.1016/j.eclinm.2020.100328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264945PMC
May 2020

Peer and parents' support are crucial protective factors against adolescent victimization by bullying.

EClinicalMedicine 2020 May 17;22:100328. Epub 2020 May 17.

Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel.

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http://dx.doi.org/10.1016/j.eclinm.2020.100328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264945PMC
May 2020

Peer and parents' support are crucial protective factors against adolescent victimization by bullying.

EClinicalMedicine 2020 May 17;22:100328. Epub 2020 May 17.

Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel.

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http://dx.doi.org/10.1016/j.eclinm.2020.100328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264945PMC
May 2020

The moderation of attachment in the association between depressive symptoms and self-harm among a clinical sample.

J Ment Health 2021 Feb 26;30(1):58-65. Epub 2019 Jun 26.

School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel.

Background: Self-harm is a severe health problem worldwide and in particular in clinical settings. The association of depression and self-harm has been extensively studied alongside various variables that have been examined as moderating this association. However, no previous study has examined the moderating role of attachment in this association.

Aim: We explored the role of attachment orientation in moderating the association between depressive symptoms and self-harm among a sample of patients in a community mental health clinic.

Method: This study was a de-identified archival study of patients' medical charts, and used a convenience sample of 199 patients, which completed self-report measures following the initial intake appointment as part of clinic procedures.

Results: Findings showed that both attachment anxiety and avoidance moderated the association between depressive symptoms and self-harm, such that depressive symptoms were positively associated with self-harm only when attachment anxiety scores were high, and attachment avoidance scores were high or average.

Conclusions: Attachment anxiety and avoidance should be assessed in the initial intake of patients as it has a contribution to understanding self-harm vulnerability among new patients. Future studies should explore this moderation longitudinally so causality could be inferred.
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http://dx.doi.org/10.1080/09638237.2019.1630723DOI Listing
February 2021

Early changes in depression predict outcomes of inpatient adolescent anorexia nervosa.

Eat Weight Disord 2020 Jun 8;25(3):777-785. Epub 2019 Apr 8.

Schneider Children's Medical Center, Petah Tikva, Israel.

Purpose: The aim of this study was to investigate the predictive value of early changes in depression levels during inpatient treatment of adolescent anorexia nervosa (AN).

Methods: Fifty-six adolescents (88% girls) aged 10-18 years (M = 15.35, SD = 2.23) diagnosed with AN were assessed at admission and 1 month following admission to an inpatient setting. Depression levels and eating disorder symptoms were reported at both assessments. Re-hospitalization within 12 months of discharge was documented using official national records.

Results: Whereas depression levels at baseline were found equivalent between subsequently re-hospitalized and non-re-hospitalized patients, at 1 month after admission patients who were later re-hospitalized had higher levels of depression compared to those who were not re-hospitalized. These differences remained significant after controlling for weight gain and anti-depressant medication intake. We additionally found that the proportion of boys in the non-re-hospitalized group was substantially larger than their proportion in the re-hospitalized group.

Conclusions: Our results suggest that depression at the point of hospital admission may not be a reliable predictor of treatment outcomes, and highlight the risk of relapse in AN patients whose depression levels do not alleviate after a month of inpatient treatment. Clinicians should consider providing more adjusted and intensive attention to such patients in their efforts to facilitate remission.

Level Of Evidence Iii: Well-designed cohort study.
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http://dx.doi.org/10.1007/s40519-019-00686-9DOI Listing
June 2020

Did Bullying Victimization Decrease After Nationwide School-Based Antibullying Program? A Time-Trend Study.

J Am Acad Child Adolesc Psychiatry 2020 04 2;59(4):531-540. Epub 2019 Apr 2.

Faculty of Medicine, University of Turku, Finland; Turku University Hospital, Turku, Finland; INVEST Research Flagship, University of Turku, Finland.

Objective: We assessed changes in traditional and cyberbullying victimization, and their associations with mental health, before and after the introduction of a nationwide antibullying program in Finnish schools in 2009.

Method: This time-trend assessment comprised two methodologically identical cross-sectional survey studies, with 2,061 adolescents in 2008 (response rate 90.2%) and 1,936 in 2014 (91.8%). Their mean age was 14.4 years. They completed questionnaires about traditional and cyberbullying, mental health, and perceptions of school safety. Odds ratios (OR) and 95% CIs are presented with 2008 as the reference year.

Results: From 2008 to 2014, traditional victimization decreased from 28.9% to 19.1% (odds ratio [OR] = 0.5, 95% CI = 0.4-0.7) among boys and from 23.2% to 17.4% (OR = 0.7, 95% CI = 0.6-0.9) among girls. Cyberbullying victimization remained fairly stable at 3.3% and 3.0% (OR = 0.7, 95% CI = 0.4-1.2) for boys and at 2.7% and 4.1% (OR = 1.4, 95% CI = 0.9-2.4) for girls. Combined traditional and cyberbullying victimization decreased from 6.1% to 3.9% (OR = 0.5, 95% CI = 0.4-0.8) among boys and from 7.5% to 6.7% (OR = 0.8, 95% CI = 0.6-1.2) among girls. Those experiencing both traditional and cyberbullying reported the highest mental health problems. Perceived school safety improved among boys, but not among girls. Both boys and girls reported greater efforts by teachers and fellow students to stop bullying.

Conclusion: Combined traditional and cyberbullying victimization was an indicator of comorbid mental health problems. Interventions that target both types of bullying, and that are integrated with mental health promotion, are needed.
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http://dx.doi.org/10.1016/j.jaac.2019.03.023DOI Listing
April 2020

Bullying victimization and depressive symptoms in adolescence: The moderating role of parent-child conflicts among boys and girls.

J Adolesc 2018 10 8;68:152-158. Epub 2018 Aug 8.

Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel. Electronic address:

Introduction: The association between bullying victimization and depressive symptoms has been studied extensively over the years. Among the variables studied as having an impact on this association were different characteristics of the parent-child relationship. The current study was the first to specifically examine parent-child conflicts as a moderator in the association between victimization and depressive symptoms among adolescents. In addition, it was the first to examine the roles of the child and parent's gender in this moderation.

Methods: 505 7th-9th graders from two schools in two different cities across Israel (mean age = 12.736, SD = 0.8154) participated in this study. 223 (44.2%) of the participants were male. The participants filled out a battery of self-report questionnaires assessing the different study's variables.

Results: Significant gender differences were found: among girls, the association between bullying victimization and depressive symptoms was stronger when the level of parent-child conflicts was high, while among boys, it was stronger when the level of conflicts was low.

Conclusions: Our results indicate that the psychological outcomes for victims depend on their relationship with their parents. Bullying intervention programs should include the victims' parents. Furthermore, intervention programs should be designed to fit the different needs of girls and boys.
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http://dx.doi.org/10.1016/j.adolescence.2018.07.014DOI Listing
October 2018

Bullying victimization and depressive symptoms in adolescence: The moderating role of parent-child conflicts among boys and girls.

J Adolesc 2018 10 8;68:152-158. Epub 2018 Aug 8.

Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel. Electronic address:

Introduction: The association between bullying victimization and depressive symptoms has been studied extensively over the years. Among the variables studied as having an impact on this association were different characteristics of the parent-child relationship. The current study was the first to specifically examine parent-child conflicts as a moderator in the association between victimization and depressive symptoms among adolescents. In addition, it was the first to examine the roles of the child and parent's gender in this moderation.

Methods: 505 7th-9th graders from two schools in two different cities across Israel (mean age = 12.736, SD = 0.8154) participated in this study. 223 (44.2%) of the participants were male. The participants filled out a battery of self-report questionnaires assessing the different study's variables.

Results: Significant gender differences were found: among girls, the association between bullying victimization and depressive symptoms was stronger when the level of parent-child conflicts was high, while among boys, it was stronger when the level of conflicts was low.

Conclusions: Our results indicate that the psychological outcomes for victims depend on their relationship with their parents. Bullying intervention programs should include the victims' parents. Furthermore, intervention programs should be designed to fit the different needs of girls and boys.
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http://dx.doi.org/10.1016/j.adolescence.2018.07.014DOI Listing
October 2018

Bullying victimization and depressive symptoms in adolescence: The moderating role of parent-child conflicts among boys and girls.

J Adolesc 2018 10 8;68:152-158. Epub 2018 Aug 8.

Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel. Electronic address:

Introduction: The association between bullying victimization and depressive symptoms has been studied extensively over the years. Among the variables studied as having an impact on this association were different characteristics of the parent-child relationship. The current study was the first to specifically examine parent-child conflicts as a moderator in the association between victimization and depressive symptoms among adolescents. In addition, it was the first to examine the roles of the child and parent's gender in this moderation.

Methods: 505 7th-9th graders from two schools in two different cities across Israel (mean age = 12.736, SD = 0.8154) participated in this study. 223 (44.2%) of the participants were male. The participants filled out a battery of self-report questionnaires assessing the different study's variables.

Results: Significant gender differences were found: among girls, the association between bullying victimization and depressive symptoms was stronger when the level of parent-child conflicts was high, while among boys, it was stronger when the level of conflicts was low.

Conclusions: Our results indicate that the psychological outcomes for victims depend on their relationship with their parents. Bullying intervention programs should include the victims' parents. Furthermore, intervention programs should be designed to fit the different needs of girls and boys.
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http://dx.doi.org/10.1016/j.adolescence.2018.07.014DOI Listing
October 2018

Inducing Behavioral Change in Seekers of Pro-Anorexia Content Using Internet Advertisements: Randomized Controlled Trial.

JMIR Ment Health 2018 Feb 22;5(1):e6. Epub 2018 Feb 22.

Department of Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel.

Background: The influence of pro-anorexia (pro-ana) websites is debated, with studies indicating both negative and positive effects, as well as significant variation in the effects of different websites for those suffering from eating disorders (EDs) and the general population. Online advertising, known to induce behavioral change both online and in the physical world, has not been used so far to modify the search behavior of people seeking pro-ana content.

Objective: The objective of this randomized controlled trial (RCT) was to examine if online advertisements (ads) can change online search behaviors of users who are looking for online pro-ana content.

Methods: Using the Bing Ads system, we conducted an RCT to randomly expose the searchers for pro-ana content to 10 different ads referring people to one of the three websites: the National Eating Disorders Association, the National Institutes of Mental Health, and MyProAna. MyProAna is a pro-ana website that was found in a previous study to be associated with less pathological online behaviors than other pro-ana websites. We followed participants exposed and unexposed to the ads to explore their past and future online searches. The ads were shown 25,554 times and clicked on 217 times.

Results: Exposure to the ads was associated with a decrease in searches for pro-ana and self-harm content. Reductions were greatest among those referred to MyProAna (reduction of 34.0% [73/215] and 37.2% [80/215] for pro-ana and self-harm, respectively) compared with users who were referred elsewhere (reduction of 15.47% [410/2650] and 3.21% [85/2650], respectively), and with users who were not shown the ads, who increased their behaviors (increase of 57.12% [6462/11,314] and 4.07% [461/11,314], respectively). In addition, those referred to MyProAna increased their search for treatment, as did control users, who did so to a lesser extent. However, users referred elsewhere decreased their searches for this content.

Conclusions: We found that referring users interested in ED-related content to specific pro-ana communities might lessen their maladaptive online search behavior. This suggests that those who are preoccupied with EDs can be redirected to less pathological online searches through appropriate pathways.

Trial Registration: ClinicalTrials.gov NCT03439553; https://clinicaltrials.gov/show/NCT03439553 (Archived by WebCite at http://www.webcitation.org/6xNYnxYlw).
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http://dx.doi.org/10.2196/mental.8212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843795PMC
February 2018

Inpatient weight curve trajectory as a prognostic factor among adolescents with anorexia nervosa: a preliminary report.

Eat Weight Disord 2018 Oct 14;23(5):645-651. Epub 2017 Jul 14.

Child and Adolescent Psychiatric Department, Schneider Children's Medical Center of Israel, 14 Kaplan Street, P. O. Box 559, 49202, Petach Tikvah, Israel.

Objective: To investigate the predictive value of weight restoration trajectories for relapse within the first year after discharge from inpatient treatment among adolescents with AN.

Methods: Forty four inpatient adolescents (5 boys, 39 girls) aged 11-18 (M 14.85, SD 1.87) diagnosed with anorexia were assessed at admission and discharge from a general hospital inpatient ward. Re-hospitalizations within 1 year of discharge were recorded. Factors assessed included 1/BMI at admission, 2/BMI at discharge, 3/percent from target weight (PFTW) at discharge, 4/length of hospitalization, and 5/a weight restoration trajectory measuring weight drops during inpatient weight restoration (rates of negative cubic variation in body weight (NCV).

Results: Logistic regression indicated that negative cubic variation rates (NCV) predicted re-hospitalization. PFTW was found only marginally significant.

Conclusion: Variations in weight restoration during inpatient treatment may be used to identify patients at risk for relapse. NCV can alert clinicians to initiate early relapse prevention interventions before discharge. Level of Evidence Level III, cohort study.
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http://dx.doi.org/10.1007/s40519-017-0415-8DOI Listing
October 2018

Inpatient weight curve trajectory as a prognostic factor among adolescents with anorexia nervosa: a preliminary report.

Eat Weight Disord 2018 Oct 14;23(5):645-651. Epub 2017 Jul 14.

Child and Adolescent Psychiatric Department, Schneider Children's Medical Center of Israel, 14 Kaplan Street, P. O. Box 559, 49202, Petach Tikvah, Israel.

Objective: To investigate the predictive value of weight restoration trajectories for relapse within the first year after discharge from inpatient treatment among adolescents with AN.

Methods: Forty four inpatient adolescents (5 boys, 39 girls) aged 11-18 (M 14.85, SD 1.87) diagnosed with anorexia were assessed at admission and discharge from a general hospital inpatient ward. Re-hospitalizations within 1 year of discharge were recorded. Factors assessed included 1/BMI at admission, 2/BMI at discharge, 3/percent from target weight (PFTW) at discharge, 4/length of hospitalization, and 5/a weight restoration trajectory measuring weight drops during inpatient weight restoration (rates of negative cubic variation in body weight (NCV).

Results: Logistic regression indicated that negative cubic variation rates (NCV) predicted re-hospitalization. PFTW was found only marginally significant.

Conclusion: Variations in weight restoration during inpatient treatment may be used to identify patients at risk for relapse. NCV can alert clinicians to initiate early relapse prevention interventions before discharge. Level of Evidence Level III, cohort study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40519-017-0415-8DOI Listing
October 2018

Inpatient weight curve trajectory as a prognostic factor among adolescents with anorexia nervosa: a preliminary report.

Eat Weight Disord 2018 Oct 14;23(5):645-651. Epub 2017 Jul 14.

Child and Adolescent Psychiatric Department, Schneider Children's Medical Center of Israel, 14 Kaplan Street, P. O. Box 559, 49202, Petach Tikvah, Israel.

Objective: To investigate the predictive value of weight restoration trajectories for relapse within the first year after discharge from inpatient treatment among adolescents with AN.

Methods: Forty four inpatient adolescents (5 boys, 39 girls) aged 11-18 (M 14.85, SD 1.87) diagnosed with anorexia were assessed at admission and discharge from a general hospital inpatient ward. Re-hospitalizations within 1 year of discharge were recorded. Factors assessed included 1/BMI at admission, 2/BMI at discharge, 3/percent from target weight (PFTW) at discharge, 4/length of hospitalization, and 5/a weight restoration trajectory measuring weight drops during inpatient weight restoration (rates of negative cubic variation in body weight (NCV).

Results: Logistic regression indicated that negative cubic variation rates (NCV) predicted re-hospitalization. PFTW was found only marginally significant.

Conclusion: Variations in weight restoration during inpatient treatment may be used to identify patients at risk for relapse. NCV can alert clinicians to initiate early relapse prevention interventions before discharge. Level of Evidence Level III, cohort study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40519-017-0415-8DOI Listing
October 2018
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