Publications by authors named "Sheri Madigan"

144 Publications

Configurations of mother-child and father-child attachment as predictors of internalizing and externalizing behavioral problems: An individual participant data (IPD) meta-analysis.

New Dir Child Adolesc Dev 2022 Jan 10. Epub 2022 Jan 10.

Department of Psychology, University of Notre Dame, Indiana, USA.

An unsettled question in attachment theory and research is the extent to which children's attachment patterns with mothers and fathers jointly predict developmental outcomes. In this study, we used individual participant data (IPD) meta-analysis to assess whether early attachment networks with mothers and fathers are associated with children's internalizing and externalizing behavioral problems. Following a pre-registered protocol, data from 9 studies and 1,097 children (mean age: 28.67 months) with attachment classifications to both mothers and fathers were included in analyses. We used a linear mixed effects analysis to assess differences in children's internalizing and externalizing behavioral problems as assessed via the average of both maternal and paternal reports based on whether children had two, one, or no insecure (or disorganized) attachments. Results indicated that children with an insecure attachment relationship with one or both parents were at higher risk for elevated internalizing behavioral problems compared with children who were securely attached to both parents. Children whose attachment relationships with both parents were classified as disorganized had more externalizing behavioral problems compared to children with either one or no disorganized attachment relationship with their parents. Across attachment classification networks and behavioral problems, findings suggest (a) an increased vulnerability to behavioral problems when children have insecure or disorganized attachment to both parents, and (b) that mother-child and father-child attachment relationships may not differ in the roles they play in children's development of internalizing and externalizing behavioral problems.
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http://dx.doi.org/10.1002/cad.20450DOI Listing
January 2022

Screen Time as a Mechanism Through Which Cumulative Risk is Related to Child Socioemotional and Developmental Outcomes in Early Childhood.

Res Child Adolesc Psychopathol 2022 Jan 8. Epub 2022 Jan 8.

University of Calgary, Calgary, AB, Canada.

Socio-demographic risks are associated with higher child screen time and higher screen time is associated with poor socioemotional and developmental health. Existing studies have not examined children's screen time as a mechanism through which distal risks may be associated with child outcomes. In the current study, we examined whether two proximal factors, screen time and parenting quality, mediate the relation between distal cumulative risk and child outcomes. Participants (N = 1992) were drawn from a birth cohort of mothers and their children (81% white; 46% female). Mothers reported on cumulative risk factors (maternal income, education, depression, stress, marital status, housing instability, unemployment, and maternal history of childhood adversity) during the prenatal period. Parenting quality (ineffective/hostile, positive interactions) and children's screen time (hours/week) were assessed when children were three years of age. Child socioemotional (internalizing and externalizing problems) and developmental (achievement of developmental milestones) outcomes were measured at five years of age. Path analysis revealed indirect effects from cumulative risk to internalizing symptoms and achievement of developmental milestones via screen time. Indirect effects were observed from cumulative risk to internalizing and externalizing behavior via hostile parenting behavior. Over and above the effects of parenting, screen time may be a factor that links structural forms of social disadvantage during the prenatal period to child socioemotional and developmental outcomes. Due to modest effect sizes of screen time, it remains the case that child socioemotional and developmental health should be conceptualized within the context of distal cumulative risk factors such as caregiver psychological and material resources.
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http://dx.doi.org/10.1007/s10802-021-00895-wDOI Listing
January 2022

Predictors of Preadolescent Children's Recreational Screen Time Duration During the COVID-19 Pandemic.

J Dev Behav Pediatr 2021 Dec 30. Epub 2021 Dec 30.

University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Alberta Health Services, Calgary, AB, Canada.

Objective: Research suggests that children's screen use during the COVID-19 pandemic has doubled. There is a need to understand factors associated with increased use to more adequately inform COVID-19 pandemic recovery efforts aimed at promoting healthy device habits. The objective of this multi-informant study of children aged 9 to 11 years was to examine whether duration of screen use during the COVID-19 pandemic was predicted by sociodemographic factors (e.g., child age and sex), COVID-19 pandemic family stressors, daily routines (e.g., sleep and physical activity), and device use factors (e.g., parent management strategies and content and context of use).

Methods: Participants included 846 children (M = 9.85, SD = 0.78) and their mothers from the All Our Families cohort, Calgary, Canada. Mothers reported (May-July 2020) on child screen use and COVID-19 pandemic impacts (e.g., job/income loss and stress), and children self-reported (July-August 2020) on their screen use and daily routines (e.g., sleep, physical activity, and device-free activities).

Results: Screen use during the COVID-19 pandemic was highest among male and minoritized children and families reporting high levels of stress. Children had lower durations of screen time when device limits were set by mothers. Children also had lower durations of screen time when they used screens to connect with others and when they engaged in higher levels of physical activity or device-free recreational activities.

Conclusion: This study sheds light on children's screen use during the COVID-19 pandemic and supports the current screen use guidelines for school-aged children, suggesting that parents monitor use and foster high-quality screen use (e.g., coviewing or used for connection) and device-free recreational activities when possible.
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http://dx.doi.org/10.1097/DBP.0000000000001057DOI Listing
December 2021

When the Bough Breaks: A systematic review and meta-analysis of mental health symptoms in mothers of young children during the COVID-19 pandemic.

Infant Ment Health J 2021 Dec 28. Epub 2021 Dec 28.

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: (1) the prevalence of depression and anxiety in parents of young children (
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http://dx.doi.org/10.1002/imhj.21959DOI Listing
December 2021

Post-secondary Student Mental Health During COVID-19: A Meta-Analysis.

Front Psychiatry 2021 10;12:777251. Epub 2021 Dec 10.

Department of Psychology, University of Calgary, Calgary, AB, Canada.

The COVID-19 pandemic has posed notable challenges to post-secondary students, causing concern for their psychological well-being. In the face of school closures, academic disruptions, and constraints on social gatherings, it is crucial to understand the extent to which mental health among post-secondary students has been impacted in order to inform support implementation for this population. The present meta-analysis examines the global prevalence of clinically significant depression and anxiety among post-secondary students during the COVID-19 pandemic. Several moderator analyses were also performed to examine sources of variability in depression and anxiety prevalence rates. A systematic search was conducted across six databases on May 3, 2021, yielding a total of 176 studies (1,732,456 participants) which met inclusion criteria. Random-effects meta-analyses of 126 studies assessing depression symptoms and 144 studies assessing anxiety symptoms were conducted. The pooled prevalence estimates of clinically elevated depressive and anxiety symptoms for post-secondary students during the COVID-19 pandemic was 30.6% (95% CI: 0.274, 0.340) and 28.2% (CI: 0.246, 0.321), respectively. The month of data collection and geographical region were determined to be significant moderators. However, student age, sex, type (i.e., healthcare student vs. non-healthcare student), and level of training (i.e., undergraduate, university or college generally; graduate, medical, post-doctorate, fellow, trainee), were not sources of variability in pooled rates of depression and anxiety symptoms during the pandemic. The current study indicates a call for continued access to mental health services to ensure post-secondary students receive adequate support during and after the COVID-19 pandemic. PROSPERO website: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021253547.
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http://dx.doi.org/10.3389/fpsyt.2021.777251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8709535PMC
December 2021

Are Youth Sexting Rates Still on the Rise? A Meta-analytic Update.

J Adolesc Health 2021 Dec 13. Epub 2021 Dec 13.

Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada. Electronic address:

A meta-analysis of 39 studies (110,380 participants) from 2009 to 2015 indicated that youth sexting increased over time. To inform current practice and policy initiatives, this meta-analytic update of studies since 2016 examined if rates of youth sexting have continued to rise and whether youth sexting differs by age, sex, sexting methods, and geographical location. Electronic searches were conducted in March 2020 in Embase, PsycINFO, MEDLINE, and Web of Science, yielding 1,101 nonduplicate records. Studies were included if they provided prevalence of youth sexting and data collection occurred ≥2016. Literature review and data extraction were conducted by following established PRISMA guidelines. All relevant data were extracted by two independent reviewers. To calculate mean prevalence rates, random-effects meta-analyses were conducted. Twenty-eight studies (N = 48,024) met inclusion criteria. The estimated pooled prevalence rates were as follows: (1) sending (19.3%), (2) receiving (34.8%), and (3) forwarding sexts without consent (14.5%). These prevalence rates are statistically similar to studies with data collected before 2016. In recent studies, females receive sexts at a higher rate than males, older youth are more likely to send sexts, and younger and older adolescents receive sexts at similar rates. Youth sexting rates have likely plateaued. Sexting education initiatives should begin early and encourage safe, ethical, and respectful online behavior.
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http://dx.doi.org/10.1016/j.jadohealth.2021.10.026DOI Listing
December 2021

Mediating mechanisms for maternal mental health from pre- to during the COVID-19 pandemic: Mediators of maternal mental illness during COVID-19.

J Affect Disord Rep 2021 Dec 29;6:100287. Epub 2021 Nov 29.

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

Background: Mothers have experienced a near doubling of depression and anxiety symptoms pre- to during the COVID-19 pandemic. The identification of mechanisms that account for this increase can help inform specific targets for mental health recovery efforts. The current study examined whether women with higher levels of depression and anxiety symptoms pre-pandemic, reported higher levels of depression and anxiety symptoms during the pandemic, and whether these increases were mediated by perceived stress, strained relationships, coping attitudes, participation in activities, alcohol use, and financial impact.

Methods: Mothers ( = 1,333) from an ongoing longitudinal cohort (All Our Families; AOF) from Calgary, Alberta, Canada, completed online questionnaires prior to (2017-2019) and during the COVID-19 pandemic (May-July 2020). Mothers reported on depressive and anxiety symptoms pre- and during the pandemic, as well as perceived stress, engagement in physical and leisure activities, coping, alcohol use, and financial impact of the pandemic.

Results: In unadjusted analyses, maternal depression and anxiety symptoms pre-pandemic were strongly associated with COVID-19 depressive ( = 0.57, <.01) and anxiety symptoms ( = 0.49, <.01). Significant indirect effects between maternal depressive symptoms pre- and during COVID-19 were found for coping behavior (ab=0.014, 95%CI=0.005, 0.022, =.001), perceived stress (ab=0.22, 95%CI=0.179, 0.258, <.001), and strained relationships (ab=0.013, 95%CI= 0.005, 0.022, =.003). For maternal anxiety symptoms pre- and during COVID-19, significant indirect effects were observed for perceived stress (ab=0.012, 95%CI=0.077, 0.154, =.003) and strained relationships (ab=0.010, 95%CI=0.001, 0.018, =.03).

Conclusions: Perceived stress, coping attitudes, and interpersonal relationships are three potential intervention targets for mitigating COVID-19 related mental distress in mothers.
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http://dx.doi.org/10.1016/j.jadr.2021.100287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640076PMC
December 2021

Asking About Childhood Adversity in the Prenatal Care Setting: Cross-Sectional Associations with Maternal Health and Mental Health Outcomes.

Matern Child Health J 2021 Nov 27. Epub 2021 Nov 27.

Department of Psychology, University of Calgary, 2500 University Ave., Calgary, AB, T2N 1N4, Canada.

Objectives: Adverse childhood experiences (ACEs) are associated with poor physical and mental health outcomes in pregnancy, prompting many care agencies to ask about ACEs as part of routine care. However, limited research has been conducted in the clinical setting to demonstrate associations between ACEs and maternal health (i.e., pregnancy complications and birth outcomes) and mental health in pregnancy (i.e., depression, anxiety, and substance use). The aims of the current study were to: (1) examine the prevalence of ACEs reported by patients attending a maternity clinic for medically low-risk patients, and (2) evaluate whether these reports were associated with prenatal health and mental health.

Methods: Participants included pregnant women (n = 338) receiving prenatal care at a low-risk outpatient medical clinical from June 2017 to December 2018. Total ACE scores, pregnancy complications (e.g., gestational hypertension, preeclampsia), birth outcomes (e.g., Apgar scores, preterm birth), and mental health outcomes (i.e., anxiety, depression, and substance use) were extracted from electronic medical records.

Results: The majority of women (67.8%) reported experiencing no ACEs, 16.0% reported one ACE, 10.1% reported two ACEs, and 6.2% reported three or more ACEs. ACEs were associated with increased odds of prenatal depression, anxiety, and substance use in a dose-response fashion, but not pregnancy health or birth outcomes.

Conclusions For Practice: Prevalence rates of maternal ACEs obtained in the prenatal care setting were low compared to the general population. While ACEs were positively associated with maternal mental health and substance use in pregnancy, they were not associated with pregnancy complications.
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http://dx.doi.org/10.1007/s10995-021-03301-5DOI Listing
November 2021

Maternal-Child Health Outcomes from Pre- to Post-Implementation of a Trauma-Informed Care Initiative in the Prenatal Care Setting: A Retrospective Study.

Children (Basel) 2021 Nov 18;8(11). Epub 2021 Nov 18.

Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada.

Background: There has been an increase in use of trauma-informed care (TIC) approaches, which can include screening for maternal Adverse Childhood Experiences (ACEs) during prenatal care. However, there is a paucity of research showing that TIC approaches are associated with improvements in maternal or offspring health outcomes. Using retrospective file review, the current study evaluated whether differences in pregnancy health and infant birth outcomes were observed from before to after the implementation of a TIC approach in a low-risk maternity clinic, serving women of low medical risk.

Methods: Demographic and health data were extracted from the medical records of 601 women ( = 338 TIC care, = 263 pre-TIC initiative) who received prenatal care at a low-risk maternity clinic. Cumulative risk scores for maternal pregnancy health and infant birth outcomes were completed by health professionals.

Results: Using independent chi-squared tests, the proportion of women without pregnancy health risks did not differ for women from before to after the implementation of TIC, (2, 601) = 3.75, = 0.15. Infants of mothers who received TIC were less likely to have a health risk at birth, (2, 519) = 6.17, = 0.046.

Conclusion: A TIC approach conveyed modest benefits for infant outcomes, but not maternal health in pregnancy. Future research examining other potential benefits of TIC approaches are needed including among women of high socio-demographic and medical risk.
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http://dx.doi.org/10.3390/children8111061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622334PMC
November 2021

Effect of the COVID-19 Pandemic on Adolescents With Eating Disorders-Reply.

JAMA Pediatr 2021 Nov 15. Epub 2021 Nov 15.

Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1001/jamapediatrics.2021.4681DOI Listing
November 2021

Examining Parent Adverse Childhood Experiences as a Distal Risk Factor in Pediatric Chronic Pain.

Clin J Pain 2021 Nov 8;38(2):95-107. Epub 2021 Nov 8.

Department of Psychology, University of Calgary.

Objectives: Adverse childhood experiences (ACEs; ie, exposure to abuse, neglect, household dysfunction in childhood) are associated with poor mental and physical health outcomes across the lifespan. Emerging research suggests parent ACEs also confer risk for poor child outcomes. The relation between parent ACEs and child pain in youth with chronic pain has not yet been examined. The aim of the current longitudinal study was to examine the associations among parent ACEs, parent health, and child pain, in a clinical sample of youth with chronic pain.

Methods: In total, 192 youth (75.5% female, 10 to 18 y old) and one of their parents (92.2% female) were recruited from tertiary pediatric chronic pain clinics in Canada. At baseline, parents completed self-report measures of ACEs, chronic pain status, anxiety and depressive symptoms, and posttraumatic stress disorder symptoms. At a 3-month follow-up, youth completed self-report measures of pain intensity and pain interference.

Results: Regression and mediation analyses revealed that parent ACEs significantly predicted parent chronic pain status and depressive symptoms, but not parent anxiety or posttraumatic stress disorder symptoms. Moreover, parent ACEs were not significantly related to youth pain, either directly or indirectly through parent health variables.

Discussion: Findings suggest that an intergenerational cascade from parent ACEs to parent health to child pain was not present in the current sample. Further research that examines the role of parent ACEs in the development of child chronic pain, as well as other risk and resiliency factors that may mediate or moderate the association between parent ACEs and child chronic pain, is needed.
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http://dx.doi.org/10.1097/AJP.0000000000001002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8719510PMC
November 2021

Tweens are not teens: the problem of amalgamating broad age groups when making pandemic recommendations.

Can J Public Health 2021 12 29;112(6):984-987. Epub 2021 Oct 29.

Department of Psychiatry, Hospital for Sick Children, 1145 Burton Wing, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.

Demarcating childhood into two distinct and broad 10-year age bands of over and under age 10 is a disservice to our tween population (9-12 years), and may be overlooking our role in understanding the negative impacts of SARS-CoV-2 (COVID-19) during a formative period of development. In this commentary, we discuss the importance of considering tweens as a unique population of youth who are differentially impacted by the COVID-19 pandemic. We first describe the distinctive progress of tweens across various facets of developmental health, followed by recommendations to improve understanding and address impact of the pandemic and its restrictions on tweens. The COVID-19 pandemic has had a large impact on the day-to-day lives of tweens and what we do now will have long-lasting effects on their lifelong trajectories.
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http://dx.doi.org/10.17269/s41997-021-00585-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555731PMC
December 2021

A mediation meta-analysis of the role of maternal responsivity in the association between socioeconomic risk and children's language.

Child Dev 2021 11 19;92(6):2177-2193. Epub 2021 Oct 19.

Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada.

This meta-analysis tested maternal responsivity as a mediator of the association between socioeconomic risk and children's preschool language abilities. The search included studies up to 2017 and meta-analytic structural equation modeling, allowed us to examine the magnitude of the indirect effect across 17 studies (k = 19). The meta-analysis included 6433 predominantly White, English speaking children (M  = 36 months; 50% female) from Western, industrialized countries. All paths in the model were statistically significant, notably, the indirect effect was significant (b = -.052), showing that maternal responsivity may be a proximal intervening variable between socioeconomic risk and children's language development. Moderator analyses found that the indirect effect was stronger for sensitive parenting than warmth and when parenting was assessed in the family home.
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http://dx.doi.org/10.1111/cdev.13695DOI Listing
November 2021

Child-father attachment in early childhood and behavior problems: A meta-analysis.

New Dir Child Adolesc Dev 2021 Oct 14. Epub 2021 Oct 14.

Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.

This meta-analytic study examined the associations between child-father attachment in early childhood and children's externalizing and internalizing behavior problems. Based on 15 samples (N = 1,304 dyads), the association between child-father attachment insecurity and externalizing behaviors was significant and moderate in magnitude (r = 0.18, 95% CI: 0.10, 0.27 or d = 0.37, 95% CI: 0.20, 0.55). No moderators of this association were identified. Based on 12 samples (N = 1,073), the association between child-father attachment insecurity and internalizing behaviors was also significant, albeit smaller in magnitude (r = 0.09, 95% CI: 0.02, 0.15; or d = 0.17, 95% CI: 0.03, 0.31). Between-study heterogeneity was insufficient to consider moderators. When compared to the effect sizes of prior meta-analyses on child-mother attachment and behavior problems, the quality of the attachment relationship with fathers yields a similar magnitude of associations to children's externalizing and internalizing behaviors. Results support the need to consider the role of the attachment network, which notably includes attachment relationships to both fathers and mothers, to understand how attachment relationships contribute to child development.
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http://dx.doi.org/10.1002/cad.20434DOI Listing
October 2021

A Lifespan Development Theory of Insecure Attachment and Internalizing Symptoms: Integrating Meta-Analytic Evidence via a Testable Evolutionary Mis/Match Hypothesis.

Brain Sci 2021 Sep 16;11(9). Epub 2021 Sep 16.

Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA.

Attachment scholars have long argued that insecure attachment patterns are associated with vulnerability to internalizing symptoms, such as depression and anxiety symptoms. However, accumulating evidence from the past four decades, summarized in four large meta-analyses evaluating the link between insecure attachment and internalizing symptoms, provide divergent evidence for this claim. This divergent evidence may be accounted for, at least in part, by the developmental period under examination. Specifically, children with histories of deactivating (i.e., insecure/avoidant) but not hyperactivating (i.e., insecure/resistant) attachment patterns in infancy and early childhood showed elevated internalizing symptoms. In contrast, adolescents and adults with hyperactivating (i.e., insecure/preoccupied) but not deactivating (i.e., insecure/dismissing) attachment classifications showed elevated internalizing symptoms. In this paper, we summarize findings from four large meta-analyses and highlight the divergent meta-analytic findings that emerge across different developmental periods. We first present several potential methodological issues that may have contributed to these divergent findings. Then, we leverage clinical, developmental, and evolutionary perspectives to propose a testable lifespan development theory of attachment and internalizing symptoms that integrates findings across meta-analyses. According to this theory, subtypes of insecure attachment patterns may be differentially linked to internalizing symptoms depending on their mis/match with the developmentally appropriate orientation tendency toward caregivers (in childhood) or away from them (i.e., toward greater independence in post-childhood). Lastly, we offer future research directions to test this theory.
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http://dx.doi.org/10.3390/brainsci11091226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469853PMC
September 2021

Videogame exposure positively associates with selective attention in a cross-sectional sample of young children.

PLoS One 2021 27;16(9):e0257877. Epub 2021 Sep 27.

Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

There is growing interest in how exposure to videogames is associated with young children's development. While videogames may displace time from developmentally important activities and have been related to lower reading skills, work in older children and adolescents has suggested that experience with attention-demanding/fast-reaction games positively associates with attention and visuomotor skills. In the current study, we assessed 154 children aged 4-7 years (77 male; mean age 5.38) whose parents reported average daily weekday recreational videogame time, including information about which videogames were played. We investigated associations between videogame exposure and children's sustained, selective, and executive attention skills. We found that videogame time was significantly positively associated only with selective attention. Longitudinal studies are needed to elucidate the directional association between time spent playing recreational videogames and attention skills.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257877PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476027PMC
November 2021

Maternal depressive symptoms and language development: The moderating role of child temperament.

Dev Psychol 2021 Jun;57(6):863-875

Department of Psychology, University of Calgary.

The current study examined the interaction between maternal depressive symptoms and child temperament in predicting subsequent child language skills. Participants were 252 mother-child dyads recruited from the All Our Families longitudinal cohort, a primarily middle-class sample (62.9% completed postsecondary education) from Alberta, Canada (90.5% White, 6% Asian, 3.5% other). Maternal depressive symptoms at age 3, controlling for prenatal depressive symptoms, did not evidence a direct effect on child language skills at age 5 (49.6% males; mean [M] = 5.12 years old, standard deviation [SD] = .11). However, both child surgency and effortful control interacted with maternal depression at age 3 to predict later language skills. Low effortful control was a risk factor for poorer language abilities in contexts of high maternal depressive symptoms. High child surgency emerged as a differential susceptibility marker, predicting poorer language skills in contexts of high maternal depressive symptoms but better language skills in contexts of low depressive symptoms. Negative affect did not interact with maternal depressive symptoms in predicting language skills. These findings highlight the complex interaction between maternal and child characteristics in predicting language development during a developmental period in which language skills are a prime indicator of school readiness and a predictor of future academic achievement and socioemotional adjustment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/dev0001184DOI Listing
June 2021

Does screening for maternal ACEs in prenatal care predict pregnancy health risk above and beyond demographic and routine mental health screening?

Child Abuse Negl 2021 Nov 17;121:105256. Epub 2021 Aug 17.

University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute, 3330 Hospital Dr. NW, 3B2X9, Calgary, AB, T2N 4N1, Canada. Electronic address:

Background: Adverse childhood experiences (ACEs), including abuse, neglect, and/or household dysfunction, are associated with physical and mental health difficulties in pregnancy and the postpartum period. These associations have prompted the adoption of screening for ACEs in prenatal care settings; however, little is known about whether asking about ACEs in the prenatal care context is additive to other forms of routine prenatal demographic and mental health screening.

Objective: To identify whether ACEs are predictive of cumulative pregnancy health risk and identify whether ACEs predict maternal health risks in pregnancy above and beyond screening for financial stress, depression, and anxiety.

Participants And Setting: The electronic medical records of three hundred and thirty-eight patients who accessed prenatal care at a low-risk primary care maternity clinic were included.

Methods: Women retrospectively self-reported their ACEs during their second prenatal primary care visit (~20 weeks' gestation) and reported financial stress as well as their depressive and anxious symptoms using the PHQ-2 and GAD-2. Health risk factors and complications were documented by healthcare providers in the files at birth. Approximately 32% of patients reported at least one ACE.

Results: Regression analyses revealed that after accounting for financial stress, neither depression nor anxiety predicted cumulative health risk in the antenatal period. ACEs significantly predicted cumulative health risk (B = 0.14, p = .02) and an additional 1.7% of variance in the outcome. However, the model only accounted for 5.0% of the variance in cumulative health risk.

Conclusions: The total health risk predicted by demographic and ACEs screening is modest in this low-risk sample. Additional research on the implications of broader trauma-informed approaches is needed to evaluate their impact.
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http://dx.doi.org/10.1016/j.chiabu.2021.105256DOI Listing
November 2021

Maternal Adverse Childhood Experiences and Child Behavior Problems: A Systematic Review.

Pediatrics 2021 09 19;148(3). Epub 2021 Aug 19.

Department of Psychology, University of Calgary, Calgary, Canada

Context: A growing body of research has examined the role of maternal adverse childhood experiences (ACEs) on child behavior problems.

Objective: To summarize the literature examining the association between maternal ACEs and child behavior problems via a systematic review.

Data Sources: Electronic searches were conducted in Medline, PsycINFO, and Embase (1998-June 2020). Reference lists were reviewed. In total, 3048 records were screened.

Study Selection: Studies were included if an association between maternal ACEs and child externalizing (eg, aggression) and/or internalizing (eg, anxiety) problems was reported. In total, 139 full-text articles were reviewed for inclusion.

Data Extraction: Data from 16 studies met full inclusion criteria. Studies were synthesized by child externalizing and internalizing outcomes.

Results: Maternal ACEs were significantly associated with child externalizing problems across all studies (number of studies synthesized per outcome [] = 11). Significant associations were also found for inattention, hyperactivity, and impulsivity ( = 4), and aggression ( = 2). For internalizing problems ( = 11), significant associations were identified across 8 studies and nonsignificant associations were reported for 3 studies. Maternal ACEs were consistently associated with child anxiety and depression ( = 5). However, inconsistent findings were reported for somatization ( = 2).

Limitations: Results are limited to mother-child dyads and questionnaire measures of behavior problems in primarily North American countries.

Conclusions: Mothers' ACEs demonstrated largely consistent associations with children's behavior problems. Future research is needed to determine if specific types of maternal ACEs (eg, household dysfunction) are more strongly associated with child behavior problems.
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http://dx.doi.org/10.1542/peds.2020-044131DOI Listing
September 2021

Cumulative Social Risk and Child Screen Use: The Role of Child Temperament.

J Pediatr Psychol 2021 Aug 13. Epub 2021 Aug 13.

Psychology Department, University of Calgary, Calgary, AB, Canada.

Objectives: It is critical to understand what children, and in which context, are at risk for high levels of screen use. This study examines whether child temperament interacts with cumulative social risk to predict young children's screen use and if the results are consistent with differential susceptibility or diathesis-stress models.

Methods: Data from 1,992 families in Calgary, Alberta (81% White; 47% female; 94% >$40,000 income) from the All Our Families cohort were included. Mothers reported on cumulative social risk (e.g., low income and education, maternal depression) at <25 weeks of gestation, child's temperament at 36 months of age (surgency/extraversion, negative affectivity, effortful control), and child's screen use (hours/day) at 60 months of age. Along with socio-demographic factors, baseline levels of screen use were included as covariates.

Results: Children high in surgency (i.e., high-intensity pleasure, impulsivity) had greater screen use than children low in surgency as social risk exposure increased. In line with differential susceptibility, children high in surgency also had less screen use than children low in surgency in contexts of low social risk. Children with heightened negative affectivity (i.e., frequent expressions of fear/frustration) had greater screen use as social risk increased, supporting a diathesis-stress model.

Conclusions: Young children predisposed to high-intensity pleasure seeking and negative affectivity in environments characterized as high in social risk may be prone to greater durations of screen use. Findings suggest that an understanding of social risks and individual characteristics of the child should be considered when promoting healthy digital health habits.
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http://dx.doi.org/10.1093/jpepsy/jsab087DOI Listing
August 2021

Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis.

JAMA Pediatr 2021 11;175(11):1142-1150

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

Importance: Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature.

Objective: To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained variation in prevalence rates across studies.

Data Sources: Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were searched in PsycArXiv on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19, mental health, and child/adolescent were used.

Study Selection: Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years).

Data Extraction And Synthesis: A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021.

Main Outcomes And Measures: Prevalence rates of clinically elevated depression and anxiety symptoms in youth.

Results: Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies collected later in the pandemic and in girls. Depression symptoms were higher in older children.

Conclusions And Relevance: Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of resources to address child and adolescent mental health concerns are essential.
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http://dx.doi.org/10.1001/jamapediatrics.2021.2482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353576PMC
November 2021

Dietary patterns and internalizing symptoms in children and adolescents: A meta-analysis.

Aust N Z J Psychiatry 2021 Jul 27:48674211031486. Epub 2021 Jul 27.

Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Context: Studies of child and adolescent internalizing symptoms and dietary pattern have produced mixed results.

Objectives: To quantify the association between dietary patterns and internalizing symptoms, including depression, in children and adolescents.

Data Sources: Embase, PsycINFO, MEDLINE, Web of Science and Cochrane up to March 2021.

Study Selection: Observational studies and randomized controlled trials with mean age ⩽ 18 years, reporting associations between diet patterns and internalizing symptoms.

Data Extraction: Mean effect sizes and 95% confidence intervals were determined under a random-effects model.

Results: Twenty-six studies were cross-sectional, 12 were prospective, and 1 used a case-control design. The total number of participants enrolled ranged from 73,726 to 116,546. Healthy dietary patterns were negatively associated with internalizing ( = -0.07,  < 0.001, 95% confidence interval [-0.12, 0.06]) and depressive symptoms ( = -0.10,  < 0.001, 95% confidence interval [-0.18, -0.08]). Effect sizes were larger for studies of healthy dietary patterns and internalizing and depressive symptoms using self-report versus parent-report measures, as well as in cross-sectional studies of healthy dietary patterns and depression compared to prospective studies. Unhealthy dietary patterns were positively associated with internalizing ( = 0.09,  < 0.001, 95% confidence interval [0.06, 0.14]) and depressive symptoms ( = 0.10,  < 0.01, 95% CI [0.05, 0.17]). Larger effect sizes were observed for studies of unhealthy dietary patterns and internalizing and depressive symptoms using self-report versus parent-report measures.

Limitations: A lack of studies including clinical samples and/or physician diagnosis, and a paucity of studies in which anxiety symptoms were the primary mental health outcome.

Conclusion: Greater depression and internalizing symptoms are associated with greater unhealthy dietary patterns and with lower healthy dietary intake among children and adolescents.
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http://dx.doi.org/10.1177/00048674211031486DOI Listing
July 2021

Child and family factors associated with child mental health and well-being during COVID-19.

Eur Child Adolesc Psychiatry 2021 Jul 24. Epub 2021 Jul 24.

Department of Psychology, Faculty of Arts, Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Dr. NW., Calgary, AB, T2N 1N4, Canada.

Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep, physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financial impact, maternal depression and anxiety) factors associated with children's mental health and well-being during the COVID-19 pandemic, after controlling for pre-pandemic mental health. This study included 846 mother-child dyads (child age 9-11) from the All Our Families cohort. Mothers reported on the child's pre-pandemic mental health at age 8 (2017-2019) and during COVID-19 (May-July 2020), the family's financial impact due to COVID-19, and maternal depression and anxiety. During COVID-19 (July-August 2020), children reported on their screen time, sleep, physical activity, peer and family relationships, and recreational activities, as well as their happiness, anxiety and depression. After controlling for pre-pandemic anxiety, connectedness to caregivers (B - 0.16; 95% CI - 0.22 to - 0.09), child sleep (B - 0.11; 95% CI - 0.19 to - 0.04), and child screen time (B 0.11; 95% CI 0.04-0.17) predicted child COVID-19 anxiety symptoms. After controlling for pre-pandemic depression, connectedness to caregivers (B - 0.26; 95% CI - 0.32 to - 0.21) and screen time (B 0.09; 95% CI 0.02-0.16) predicted child COVID-19 depressive symptoms. After controlling for covariates, connectedness to caregivers (B 0.36; 95% CI 0.28-0.39) predicted child COVID-19 happiness. Fostering parent-child connections and promoting healthy device and sleep habits are critical modifiable factors that warrant attention in post-pandemic mental health recovery planning.
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http://dx.doi.org/10.1007/s00787-021-01849-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302979PMC
July 2021

Do Healthy Dietary Interventions Improve Pediatric Depressive Symptoms? A Systematic Review and Meta-Analysis.

Adv Nutr 2021 Dec;12(6):2495-2507

Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.

Dietary recommendations have been proposed as a way of impacting current and future mental health. There exists a limited body of conflicting literature related to pediatric nutritional interventions and depression. This meta-analysis aims to determine the efficacy of child and adolescent dietary interventions on depression. Systematic searches in electronic databases and gray literature were conducted. After screening 6725 citations, 17 studies were included in this systematic review. Quality assessment was performed using the Cochrane risk-of-bias tool and the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. A meta-analysis of Hedges g values was calculated using the Hartung-Knapp-Sidik-Jonkman method. Publication bias was assessed with funnel plots and the Egger test. The results of the meta-analysis of the RCTs (k = 7) demonstrated a nonsignificant effect of dietary intervention (g = 0.05; 95% CI: -0.25, 0.35; P = 0.70) whereas the results of the pre-post intervention studies (k = 9) demonstrated a significant small-to-medium effect favoring dietary intervention for reducing depression (g = -0.45; 95% CI: -0.64, -0.27; P = 0.001). Publication bias was not detected by the Egger test or by funnel plot asymmetry. The current meta-analysis demonstrates that "healthy" dietary interventions for children or adolescents in the community have little impact on nonclinical depression. Confusion will persist until better-designed studies in pediatric nutritional psychiatry research focusing on adolescents with depressive illness are conducted.
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http://dx.doi.org/10.1093/advances/nmab088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634309PMC
December 2021

Cross-Sectional Study Protocol for the COVID-19 Impact Survey of Mothers and Their 7-11 Year Old Children in Alberta, Canada.

Front Psychiatry 2021 22;12:597759. Epub 2021 Jun 22.

Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Our aim is to understand the effect of the COVID-19 pandemic on families who have been followed longitudinally in two cohorts studied in Alberta, Canada. We will examine household infections during the COVID-19 pandemic, financial impact, domestic violence, substance use, child school and daily life and relationships in the home. We will identify risk and protective factors for maternal mental health outcomes using longitudinal data that can inform policy and government resource allocation in future disasters. Mothers who are currently participating in two longitudinal studies, Alberta Pregnancy Outcomes and Nutrition (APrON; = 1,800) and All Our Families (AOF: = 2,534) were eligible to participate. Mothers were invited to complete the baseline COVID-19 Impact Survey (20-30 min) within 4 months of March 15, 2020, which was when the province of Alberta, Canada, implemented school closures and physical-distancing measures to prevent the spread of COVID-19. Mothers were asked to report on their own, their child's and their family's functioning. Mothers were re-surveyed at 6 months after completion of the initial COVID-19 Impact Survey, and will be re-surveyed again at 12 months. Responses from participants in both cohorts will be examined in harmonized analyses as well as separately. Descriptive, multivariable analysis will be undertaken to examine risk and resiliency over time and factors that predict mental health and well-being. This study will provide timely information on the impact of COVID-19 for Albertan families. It will identify risk and protective factors for mental health and well-being among contemporary urban families supported by a publicly funded health care system to inform allocation of resources to support those most vulnerable during a global pandemic.
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http://dx.doi.org/10.3389/fpsyt.2021.597759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260076PMC
June 2021

Child Welfare System Involvement Among Children With Medical Complexity.

Child Maltreat 2021 Jul 5:10775595211029713. Epub 2021 Jul 5.

Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.

Children with medical complexity may be at elevated risk of experiencing child maltreatment and child welfare system involvement, though empirical data are limited. This study examined the extent of child welfare system involvement among children with medical complexity and investigated associated health and social factors. A retrospective chart review of children with medical complexity (N = 208) followed at a pediatric hospital-based complex care program in Canada was conducted. Descriptive statistics and odds ratios using logistic regression were computed. Results showed that nearly one-quarter (23.6%) had documented contact with the child welfare system, most commonly for neglect; of those, more than one-third (38.8%) were placed in care. Caregiver reported history of mental health problems (aOR = 3.19, 95%CI = 1.55-6.56), chronic medical conditions (aOR = 2.86, 95%CI = 1.09-7.47), and interpersonal violence or trauma (aOR = 17.58, 95%CI = 5.43-56.98) were associated with increased likelihood of child welfare system involvement, while caregiver married/common-law relationship status (aOR = 0.35, 95%CI = 0.16-0.74) and higher number of medical technology supports (aOR = 0.75, 95%CI = 0.57-0.99) were associated with decreased likelihood. Implications for intervention and prevention of maltreatment in children with high healthcare needs are discussed.
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http://dx.doi.org/10.1177/10775595211029713DOI Listing
July 2021

Longitudinal Associations Between Screen Use and Reading in Preschool-Aged Children.

Pediatrics 2021 06 24;147(6). Epub 2021 May 24.

University of Calgary, Calgary Alberta, Canada;

Background And Objectives: The home literacy environment has been identified as a key predictor of children's language, school readiness, academic achievement, and behavioral outcomes. With the increased accessibility and consumption of digital media, it is important to understand whether screen use impacts off-line enrichment activities such as reading or whether reading activities offset screen use. Using a prospective birth cohort, we examined reading and screen use at 24, 36, and 60 months to elucidate the directional association between screen use and reading over time.

Methods: This study included data from 2440 mothers and children in Calgary, Alberta, drawn from the All Our Families cohort. Children's screen use and reading activities were assessed via maternal report at age 24, 36, and 60 months. Sociodemographic covariates were also collected.

Results: Using a random-intercepts cross-lagged panel model, which statistically controls for individual-level confounds, this study revealed that greater screen use at 24 months was associated with lower reading at 36 months (β = -.08; 95% confidence interval: -0.13 to -0.02). In turn, lower reading at 36 months was associated with greater screen use at 60 months (β = -.11; 95% confidence interval: -0.19 to -0.02). Covariates did not modify the associations.

Conclusions: A reciprocal relationship between screen use and reading was identified. Early screen use was associated with lower reading activities, resulting in greater screen use at later ages. Findings emphasize the need for practitioners and educators to discuss screen use guidelines and encourage families to engage in device-free activities to foster early literacy exposure.
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http://dx.doi.org/10.1542/peds.2020-011429DOI Listing
June 2021

SARS-CoV-2 vaccination intentions among mothers of children aged 9 to 12 years: a survey of the All Our Families cohort.

CMAJ Open 2021 Apr-Jun;9(2):E548-E555. Epub 2021 May 21.

Department of Obstetrics and Gynaecology (Hetherington), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Community Health Sciences (Edwards, Tough), Cumming School of Medicine, University of Calgary; Department of Pediatrics (MacDonald, McDonald, Tough), Cumming School of Medicine, University of Calgary; Faculty of Nursing (MacDonald), University of Alberta; Department of Psychology (Racine, Madigan, Tough), University of Calgary; Alberta Children's Hospital Research Institute (Racine, Madigan), Calgary, Alta.

Background: Acceptance of a vaccine against SARS-CoV-2 is critical to achieving high levels of immunization. The objectives of this study were to understand mothers' SARS-CoV-2 vaccine intentions to explore reasons for and against SARS-CoV-2 vaccination.

Methods: Participants from the All Our Families pregnancy longitudinal cohort whose children had reached ages 9-12 years were invited in May-June 2020 to complete a survey on the impact of COVID-19. The survey covered topics about the impact of the pandemic and included 2 specific questions on mothers' intentions to vaccinate their child against SARS-CoV-2. Current responses were linked to previously collected data, including infant vaccine uptake. Multinomial regression models were run to estimate associations between demographic factors, past vaccination status and vaccination intention. Qualitative responses regarding factors affecting decision-making were analyzed thematically.

Results: The response rate was 53.8% (1321/2455). A minority of children of participants had partial or no vaccinations at age 2 ( = 200, 15.1%). A total of 60.4% of mothers ( = 798) intended to vaccinate their children with the SARS-CoV-2 vaccine, 8.6% ( = 113) did not intend to vaccinate and 31.0% ( = 410) were unsure. Lower education, lower income and incomplete vaccination history were inversely associated with intention to vaccinate. Thematic analysis of qualitative responses showed 10 themes, including safety and efficacy, long-term effects and a rushed process.

Interpretation: Within a cohort with historically high infant vaccination, a third of mothers remained unsure about vaccinating their children against SARS-CoV-2. Given the many uncertainties about future SARS-CoV-2 vaccines, clear communication regarding safety will be critical to ensuring vaccine uptake.
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http://dx.doi.org/10.9778/cmajo.20200302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177949PMC
May 2021

Disentangling adversity timing and type: Contrasting theories in the context of maternal prenatal physical and mental health using latent formative models.

Dev Psychopathol 2021 May 21:1-13. Epub 2021 May 21.

Department of Psychology, Faculty of Arts, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Canada.

Research on the effects of adversity has led to mounting interest in examining the differential impact of adversity as a function of its timing and type. The current study examines whether the effects of different types (i.e., physical, sexual, and emotional abuse) and timing (i.e., early, middle childhood, adolescence, or adulthood) of adversity on maternal mental and physical health outcomes in pregnancy, are best accounted for by a cumulative model or independent effects model. Women from a prospective pregnancy cohort (N =3,362) reported retrospectively on their experiences of adversity (i.e., physical, sexual, and emotional abuse) in early childhood (0-5 years], middle childhood (6-12 years], adolescence (13-18 years], and adulthood (19+ years]. Measures of overall health, stress, anxiety, and depression were gathered in pregnancy. Results showed that a cumulative formative latent model was selected as more parsimonious than a direct effects model. Results also supported a model where the strength of the effect of adversity did not vary across abuse timing or type. Thus, cumulative adversity resulted in greater physical and mental health difficulties. In conclusion, cumulative adversity is a more parsimonious predictor of maternal physical and mental health outcomes than adversity at any one specific adversity timing or subtype.
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http://dx.doi.org/10.1017/S0954579421000353DOI Listing
May 2021
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