Maternal insecure attachment representation as a long-term risk factor for disrupted mother-child-interaction and child mental health.

Maternal childhood maltreatment (CM) represents an important factor in the transmission of trauma that may lead to impaired child mental health. Apart from childhood maltreatment insecure attachment has been identified as a risk factor for insensitive caregiving behavior, which may affect child's mental health. The aim of this study is to identify the working mechanisms in the relationship between maternal CM and child mental health, considering maternal attachment representation, mother-child-interaction und maternal helplessness and fear. N = 103 mother-child-dyads from a longitudinal cohort study were examined at four different measuring points. Data was assessed using self and external report questionnaires as well as the AMBIANCE scales during the Strange Situation Procedure and the Adult Attachment Projective Picture System (AAP). Maternal CM experience did not predict an insecure attachment representation (OR = 2.46 [0.98, 6.53], p = .060). Maternal insecure attachment was associated with higher AMBIANCE scores (F(8, 94) = 11.46, p < .001), which indicates more disrupted communication between mother and child. AMBIANCE scores in turn predicted higher self-perceived helplessness (F(9, 93) = 8.62, p < .001) and fear (F(9, 93) = 7.40, p < .001) in mothers. Helplessness and fear both were associated with higher SDQ-scores, indicating more mental health problems in children (F(10, 92) = 3.98, p < .001; F(10, 92) = 3.87, p < .001). The results of this study highlight how even insecure attachment in a low-risk sample has a long-term impact on parenting behavior and child mental health, therefore underlining the need of early intervention programs in affected and at-risk families.

Dealing with the challenges of the pandemic - results of a population-based survey during the second year of the COVID-19 pandemic contrasting benefits and burden.

BACKGROUND: The pandemic and the associated consequences have been ongoing stressors with severe impacts on the population and particularly on families. Research focusing on groups dealing well with the challenges of the pandemic is scarce. Here, we aimed to identify groups being well-adjusted during the pandemic and associated predictors. METHODS: A representative sample of the German population (N = 2,515, 51.6% women, 50.09 years), and a subsample of persons with children or adolescents under the age of 18 (N = 453, 60.3% women, 40.08 years) was assessed from July to October 2021. As huge differences in coping with the pandemic are seen, cluster analysis was performed. RESULTS: Persons in the "well-adjusted cluster" were characterized by higher quality of life, better coping with the pandemic and lower burden of the pandemic. The family subsample well-adjusted cluster was characterized by lower pandemic-associated burden, lower parental stress compared to before the pandemic and a better relationship with the child. Fewer mental health symptoms and less pandemic-associated negative impact on career predicted membership of the well-adjusted cluster in both samples. An interaction between mental health symptoms and the negative impact of COVID-19 on the career was found. CONCLUSIONS: Our results underscore the importance of mental health and work-related factors for coping with the pandemic.

Acute response to the October 7th hostage release: rapid development and evaluation of the novel ReSPOND protocol implementation within a children's hospital.

BACKGROUND: The decision to allocate hospitals for the initial reception of hostages abducted on the October 7th Hamas attack introduced an array of unprecedented challenges. These challenges stemmed from a paucity of existing literature and protocols, lack of information regarding captivity conditions, and variability in hostage characteristics and circumstances. OBJECTIVE: To describe the rapid development, implementation and evaluation of the Hostage-ReSPOND protocol, a comprehensive trauma-informed procedure for the care of hostages, including young children, their caregivers and families, immediately following their release from prolonged captivity. METHODS: A multidisciplinary expert focus group conducted a comprehensive literature review to develop the ReSPOND protocol, consisting of: Readiness of teams via multifaceted trainings, utilizing live simulations and video debriefings; Specialized professional teams experienced in providing holistic trauma-informed care; Personalized care tailored to individualized and developmentally-informed needs; Optimal safety rooted in creating a secure environment and trauma-informed response to young children, adolescents, caregivers and families; and Navigating Discharge, through coordination with community-based care systems. RESULTS: A designated facility at the Children's hospital was carefully prepared for receiving 29 hostages, aged 3.9-80 years, 28% under the age of 18. Implementation of the ReSPOND protocol, which prioritized holistic psychosocial interventions above urgent medical care, proved feasible and effective in managing the diverse and complex needs of returnees as per provider report. Finally, systemic assessment of returnee's immediate and long-term mental health needs proved highly challenging. CONCLUSIONS: There is currently no literature addressing the response to released hostages, especially those involving infants, young children and families within a children's hospital facility. This study has the potential to fill a crucial gap in knowledge by introducing a novel protocol which could offer valuable insights for public health organizations tasked with providing acute care to diverse individuals and families experiencing extreme, multi-layered mass traumatization.

[Rapid assistance for victims of acute violence-Current treatment in outpatient trauma clinics in Germany]. / Schnelle Hilfen für Betroffene von akuter Gewalt ­ aktuelle Versorgung in Traumaambulanzen in Deutschland.

BACKGROUND: Assistance following acute violence was previously regulated by the Victim Compensation Act (OEG). At the beginning of the current year it was replaced by the Social Code XIV (SGB XIV). The SGB XIV defines new groups of beneficiaries, outpatient trauma clinics must be provided nationwide and binding criteria for the quality of care were established. The aim of this study was to map the current status of care in outpatient trauma clinics in accordance with the requirements of the new SGB XIV. With respect to new beneficiaries, the status of services for victims of human trafficking was recorded as an example. METHODS: Outpatient clinics that provide rapid assistance under the OEG or SGB XIV were surveyed on structural and content-related aspects of their work. An online survey consisting of 10 thematic modules was used. Data were obtained from a total of N = 110 outpatient clinics (response rate 50%). RESULTS: The participating outpatient clinics reported a wide range in terms of the number of staff and the number of people seeking counselling. Some of the outpatient clinics reported deficits with respect to structural aspects, such as the waiting time for the initial consultation and specific training in trauma treatment for staff. The majority of outpatient clinics were uncertain about how to deal with victims of human trafficking. DISCUSSION: Outpatient trauma clinics appear to reach their target population and provide appropriate services for their care; however, a significant number of outpatient clinics need to make improvements in order to fulfil the quality criteria of SGB XIV and provide adequate care to new groups of beneficiaries.

Corrigendum: Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood.

[This corrects the article DOI: 10.3389/fpsyt.2022.919191.].

Serum Concentration-Dose Relationship and Modulation Factors in Children and Adolescents Treated with Fluvoxamine.

INTRODUCTION: Fluvoxamine is used in children and adolescents ('youths') for treating obsessive compulsive disorder (OCD) but also off-label for depressive and anxiety disorders. This study aimed to investigate the relationship between fluvoxamine dose and serum concentrations, independent correlates of fluvoxamine concentrations, and a preliminary therapeutic reference range (TRR) for youths with OCD and treatment response. METHODS: Multicenter naturalistic data of a therapeutic drug monitoring service, as well as prospective data of the 'TDM Vigil study' (EudraCT 2013-004881-33), were analyzed. Patient and treatment characteristics were assessed by standardized measures, including Clinical Global Impressions-Severity (CGI-S) and -Change (CGI-I), with CGI-I of much or very much improved defining treatment response and adverse drug reactions using the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale. Multivariable regression analysis was used to evaluate the influence of sex, age, body weight, body mass index (BMI), and fluvoxamine dose on fluvoxamine serum concentrations. RESULTS: The study included 70 youths (age = 6.7-19.6 years, OCD = 78%, mean fluvoxamine dose = 140.4 (range = 25-300) mg/d). A weak positive correlation between daily dose and steady-state trough serum concentrations was found (rs = 0.34, p = 0.004), with dose variation explaining 16.2% of serum concentration variability. Multivariable correlates explaining 25.3% of the variance of fluvoxamine concentrations included higher fluvoxamine dose and lower BMI. Considering responders with OCD, the estimated TRR for youths was 55-371 ng/mL, exceeding the TRR for adults with depression of 60-230 ng/mL. DISCUSSION: These preliminary data contribute to the definition of a TRR in youth with OCD treated with fluvoxamine and identify higher BMI as a moderator of lower fluvoxamine concentrations.

A Pilot Study on the Influence of Maternal Attachment Representations on Maternal Heart Rate Mediated by Perceived Stress.

Past findings have suggested that there is a link between attachment representations and reactions towards stress (subjective and physiological). The aim of this study was to examine the mediating effect of perceived stress on the association between attachment representation and physiological changes, specifically heart rate. As part of a long-term study investigating the transgenerational transmission of childhood maltreatment, n = 163 mothers participated in multiple assessments. The Adult Attachment Projective Picture System (AAP) was used to measure maternal attachment representation, categorizing individuals as securely or insecurely attached. Perceived daily stress was assessed using the Perceived Stress Scale 14 (PSS-14), and maternal baseline heart rate (HR) was measured via electrocardiography during a laboratory visit. The results revealed that the representation of secure attachment had a significant reducing effect on both the mother's perceived daily stress and heart rate. Furthermore, the association between secure attachment representation and heart rate was mediated by perceived stress. This study emphasizes the role of attachment representation in maternal well-being, highlighting its impact on stress and physiological responses.

Utilization of Mental Health Provision, Epistemic Stance and Comorbid Psychopathology of Individuals with Complex Post-Traumatic Stress Disorders (CPTSD)-Results from a Representative German Observational Study.

Background: Complex post-traumatic stress disorder (CPTSD) is a severely debilitating recently added symptom cluster in the International Classification of Diseases (ICD-11). So far, only limited information on mental health treatment-uptake and -satisfaction of individuals with CPTSD is available. The aim of this study is to investigate these aspects in a representative sample of the German general population. Methods: Participants completed the International Trauma Questionnaire (ITQ) to identify participants with CPTSD, as well as questionnaires on mental health treatment uptake and satisfaction, adverse childhood experiences, anxiety, depression, working ability, personality functioning, and epistemic trust. Results: Of the included n = 1918 participants, n = 29 (1.5%) fulfilled the criteria for CPTSD. Participants with CPTSD had received mental health treatment significantly more often than participants with PTSD or depression (65.5% vs. 58.8% vs. 31.6%; p = 0.031) but reported significantly less symptom improvement (52.9% vs. 78.0% vs. 80.0%; p = 0.008). Lower levels of epistemic trust were associated with higher CPTSD symptoms (p < 0.001). Conclusions: Our study shows that while the vast majority of individuals with CPTSD had received mental health treatment, subjective symptom improvement rates are not satisfactory. CPTSD was associated with a broad number of comorbidities and impairments in functioning. Lower levels of epistemic trust may partially explain worse treatment outcomes.

[Assessing Relationship Satisfaction with Four Items? Psychometric Evaluation of the Ultra-short German Version of the Dyadic Adjustment Scale (DAS-4)]. / Erfassung der Partnerschaftszufriedenheit mit vier Items? Psychometrische Evaluation der deutschen Version einer Kurzform der Dyadic Adjustment Scale (DAS-4).

The quality of an individual's relationship plays a central role in their personal well-being as well as their mental and physical health. Despite its great importance, there are only a few ultra-short self-report measures for the assessment of relationship quality. An exception is the four-item version of the Dyadic Adjustment Scale (DAS-4), which is gaining increasing popularity internationally. In this study, the German version of the DAS-4 was evaluated for the first time with regard to its psychometric properties in a general population sample of individuals in a romantic relationship (N=1296). In addition to satisfactory item characteristics, the unidimensional measurement model showed sufficient goodness of fit and the internal consistency was satisfactory (ω=0.80). Measurement invariance was shown for men and women based on the latent construct of the DAS-4. In line with the hypothesis, associations of the DAS-4 with gender, general life satisfaction, psychopathology and attachment styles were found, which suggests construct validity. Despite the lack of application experiences and pending psychometric analyses of the DAS-4 in relevant target groups, such as individuals in couples counselling or therapy, the four-item version can be recommended for assessing relationship satisfaction.

[Ritual sexual abuse : Orientation to patient well-being in a polarized debate]. / Ritueller sexueller Missbrauch : Orientierung am Patientenwohl in einer polarisierten Debatte.

BACKGROUND: The background to this article is a polarized media debate about ritual violence against children in German speaking countries. Two opposing positions have formed, which are unable to engage in a reasonable exchange with each other. OBJECTIVE: The article therefore aims to contribute to bridging the differences and argues, above all in the interests of patient well-being, for positioning oneself beyond polarization and to reflect on an evidence-base in treatment as well as in scientific discourse. MATERIAL AND METHODS: The article is based on a critical examination of exemplary scientific literature, public investigation reports and diverse media coverage. RESULTS: In certain psychotraumatology circles and in the media (especially on social media, such as telegram), there is a conspiracy narrative about a large network of perpetrators who inflict the most serious sexual violence on children in a ritual context. An uncritical belief in this has already led to mistreatment of patients and also to a fundamental mistrust of their statements. This threatens these already vulnerable patients with further harm, which contradicts the basic principles of medical ethics.

Running in the FAMILY: understanding and predicting the intergenerational transmission of mental illness.

Over 50% of children with a parent with severe mental illness will develop mental illness by early adulthood. However, intergenerational transmission of risk for mental illness in one's children is insufficiently considered in clinical practice, nor is it sufficiently utilised into diagnostics and care for children of ill parents. This leads to delays in diagnosing young offspring and missed opportunities for protective actions and resilience strengthening. Prior twin, family, and adoption studies suggest that the aetiology of mental illness is governed by a complex interplay of genetic and environmental factors, potentially mediated by changes in epigenetic programming and brain development. However, how these factors ultimately materialise into mental disorders remains unclear. Here, we present the FAMILY consortium, an interdisciplinary, multimodal (e.g., (epi)genetics, neuroimaging, environment, behaviour), multilevel (e.g., individual-level, family-level), and multisite study funded by a European Union Horizon-Staying-Healthy-2021 grant. FAMILY focuses on understanding and prediction of intergenerational transmission of mental illness, using genetically informed causal inference, multimodal normative prediction, and animal modelling. Moreover, FAMILY applies methods from social sciences to map social and ethical consequences of risk prediction to prepare clinical practice for future implementation. FAMILY aims to deliver: (i) new discoveries clarifying the aetiology of mental illness and the process of resilience, thereby providing new targets for prevention and intervention studies; (ii) a risk prediction model within a normative modelling framework to predict who is at risk for developing mental illness; and (iii) insight into social and ethical issues related to risk prediction to inform clinical guidelines.

Organized sexualized and ritual violence: Results from two representative German samples.

BACKGROUND: Organized sexualized and ritual abuse (ORA), a contentious issue since the 1980s, remains a polarizing topic. Although there is much debate about the existence of this phenomenon, a differentiated perspective is lacking, and no representative study has yet addressed the frequency. OBJECTIVE: This paper aims to investigate the frequency of ORA in Germany using two representative datasets. PARTICIPANTS AND SETTING: Data were collected from representative samples of the German population (N = 2522, N = 2515). Participants aged 16 to 96 years (50 and 53 % female) were recruited. They were selected by a random route procedure and asked to fill out a paper-pencil-questionnaire. METHODS: The four aspects of ORA (severe sexual violence, perpetrator networks, commercial exploitation, ideology) were assessed based on the definition provided by an expert group. Additionally, in the second survey, a direct yes/no question about the experience of ORA as well as details on perpetrators and offense characteristics were surveyed. RESULTS: Frequency of ORA was low. The direct question on ORA was affirmed by 0.5 % (n = 13), while according to the criteria of the definition, only 0.2 % or less of individuals experienced organized sexualized abuse, and <0.1 % experienced ritual abuse. CONCLUSION: Although ORA is discussed thoroughly, frequencies in the German population are low. This may be due to inconsistent terminology and operationalization of definitions with lack of precision. However, an intersection of conspiracy beliefs and the topic of ritual violence sheds another light on this issue that should receive more attention.

Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia's invasion of Ukraine in 2022.

BACKGROUND: With Russia's invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription. MAIN BODY: In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems. CONCLUSION: As children's and adolescents' mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.

Suicidal ideation in patients with diabetes and childhood abuse - The mediating role of personality functioning: Results of a German representative population-based study.

AIMS: Suicidal ideation (SID) in patients with diabetes mellitus is increasingly acknowledged. Still, the underlying mechanisms are unclear. We examined SID prevalences in patients with diabetes, its association with different types of abuse, and a mediating effect of personality functioning. METHODS: In a representative population sample (N = 2,515), diabetes, SID, abuse (ICAST-R), personality functioning (OPD-SQS), and depression/anxiety (PHQ-4) were assessed by self-report. Statistical analyses comprised Chi2-Tests, logistic regression and mediation analyses. RESULTS: The prevalence of SID (21.8 %) was three fold higher in patients with diabetes compared to the general population. Abuse further increased the likelihood to report SID in diabetes patients (sexual: 48.1 % vs. 18.2 %; χ2(1) = 12.233, p <.001; emotional: 35.7 % vs. 15.7 %; χ2(1) = 10.892, p <.001). A dose-response relationship between the number of abuse experiences and SID was observed (one abuse experience: OR = 1.138, 95 %-CI [0.433, 2.990], p =.793, >2 abuse experiences: OR = 2.693, 95 %-CI [1.278, 5.675], p =.009). Impaired personality functioning had an indirect effect on the association between emotional abuse and SID (b = 0.25, 95 %-CI [0.037, 0.551]). CONCLUSIONS: Diabetes patients experience increased SID prevalences, especially those with emotional or sexual abuse. In individuals with a history of emotional abuse, impaired personality functioning partly explained SID and should therefore be considered and addressed in this patient group.

Long-term consequences of childhood emotional abuse in mothers on parental load and child mental health.

BACKGROUND: Childhood emotional maltreatment can be associated with long-term consequences on mental health. In addition, transgenerational transmission of adverse childhood experiences to the next generation can occur and thus have an impact on the mental health of one's own children. OBJECTIVE: The purpose of this study was to examine the role of stress on the association between childhood emotional maltreatment and parental load what is referred to in this study as limitations in parental functioning that affect the resources available to parents to cope with the demands of raising, caring for, and providing for their child. Furthermore the effect of parental load on the mental health of one's own children will be examined. PARTICIPANTS AND SETTING: N = 237 mother-child dyads (age mother M = 33.76, SD = 4.07 years; age child M = 11.91 months, SD = 0.89 months) from a longitudinal cohort study were examined at two different measuring points. METHODS: Emotional abuse, perceived stress, parental load and child mental health were assessed using self and external report questionnaires. RESULTS: The calculation of a mediation showed that the association of emotional abuse and parental load was completely mediated by perceived stress (indirect effect ab = 0.44, 95 %-CI[0.17, 0.78]). In addition, effects of parental load on the child's mental health (ß = 0.13, 95%CI [0.07;0.20]), mainly hyperactivity (ß = 0.06, 95%CI [0.03;0.11]) and prosocial behavior (ß = -0.04, 95%CI [-0.07; -0.01]), were evident. CONCLUSIONS: The results of this study provide evidence that the mental health of children can be influenced in the long term by increased parental load.