[Medical Child Abuse - A Guideline to Detecting this Particular Form of Child Maltreatment]. / Medical Child Abuse ­ Ein Leitfaden zur Diagnostik dieser Sonderform der emotionalen und körperlichen Gewalt.

The term Medical Child Abuse (MCA) describes a form of child abuse in which the medical system is "abused" by carrying out unnecessary medical procedures on a child. This abuse of the medical system occurs through misrepresentation, non-disclosure, fabrication, misinterpretation or active causation of symptoms by a parent. In this article, the construct ofmedical child abuse is defined and predisposing and motivational factors are examined. It also provides an overview of terms that are used synonymously or comparably in the literature and discusses the connection between MCA and Munchausen-by-proxy-syndrome.The core of the article is the presentation of an internal guideline, which was created by the interdisciplinary working group on MCA of the Clinics for Paediatric and Adolescent Medicine, the Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, the Child Protection Outpatient Clinic and the Social Services at the Charité. It also outlines possible interventions.

[Diagnostic Options for Suspected Cases of Emotional Maltreatment - Presentation of the Interdisciplinary Perspective of a Child Protection Outpatient Clinic]. / Möglichkeiten der Diagnostik bei Verdachtsfällen von Emotionaler Gewalt ­ Darstellung der interdisziplinären Perspektive einer Kinderschutzambulanz.

Compared to sexual and physical violence, cases of emotional abuse are often more difficult to detect. An increasingly advocated approach involves regular assessments within social and healthcare structures tto proactively identify affected children and adolescents at an early stage. This enables the prompt initiation of appropriate interventions. Following, interdisciplinary institutions such as a child protection outpatient clinic can play an important role for professionals in the clarification of suspected child endangerment.This article aims to show possible courses of action for the early detection of emotional abuse based on a child protection outpatient clinic. In addition to the description of the interdisciplinary diagnostic procedure a selection of psychometric questionnaires and interviews is presented, which inquire about emotional abuse. When looking at the total number of 1,388 cases seen at the child protection outpatient clinic, it is noticeable that only 117 cases (8.4 %) were assigned with a suspicion of emotional abuse.This contrasts with 477 cases (34.3 %) in which confirmed indications for emotional abuse were found after the clarification process. An intersection of emotional abuse with other forms of child maltreatment was given in 341 cases (71.4 %). Psychometric questionnaires and interviews can facilitate a regular recording in health and social service institutions. Emotional abuse often goes unnoticed despite its frequency. Itsmanifestations are diverse and significantly overlap with other forms of maltreatment, necessitating a nuanced evaluation process. Specific diagnostic tools and interdisciplinary collaboration can contribute to better recognition of emotional abuse.

Children with maltreatment exposure exhibit rumination-like spontaneous thought patterns: association with symptoms of depression, subcallosal cingulate cortex thickness, and cortisol levels.

BACKGROUND: Childhood maltreatment is associated with pervasive risk for depression. However, the immediate cognitive and neural mechanisms that mediate this risk during development are unknown. We here studied the impact of maltreatment on self-generated thought (SGT) patterns and their association with depressive symptoms, subcallosal cingulate cortex (SCC) thickness, and cortisol levels in children. METHODS: We recruited 183 children aged 6-12 years, 96 of which were exposed to maltreatment. Children performed a mind wandering task to elicit SGTs. A subgroup of children underwent structural magnetic resonance imaging (N = 155) for SCC thickness analyses and saliva collection for quantification of free cortisol concentrations (N = 126) was collected. Using network analysis, we assessed thought networks and compared these networks between children with and without maltreatment exposure. Using multilevel analyses, we then tested the association between thought networks of children with maltreatment exposure with depressive symptoms, SCC thickness, and cortisol levels. RESULTS: Children exposed to maltreatment generated fewer positively valenced thoughts. Network analysis revealed rumination-like thought patterns in children with maltreatment exposure, which were associated with depressive symptoms, SCC thickness, and cortisol levels. Children with maltreatment exposure further exhibited decreased future-self thought coupling, which was associated with depressive symptoms, while other-related and past-oriented thoughts had the greatest importance within the network. CONCLUSIONS: Using a novel network analytic approach, we provide evidence that children exposed to maltreatment exhibit ruminative clustering of thoughts, which is associated with depressive symptoms and neurobiological correlates of depression. Our results provide a specific target for clinical translation to design early interventions for middle childhood. Targeting thought patterns in children with maltreatment exposure may be an effective strategy to effectively mitigate depression risk early in life.

Magnitude and Correlates of Symptomatic, Global Illness, and Social Functioning Response; Out-of-Home Placement; and Length of Stay in 1,189 Consecutively Hospitalized Children and Adolescents With Mental Disorders.

Objective: To identify outcome predictors in hospitalized youth with mental disorders.Methods: This retrospective analysis of systematically recorded clinical parameters in youth hospitalized for psychiatric treatment in 2004-2015 assessed magnitude and correlates of symptom response (SR), global illness response (GIR), social functioning (SF), out-of-home placement (OOHP), and length of stay (LOS). Backward elimination regression analyses were performed to identify independent baseline correlates of each of the 5 outcomes, with R2 representing the variance explained by the independent correlates retained in the final model.Results: Across 1,189 youth (median age = 14.4 years; interquartile range = 11.6,16.1 years; range, 5-19 years; females = 61.5%), frequencies of coprimary outcomes were as follows: SR = 57.5% (statistically significant correlates = 13, R2 = 0.154), GIR = 30.0% (correlates = 5, R2 = 0.078), SF = 19.0% (correlates = 8, R2 = 0.207), OOHP recommendation = 35.2% (correlates = 13, R2 = 0.275), and mean ± SD LOS = 65.0 ± 37.5 days (correlates = 11, R2 = 0.219). In multivariable analyses, 11 factors were statistically significantly (P < .05) associated with > 1 poor outcome: 4 with 4 outcomes (disturbed social interaction, substance abuse/dependence symptoms; sole exception for both = LOS; disturbed drive/attention/impulse control, sole exception = OOHP; higher admission BMI percentile [but shorter LOS], sole exception = GIR), 3 with 3 outcomes (higher admission age [but good SF and shorter LOS], more abnormal psychosocial circumstances, more mental health diagnoses), and 4 with 2 outcomes (intelligence level [IQ] < 85, obsessive-compulsive disorder symptoms, disturbed social behavior, somatic findings). Additionally, 17 correlates were statistically significantly (P < .05) associated with 1 outcome, ie, SR = 6, OOHP = 5, LOS = 5, SF = 1.Conclusions: Higher admission BMI percentile, disturbed social interaction, disturbed drive/attention/impulse control, and substance abuse/dependence symptoms were independently associated with multiple poor outcomes in mentally ill youth requiring inpatient care. Knowledge of global and specific correlates of poor inpatient treatment outcomes may help inform treatment decisions.

Greater maltreatment severity is associated with smaller brain volume with implication for intellectual ability in young children.

Background: Childhood maltreatment profoundly alters trajectories of brain development, promoting markedly increased long-term health risks and impaired intellectual development. However, the immediate impact of maltreatment on brain development in children and the extent to which altered global brain volume contributes to intellectual development in children with maltreatment experience is currently unknown. We here utilized MRI data obtained from children within 6 months after the exposure to maltreatment to assess the association of maltreatment severity with global brain volume changes. We further assessed the association between maltreatment severity and intellectual development and tested for the mediating effect of brain volume on this association. Method: We used structural MRI (3T) in a sample of 49 children aged 3-5 years with maltreatment exposure, i.e. emotional and physical abuse and/or neglect within 6 months, to characterize intracranial and tissue-specific volumes. Maltreatment severity was coded using the Maternal Interview for the Classification of Maltreatment. IQ was tested at study entry and after one year using the Snijders Oomen Nonverbal Test. Results: Higher maltreatment severity was significantly correlated with smaller intracranial volume (r = -.393, p = .008), which was mainly driven by lower total brain volume (r = -.393, p = .008), which in turn was primarily due to smaller gray matter volume (r = -.454, p = .002). Furthermore, smaller gray matter volume was associated with lower IQ at study entry (r = -.548, p < .001) and predicted IQ one year later (r = -.493, p = .004.). The observed associations were independent of potential confounding variables, including height, socioeconomic status, age and sex. Importance: We provide evidence that greater maltreatment severity in early childhood is related to smaller brain size at a very young age with significant consequences for intellectual ability, likely setting a path for far-reaching long-term disadvantages. Insights into the molecular and neural processes that underlie the impact of maltreatment on brain structure and function are urgently needed to derive mechanism-driven targets for early intervention.

Operationalized Psychodynamic Diagnostic of Adolescents in Light of the New ICD-11 Model of Personality Functioning: Personality Structure, Psychodynamic Conflicts, and Mental Health Problems.

The International Classification of Diseases and Related Health Problems, 11th Revision introduced a fully dimensional approach to personality disorders which conceptionally converges with the long-standing psychodynamic understanding of psychopathology through underlying intra- and interpersonal impairments. In this study, the diagnostic contributions of the two psychodynamic concepts of personality structure and psychodynamic conflicts were investigated through the comparison of self-report data of 189 adolescents with mental health problems and 321 mentally healthy controls. The study results reveal that adolescents with mental health problems show significantly higher impairments in all four domains of personality structure and significantly higher levels of several psychodynamic conflicts. Further, adolescents with different mental health problems significantly differ regarding the impairments in the personality structure domains and several levels of psychodynamic conflicts. While higher structural impairments are shown in adolescents with eating and anxiety disorders, higher levels of the passive self-worth conflict persist in adolescents with depressive disorders, and higher levels of the passive identity conflict are affecting adolescents with eating disorders. The findings suggest that a standardized diagnostic assessment of personality structure and psychodynamic conflicts in adolescent patients could contribute to a deeper understanding of mental health problems and appropriate treatment planning through the detection of underlying intra- and interpersonal impairments.

[Parental Burden, Need for Support and Resources After Almost Two Years of COVID-19-Pandemic: Results of a Representative Study in Germany]. / Elterliche Belastungen, Unterstützungsbedarf und Ressourcen nach fast zwei Jahren COVID-19-Pandemie: Ergebnisse einer repräsentativen Studie in Deutschland.

Studies assessing the burden of families in the second year of the COVID-19-pandemic and the need for support are scarce. Burden, negative and positive changes, resources, and the need for support during the COVID-19-pandemic of a representative sample of 1,087 parents (52,0 % female; mean age 40,4) of minors in Germany were assessed in December 2021. We used a mixed-method approach.More than 50 % percent of parents were burdened about the development of the pandemic (58,5 %), restrictions in activities outside (54,8 %), the mental health of others (54,0 %), and social distance (53,7 %). Parents reported negative changes in partnership (esp. increase in conflicts and crises; 29,4 %), school development (esp. deterioration of school performance; 25,7 %), and mental health of children (38,1 %). In retrospect, over one-third of the parents saw a need for better political communication (36,0 %) and financial support (34,1 %) during the pandemic. In December, 23,8 % of parents still reported the need for support: financial (51,3 %), social (26,6 %), and psychotherapy for themselves (25,8 %). However, parents reported positive changes, especially within the family, feelings of gratitude and new attitudes. Social interaction and positive activities were identified as resources. In the second year of the pandemic, parents experienced much burden and needed support. Interventions and policies should be more targeted and needs-oriented.

Families with Mentally Ill Parents and Their Partners: Overlaps in Psychiatric Symptoms and Symptom Coping.

Partners in families with a mentally ill parent often experience psychiatric symptoms themselves. Recent studies indicate that there might be overlaps in disorder-specific symptom areas between partners and spouses. This study aimed at examining associations in psychiatric symptoms and symptom coping in partners in families with a mentally ill parent, e.g., having a psychiatric diagnosis according to the International Classification of Diseases (ICD-10). Furthermore, a moderation of the psychiatric symptoms of the parent with a mental illness on the association in symptom coping was assumed. Families with at least one parent with a mental illness were recruited into the longitudinal "Children of Mentally Ill Parents" (CHIMPS) trial at seven clinical centers in Germany and Switzerland. In total, 139 families were included in the current study. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI), Clinical Global Impression scale (CGI), Global Assessment of Functioning (GAF), and Patient Health Questionnaire (PHQ), while symptom coping strategies were measured using the Freiburger Fragebogen zur Krankheitsverarbeitung (FKV). Regression analyses have indicated an association in psychiatric symptoms between mentally ill parents and their partners concerning psychosocial functioning, somatic, and stress-related symptoms. Additionally, one symptom coping strategy of the partners was predicted by the same strategy of the parent with a mental illness. The results emphasize the importance of screening and providing support to parents burdened by the mental disorder of their partners, especially regarding the children in these partnerships.

Almost 2 years into the COVID-19 pandemic: an update on parental stress, parent mental health, and the occurrence of child maltreatment.

Increased parental stress, poorer mental health, and an increase in the occurrence of child maltreatment (CM) have been reported in earlier phases of the COVID-19 pandemic. However, data from later phases of the pandemic are not yet available. We conducted a cross-sectional, representative survey among 1087 parents (48.8% female; mean age 41.72 years, SD = 9.15) in Germany in December 2021. Data were compared to a previous representative sample, assessed in August 2020 (N = 1024), and to normative scores of the outcome measures. Predictors for the occurrence of CM were analyzed by logistic regression. Pandemic-related stress and general stress were higher and physical and mental health were poorer in the December 2021 sample than in the August 2020 sample. Occurrence rates of CM varied between 5 and 56%. Verbal emotional abuse (n = 607, 56%), witnessing domestic violence (n = 446, 41%), and emotional neglect (n = 435, 40%) were most frequently reported. For these subtypes, parental risk for alcohol abuse (OR 2.1-2.7) and parental recent experience of violence (OR 2.1-5.1) were the strongest predictors. Across all subtypes of CM, parents reporting child maltreatment showed poorer scores on all stress outcomes, with medium-large-effect sizes. Results confirm a high burden within the families, almost 2 years into the pandemic. Occurrence rates of a broad spectrum of CM subtypes raise further concerns for the well-being of children. Family-oriented intervention efforts are needed to stabilize families and provide targeted support. Longitudinal studies are needed for a description of families at risk for poorer outcomes.

Relationship between Borderline Personality Disorder, Emotional Availability, and Cortisol Output in Mother-Child Dyads.

BACKGROUND: Mothers with borderline personality disorder (BPD) often show altered emotional availability toward their own child and heightened stress vulnerability. The aims of the present study were (1) to examine total cortisol output in saliva during mother-child interaction in mothers with BPD and their children and (2) to test whether maternal nonhostility as a subscale of emotional availability mediates the relationship between maternal BPD and child total cortisol output. METHODS: We investigated 16 mothers with BPD and 30 healthy control mothers (HC) and 29 children of mothers with BPD and 33 children of HC mothers. Children were between 5 and 12 years old. Salivary cortisol was collected prior to and twice after an episode of a 21-min standardized play situation between mother and child. Nonhostility was rated using the emotional availability scales. Analyses of covariance were computed to test for group differences in total cortisol output (measured with area under the curve with respect to ground). Pearson's correlation was calculated to test the association between maternal and child total cortisol output. To test the second question, a mediation analysis according to Preacher and Hayes was conducted. RESULTS: Mothers with BPD and their children had lower total cortisol output. Maternal and child total cortisol output was significantly correlated. Contrary to our hypothesis, maternal nonhostility did not mediate the relationship between BPD and child total cortisol output. CONCLUSION: Results imply that the hormonal stress activity of mothers with BPD and their children is altered, which may reflect modified stress regulation and stress vulnerability in mother and child and may impact on mother-child interaction. The finding of a positive association between mother's and child total cortisol output could indicate an intergenerational transmission of these alterations.

An Empirical Investigation of Psychodynamic Conflicts in Stable Couples.

Introduction: Previous investigations have shown that stressful and pathological developments in couple relationships can be psychodynamically explained by rigid unconscious couple collusions. This manuscript presents and discusses the findings of a pilot study in which the psychodynamic conflicts of stable and "functioning" couples were empirically explored. Methods: We studied 116 couples (N = 232) who were currently married or in a steady relationship, had at least one child together, and showed no signs of mental disorders. Psychodynamic conflicts were measured using the OPD Conflict Questionnaire, and the Patient Health Questionnaire was used to screen for mental disorders. Results: Significant differences in the mean scores of psychodynamic conflicts between mothers and fathers appeared in the individuation versus dependency conflict, the self-worth conflict, and the guilt conflict. The maternal and paternal self-worth conflicts were associated with their socio-economic status. Parent couples mainly showed positive associations in the same coping modes and correlations between different conflict topics. Discussion: Our results provide initial insights into the psychodynamic conflicts of mothers and fathers from a nonclinical population and indicate that healthy and stable couple relationships are characterized by concordant and health-promoting ways of dealing with inner conflicts. Future longitudinal studies are needed to understand the influences of psychodynamic conflicts on the formation and maintenance of well-functioning and lasting relationships between couples.

Clinical Trial Data: Both Parents Having Psychiatric Symptoms as Risk Factor for Children's Mental Illness.

Children of mentally ill parents represent a particularly vulnerable risk group for the development of mental illness. This study examines whether there is a predictive association between children's psychiatric symptomatology and (1) the clinical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10) of their mentally ill parent as well as (2) to families both parents showing psychiatric symptoms. The study is part of the multicenter controlled trial project "Children of Mentally Ill Parents" (CHIMPS). For this purpose, the psychiatric symptomatology of the mentally ill parent (N = 196) and his or her partner (N = 134) as well as the psychiatric symptomatology of their children aged 4 to 18 years (N = 290) was measured using clinical rated ICD-10-diagnosis, self-rated Brief Symptom Inventory (BSI), and Child Behavior Checklist (CBCL). Using multilevel analyses, the severity of the parental psychiatric symptomatology (BSI) was identified as a significant predictor of children's psychiatric symptomatology (CBCL). Children of parents with a personality disorder (ICD-10) were not more affected than children of parents with another ICD-10-diagnosis. However, children with two parents showing psychiatric symptoms (CBCL) were significantly more affected than children with one mentally ill parent. The results of this study support the well-known view that parental mental illness is a risk factor for children's psychiatric symptoms. Therefore, increased support, especially in high-risk families, both parents having psychiatric symptoms, is highly necessary and should be implemented in the future psychotherapeutic family care.

Immediate impact of child maltreatment on mental, developmental, and physical health trajectories.

OBJECTIVE: The immediate impact of child maltreatment on health and developmental trajectories over time is unknown. Longitudinal studies starting in the direct aftermath of exposure with repeated follow-up are needed. METHOD: We assessed health and developmental outcomes in 6-month intervals over 2 years in 173 children, aged 3-5 years at study entry, including 86 children with exposure to emotional and physical abuse or neglect within 6 months and 87 nonmaltreated children. Assessments included clinician-administered, self- and parent-report measures of psychiatric and behavioral symptoms, development, and physical health. Linear mixed models and latent growth curve analyses were used to contrast trajectories between groups and to investigate the impact of maltreatment features on trajectories. RESULTS: Maltreated children exhibited greater numbers of psychiatric diagnoses (b = 1.998, p < .001), externalizing (b = 13.29, p < .001) and internalizing (b = 11.70, p < .001) symptoms, impairments in cognitive (b = -11.586, p < .001), verbal (b = -10.687, p < .001), and motor development (b = -7.904, p = .006), and greater numbers of medical symptoms (b = 1.021, p < .001) compared to nonmaltreated children across all time-points. Lifetime maltreatment severity and/or age at earliest maltreatment exposure predicted adverse outcomes over time. CONCLUSION: The profound, immediate, and stable impact of maltreatment on health and developmental trajectories supports a biological embedding model and provides foundation to scrutinize the precise underlying mechanisms. Such knowledge will enable the development of early risk markers and mechanism-driven interventions that mitigate adverse trajectories in maltreated children.

Families in the COVID-19 pandemic: parental stress, parent mental health and the occurrence of adverse childhood experiences-results of a representative survey in Germany.

Parenting during the COVID-19 pandemic is highly challenging, with parents having to meet various demands simultaneously. An increase in adverse childhood experiences (ACEs) has been widely predicted, but empirical evidence is still scarce. This study aimed to (1) generate representative data on pandemic-related stress, parental stress, general stress, parental subjective and mental health, and the occurrence of ACEs; (2) identify risk factors for an increase in ACEs, and (3) provide qualitative data on parents' experiences. A representative survey was conducted in Germany in August 2020 with 1024 parents of underage children (Mage = 41.70, 50.9% female). More than 50% of parents reported being stressed by social distancing and the closure of schools and childcare facilities. Parental stress increased significantly during the pandemic (d = 0.21). Subgroups of parents also reported very high levels of depressive symptoms (12.3%) and anxiety (9.7%). Up to one-third of the sample reported ACEs in the child's lifetime. In this group, 29.1% reported an increase in children witnessing domestic violence during the pandemic, and 42.2% an increase verbal emotional abuse. These families were characterized by higher parental stress, job losses, and younger parent and child age. Positive aspects of the pandemic related primarily to personal or family life (e.g. slower pace of life, increase in family time). While some parents coped well, a particularly negative pattern was observed in a subgroup of families that experienced an increase in ACEs. Parental stress emerged as important target point for interventions addressing the negative sequelae of the pandemic.

Risk and Protective Factors Associated With Health-Related Quality of Life of Parents With Mental Illness.

Purpose: Health-related quality of life (HRQoL) can be reduced in parents with mental illness (mental illness) who face the dual demands of disabling symptoms and their impact on family, social, and occupational life. This study aimed at analyzing the influence of various factors on HRQoL in parents with mental illness. Method: Baseline data of the German randomized controlled multicenter project CHIMPS (children of parents with mental illness) was used for analyses. The final sample consisted of n = 208 parents with mental illness and n = 197 children and adolescents aged 8-18 years. HRQoL was assessed with the EQ-5D. Results: Parents with mental illness reported significantly lower global and specific HRQoL than the German reference population. They were least satisfied with aspects that relate to anxiety and depression followed by usual activities, pain and discomfort. Better global HRQoL was primarily associated with self-reported physical and mental health, as well as adaptive coping behavior. Associations with mobility, self-care, usual activity, pain and discomfort, anxiety and depression were analyzed and discussed. Conclusions: HRQoL in parents with mental illness is reduced. Clinical interventions should focus on the alleviation of mental health symptoms and probably somatic symptoms and promote adaptive coping skills.

Parents With Mental Illness: Parental Coping Behavior and Its Association With Children's Mental Health.

The relevance of coping behavior for the individual's own mental health has been widely investigated. However, research on the association between coping of parents with a mental illness and their children's mental health is scarce. In the current study, we address the role of several parental coping strategies and their relation to child psychological symptoms. As part of the German randomized controlled multicenter study CHIMPS (children of mentally ill parents), parents with mental illness completed questionnaires on illness-related coping and child mental health symptoms. Children's diagnoses of a mental disorder were assessed with diagnostic interviews. The sample comprised n = 195 parents with mental illness and n = 290 children and adolescents aged 4-18 years. We conducted mixed models to investigate the associations of parental coping strategies with internalizing and externalizing symptoms as well as the diagnosis of a mental disorder in children controlling for sociodemographic factors and parental symptom severity. Parental coping characterized by religiosity and quest for meaning was significantly associated with fewer mental health symptoms and lower odds of a mental disorder in children, whereas a depressed processing style was related to increased internalizing problems in the children. Coping behavior in parents with mental illness is a relevant factor for the mental health of their children and should be considered in preventive interventions.

Assessment of Psychological Distress and Peer Relations among Trans Adolescents-An Examination of the Use of Gender Norms and Parent-Child Congruence of the YSR-R/CBCL-R among a Treatment-Seeking Sample.

Among trans adolescents, increased psychological distress is reported in the literature. The goal of this study was to examine psychological distress, associated peer relations and parent report congruence among the treatment-seeking sample of the Gender Identity Special Consultation (GISC) for youth at the Charité Berlin. Further, differences between the instruments' binary gender norms were investigated. Retrospectively, we analyzed clinical data derived from the GISC. By initial interviews and using the Youth Self-Report and Child Behavior Checklist, n = 50 trans adolescents aged 12-18 years (M = 15.5) were examined for psychological problems and peer relations. Congruence between self and parent report was analyzed by correlations. Half of the sample reported suicidality, self-harm and bullying. Trans adolescents showed significantly higher internalizing and total problems than the German norm population. The congruence between self and parent report proved to be moderate to high. The level of congruence and poor peer relations were identified as predictors of internalizing problems. Significant differences between the female vs. male gender norms emerged regarding mean scores and the number of clinically significant cases. Data provide valuable implications for intervention on a peer and family level. There are limitations to the suitability of questionnaires that use binary gender norms, and further research on adequate instruments and assessment is needed.

Evaluation of an Early Intervention Model for Child and Adolescent Victims of Interpersonal Violence.

Only the minority of youth exposed to traumatic events receive mental health care, as trauma-informed clinical services are lacking or are poorly accessible. In order to bridge this gap, the Outpatient Trauma Clinic (OTC) was founded, an easily accessible early, short-time intervention, with onward referral to follow-up treatment. This report presents the OTC's interventional approach and first outcome data. Using a retrospective naturalistic design, we analyzed trauma- and intervention-related data of the sample (n = 377, 55.4% female, mean age 10.95, SD = 4.69). Following drop-out analyses, predictors for treatment outcome were identified by logistic regression. The majority (81.9%) was suffering from posttraumatic stress disorder (PTSD) or adjustment disorders. Around one forth dropped out of treatment; these cases showed higher avoidance symptoms at presentation. In 91%, psychological symptoms improved. Experience of multiple traumatic events was the strongest predictor for poor treatment outcome (B = -0.823, SE = 0.313, OR = 0.439, 95% CI 0.238-0.811). Around two thirds were connected to follow-up treatment. The OTC realized a high retention rate, initial improvement of symptoms and referral to subsequent longer-term psychotherapeutic treatment in the majority. Further dissemination of comparable early intervention models is needed, in order to improve mental health care for this vulnerable group.

Associations of Family Functioning and Social Support With Psychopathology in Children of Mentally Ill Parents: Multilevel Analyses From Different Rating Perspectives.

Offspring of mentally ill parents is at heightened risk for psychological symptoms. The identification of environmental factors that predict their mental health is crucial for the development of preventive and therapeutic measures. In the current study, we addressed the combined role of family functioning and social support by taking mentally ill patients', their partners', and children's perspectives into account. The cross-sectional sample included n=195 families (195 patients, 127 partners, and 295 children). Family members completed questionnaires related to family functioning, social support as well as parental and child psychopathology. We conducted multilevel analyses to investigate the associations with internalizing and externalizing problems in children. Family functioning and social support were significantly associated with child internalizing and externalizing problems. However, results varied depending on the rating perspective. We found significant interaction effects of family functioning and social support on child psychopathology. The findings point to the importance of family functioning and social support as potential targets for interventions. Findings should be replicated in future longitudinal studies.