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- Sequelae of child maltreatment: Umbrella synthesis of 148 meta‐analyses on the mental health correlatesPublication . Coughlan, Barry; Duschinsky, Robbie; Bakermans‐Kranenburg, Marian J.; Bakkum, Lianne; Skinner, Guy C. M.; Markham, Alfred; Beckwith, Helen; Ijzendoorn, Marinus H. vanBackground: Numerous meta‐analyses have established associations between child maltreatment (CM) and mental health difficulties (MH). However, variation exists between meta‐analyses regarding the magnitude of these predictions. Methods: A systematic, quantitative umbrella synthesis (i.e., meta‐analysis of metaanalyses) was undertaken to describe the associations between various types of CM and MH. Meta‐analyses were included if they examined CM, including but not limited to retrospective reports in adulthood, and MH at any point. Included forms of CM were: physical abuse, emotional abuse, sexual abuse, neglect, and exposure to intimate partner violence. MH outcomes were: externalising problems, internalising problems, thought problems, suicidal distress, substance misuse, and other psychological difficulties. Searches were run in January 2024. Random effects models were created in R version 4.2.0. Results: We analysed and combined effect sizes from 148 quantitative metaanalyses, including 668 effect sizes and over 9.5 million data points. CM was associated with all MH outcomes: (1) externalising problems (r = 0.21; 95% CI = 0.18–0.24; k = 32), (2) internalising problems (r = 0.22; 95% CI = 0.20–0.24; k = 46), (3) thought problems (r = 0.24; 95% CI = 0.21–0.27; k = 38), (4) suicidal distress (r = 0.23; 95% CI 0.18–0.28; k = 19), (5) substance misuse (r = 0.19; 95% CI = 0.13–0.26; k = 13), (6) other psychological difficulties (r = 0.24; 95% CI = 0.20–0.28; k = 50). Associations tend to be of similar magnitude for different forms of CM. Conclusion: CM is robustly associated with MH. A parsimonious explanation for these findings would be a common mechanism(s) or a general psychopathology factor conferring high‐risk for different mental health difficulties following CM. The results possibly question the conventional wisdom that suggests some forms of maltreatment are intrinsically more harmful to mental health than others. However, further work is required to understand how potentially confounding factors (e.g., age, measurement of CM) influence these associations.
- Understanding PTSD in Portuguese Youth: Predictors and Risk Factors in a Multi‐Clinic, Treatment‐Engaged SamplePublication . Inês Barroca; Inês Pinto; Paula Saraiva CarvalhoPosttraumatic stress disorder (PTSD) in childhood and adolescence is common. Studies have focused on a small group of predictors related to the traumatic event and still focus on the adult population.To explore the prevalence of PTSD and to identify factors that potentially increase the risk for the development of PTSD in a clinical sample of children and adolescents. Eligibility criteria included: experienced at least one traumatic event; age between 7 and 18 years; follow‐up period of at least 1 month. Data collection was achieved by using: clinical records to obtain the patients’ clinical data; the Clinician‐Administered PTSD Scale and the Checklist of Potentially Traumatic Events in Children and Adolescents. A total of 101 participants were included. The prevalence of PTSD was 35.6%. For pre‐traumatic factors, significant association was found for age, suggesting increased likelihood of PTSD for older participants. Regarding the type of event, PTSD was significantly associated with interpersonal events. Participants who were a single intervenient (involved person) had increased odds for PTSD. It was found that the association with PTSD, in a decreasing manner, occurred with dissociative symptoms, followed by symptoms of Group C (avoidance), Group B (intrusive thoughts), Group E (activation and reactivity) and Group D (cognitions and mood). Dissociative symptoms were significantly associated with PTSD. The study provides evidence that several factors can predict the development of PTSD in childhood and adolescence. Awareness about these factors, healthcare workers’ specific training, and prevention and intervention strategies are the foundation to promote child well‐being throughout life.
- Components of multiple health behaviour change interventions for patients with chronic conditions: a systematic review and meta-regression of randomized trialsPublication . Silva, Carolina C.; Presseau, Justin; Van Allen, Zack; Dinsmore, John; Schenk, Paulina; Moreto, M.; Marques, Marta M.Interventions addressing more than one health behaviour at a time could be an efficient way of intervening to manage chronic conditions. Within a systematic review of multiple health behaviour change (MBHC) interventions, we identified key components of interventions in patients with chronic conditions, assessed how they are linked to theory, behaviour change techniques implemented, and evaluated their impact on intervention effectiveness. Studies were identified by systematically searching five electronic databases. Subgroup analyses and metaregressions were conducted to analyse the association between intervention components and behavioural changes. In total, 61 studies were included spanning different chronic conditions (e.g., cardiovascular conditions, type 2 diabetes). Most interventions sought to change behaviours simultaneously (72%), often targeting the ‘physical activity, diet and smoking’ cluster of behaviours (33%), and were not theory informed (55%). A total of 36 behaviour change techniques were identified, most commonly goal setting behaviour and self-monitoring of behaviour. Subgroup analyses indicated that MHBC interventions delivered entirely face-to-face might not be as effective for physical activity outcomes, and not using goal setting (behaviour) might be more effective for smoking cessation outcomes. Metaregressions indicated that a longer intervention duration may work best to achieve better physical activity outcomes. This review provides a comprehensive understanding of interventions and contributes to the field of MHBC by facilitating data-driven insights for future optimisation and dissemination.
- Positive youth development, mental stress and life satisfaction in middle school and high school students in portugal: outcomes on stress, anxiety and depressionPublication . Carvalho, Marina; Branquinho, Cátia; Moraes, Barbara; Cerqueira, Ana; Tomé, Gina; Noronha, Catarina; Gaspar, Tânia; Rodrigues, Nuno; Matos, M. G.Abstract: The relation between positive youth development and stress, anxiety and depression was studied considering the mediator role of psychological symptoms and life satisfaction. A total of 3109 students included in the “Psychological Health and Well-being” study of the School Observatory participated, including 1618 females and 1491 males aged between 11 and 18 years old (M = 14.45; SD = 1.88), belonging to different school groups in different regions of the country. Adolescents with higher stress, depression and anxiety levels reported lower levels of competence, confidence and connection, as well as more psychological symptoms and lower life satisfaction. The results also showed that adolescents with higher levels of competence, confidence and connection reported less psychological symptoms and more life satisfaction. Two separate mediation analyses were performed to analyse the role of mental distress and life satisfaction on the relationship between positive youth development indicators and stress, anxiety and depression. These analyses confirmed the predicted relationships and partial mediations between mental distress and life satisfaction. These results should be taken into account in public policies concerning young people’s health and education that should involve both targeted and indicated prevention strategies, including school and community-based interventions, in order to be effective.
- The impacts of Alexithymia and sexual distress on sexual functioning among portuguese womenPublication . Ribeiro, Celina Marques; Pereira, HenriqueIntroduction: Recognizing own’s emotions seems to have an important role regarding not only our overall well-being, but also our sexual functioning. Aims: The aim of this study is to analyze the association or impact of alexithymia on female sexual functioning. Methods: 459 Portuguese women, with a mean age of 34.57 years (SD = 10.27), ranging from 18 to 65 years, completed the Toronto Alexithymia Scale (TAS-20), the Female Sexual Distress Scale – Revised (FSDS-R) and, additionally, completed the Female Sexual Function Index (FSFI), indicating if and when a sexual relationship occurred in the last month. Results: The results showed that higher levels of alexithymia were associated with worse sexual functioning and higher levels of sexual distress. Higher levels of sexual distress were associated with worse sexual functioning. It was possible to establish a significant linear regression model between dimensions of alexithymia (difficulties in identifying feelings and difficulties in describing feelings) and sexual distress in sexual functioning; the variables together explained about 45.2% of sexual functioning in these women. Conclusions: The results emphasize the relevance of alexithymia’s dimensions in sexual functioning concerning women with or without sexual dysfunction, since they present themselves as significant predictors. Professionals working in women’s sexual health should take this into account for more effective assessment and intervention in matters concerning sexual health
- Development of the virtual-VIPP and a systematic review of online support for families during the COVID-19 pandemicPublication . Van IJzendoorn, Marinus; Stevens, Eloise; Bakermans-Kranenburg, MarianDuring the COVID-19 pandemic lockdowns made it impossible for parenting coaches to reach the families without digital means of communication. Several studies were initiated to transform existing parenting interventions into hybrid or fully online versions and to examine their feasibility, acceptability and efficacy. We present one such transformation in detail, the Virtual-VIPP which is based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). Furthermore, we report a systematic review of 17 published trials with online versions of parenting programs. Overall, online parenting interventions seem feasible to implement, are well-received by most families, and to show equivalent effects to face-to-face approaches. Careful preparation of technicalities and monitoring of fidelity are prerequisites. Advantages of online parenting interventions are their potentially broader reach, more detailed process documentation, and better cost-utility balance. We expect that online parenting interventions are here to stay, but their efficacy needs to be rigorously tested.
- Effectiveness of Interventions for changing more than one behavior at a time to manage chronic conditions: A systematic review and meta-analysisPublication . Silva, Carolina C.; Presseau, Justin; Van Allen, Zack; Schenk, Paulina; Moreto, M.; Dinsmore, John; Marques, Marta M.Background Health behaviors play a significant role in chronic disease management. Rather than being independent of one another, health behaviors often co-occur, suggesting that targeting more than one health behavior in an intervention has the potential to be more effective in promoting better health outcomes. Purpose We aimed to conduct a systematic review and meta-analysis of randomized trials of interventions that target more than one behavior to examine the effectiveness of multiple health behavior change interventions in patients with chronic conditions. Methods Five electronic databases (Web of Science, PubMed, CINAHL, EMBASE, and Cochrane) were systematically searched in November 2023, and studies included in previous reviews were also consulted. We included randomized trials of interventions aiming to change more than one health behavior in individuals with chronic conditions. Two independent reviewers screened and extracted data, and used Cochrane’s Risk of Bias 2 tool. Meta-analyses were conducted to estimate the effects of interventions on change in health behaviors. Results were presented as Cohen’s d for continuous data, and risk ratio for dichotomous data. Results Sixty-one studies were included spanning a range of chronic diseases: cardiovascular (k = 25), type 2 diabetes (k = 15), hypertension (k = 10), cancer (k = 7), one or more chronic conditions (k = 3), and multiple conditions (k = 1). Most interventions aimed to change more than one behavior simultaneously (rather than in sequence) and most targeted three particular behaviors at once: “physical activity, diet and smoking” (k = 20). Meta-analysis of 43 eligible studies showed for continuous data (k = 29) a small to substantial positive effect on behavior change for all health behaviors (d = 0.081–2.003) except for smoking (d = −0.019). For dichotomous data (k = 23) all analyses showed positive effects of targeting more than one behavior on all behaviors (RR = 1.026–2.247). Conclusions Targeting more than one behavior at a time is effective in chronic disease management and more research should be directed into developing the science of multiple behavior change.
- The first portuguese open dialogue pilot project interventionPublication . Tavares, Sofia; Ribeiro, Joana; Graça, Sofia; Araújo, Bruna; Puchivailo, Mariana; Pereira, João G.Introduction: In 2020, the Directorate General of Health (DGS), a central service of the Ministry of Health in Portugal, approved and co-financed the first Open Dialogue program in the country. The present report aims to demonstrate the preliminary results of the first year of the project, implemented in the northern interior region of Alentejo. Methods: Seven people at the Center of Concern (PCC) and 21 family members/social networks received care through Open Dialogue; four external social workers and psychologists were also involved in the project as members of the support network. A total of 160 network meetings were undertaken, reaching as many as 27 per month in the busiest periods. Based on a previous Italian Research Protocol, developed by Pocobello et al. (non-published manuscript), quantitative and qualitative data were collected in and after the clinical meetings involving PCC and their family/social network, through a multi-method approach: clinical history interview (e.g., generic research on sociodemographic data, duration of untreated symptoms, reasons for requesting help, possible hospitalizations, and/or treatments/therapies) and the following scales applied every five sessions (e.g., CORE-OM, BSI, GAF, and LSNS-6). Results: The preliminary results indicate an improvement in global functioning and the enlargement of social network size/support, a decrease in symptoms, and a negative correlation between the number of sessions and the LSNS6. Medication use remained largely unchanged at the end of the project. Discussion: In general, even with a small sample, the results are considered satisfactory and seem to be aligned with the vast majority of Open Dialogue studies, which for several decades have consistently pointed toward better recovery rates than treatment as usual as well as increased client satisfaction. We expect that the results presented can boost further research and help strengthen the OD approach.
- Well‐being trajectories in breast cancer and their predictors: A machine‐learning approachPublication . Karademas, Evangelos; Mylona, Eugenia; Mazzocco, Ketti; Pat‐Horenczyk, Ruth; Sousa, Berta; Oliveira‐Maia, Albino J.; Oliveira, Jose; Roziner, Ilan; Stamatakos, Georgios; Cardoso, Fatima; Kondylakis, Haridimos; Kolokotroni, Eleni; Kourou, Konstantina; Lemos, Raquel; Manica, Isabel; Manikis, George; Marzorati, Chiara; Mattson, Johanna; Travado, Luzia; Tziraki‐Segal, Chariklia; Fotiadis, Dimitris; Poikonen‐Saksela, Paula; Simos, PanagiotisObjective:This study aimed to described istinct trajectories of anxiety/depression symptoms and overall health status/quality of life over a period of 18 months followinga breast cancer diagnosis,and identify the medical, socio-demographic,lifestyle, and psychologica lfactors that predict these trajectories.Methods:474 females (mean age=55.79 years) were enrolled in the first weeksafter surgery or biopsy. Data from seven assessmentpoints over 18 months, at 3-month intervals,were used. The two outcomeswere assessedat all points. Potential predictors were assessed at baseline and the first follow‐up. Machine‐ Learning techniques were used to detect latent patterns of change and identify the most important predictors. Results: Five trajectories were identified for each outcome: stably high, high with fluctuations, recovery, deteriorating/delayed response, and stably poor well‐being (chronic distress). Psychological factors (i.e., negative affect, coping, sense of control, social support), age, and a few medical variables (e.g., symptoms, immune‐ related inflammation) predicted patients' participation in the delayed response and the chronic distress trajectories versus all other trajectories. Conclusions: There is a strong possibility that resilience does not always reflect a stable response pattern, as there might be some interim fluctuations. The use of machine‐learning techniques provides a unique opportunity for the identification of illness trajectories and a shortlist of major bio/behavioral predictors. This will facilitate the development of early interventions to prevent a significant deterioration in patient well‐being
- Psychedelic treatments for mental health conditions pose challenges for informed consentPublication . Seybert, Carolina; Cotovio, Gonçalo; Madeira, Luís; Ricou, Miguel; Pires, Ana Matos; Oliveira-Maia, Albino J.