JAMA Pediatrics: Psychosocial Issues Topic Collection

Associations of Early Exposure to Intimate Partner Violence and Parental Depression With Subsequent Mental Health Outcomes IPV, Parental Depression, and Mental Health

Bauer NS, Gilbert AL, Carroll AE, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Children with known exposure to intimate partner violence (IPV) or maternal depression are at risk for negative mental health outcomes as early as preschool age. Active ongoing surveillance for these risk factors can lead to earlier mental health intervention for children.

Objective

To examine the association between parent reports of IPV and depressive symptoms within the first 3 years of a child's life with subsequent mental health conditions and psychotropic drug treatment.

Design

Prospective cohort study linking parental IPV and depression with subsequent billing and pharmacy data between November 1, 2004, and June 7, 2012.

Setting

Four pediatric clinics.

Participants

A total of 2422 children receiving care from clinics that implemented the Child Health Improvement Through Computer Automation (CHICA) system.

Main Outcome Measures

Any report of IPV and/or parental depressive symptoms from birth to age 3 years, mental health diagnoses made with International Classification of Diseases, Ninth Revision criteria, and any psychotropic drug treatment between ages 3 and 6 years.

Results

Fifty-eight caregivers (2.4%) reported both IPV and depressive symptoms before their children were aged 3 years, 69 (2.8%) reported IPV only, 704 (29.1%) reported depressive symptoms only, and 1591 (65.7%) reported neither exposure. Children of parents reporting both IPV and depressive symptoms were more likely to have a diagnosis of attention-deficit/hyperactivity disorder (adjusted odds ratio = 4.0; 95% CI, 1.5-10.9), even after adjusting for the child's sex, race/ethnicity, and insurance type. Children whose parents reported depressive symptoms were more likely to have been prescribed psychotropic medication (adjusted odds ratio = 1.9; 95%, CI 1.0-3.4).

Conclusions and Relevance

Exposure to both IPV and depression before age 3 years is associated with preschool-aged onset of attention-deficit/hyperactivity disorder; early exposure to parental depression is associated with being prescribed psychotropic medication. Pediatricians play a critical role in performing active, ongoing surveillance of families with these known social risk factors and providing early intervention to negate long-term sequelae.

Prime Time Sexual Health Outcomes at 24 Months for a Clinic-Linked Intervention to Prevent Pregnancy Risk Behaviors Intervention to Prevent Pregnancy Risk Behaviors

Sieving RE, McRee A, McMorris BJ, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy.

Objective

To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention.

Design

Randomized controlled trial.

Setting

Community and school-based primary care clinics.

Participants

Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey.

Intervention

Offered during an 18-month period, Prime Time includes case management and youth leadership programs.

Main Outcome Measures

Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months.

Results

At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners.

Conclusions and Relevance

This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth.

Effect of Volunteering on Risk Factors for Cardiovascular Disease in Adolescents A Randomized Controlled Trial Volunteering and Cardiovascular Disease Risks

Schreier HC, Schonert-Reichl KA, Chen E. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

The idea that individuals who help others incur health benefits themselves suggests a novel approach to improving health while simultaneously promoting greater civic orientation in our society. The present study is the first experimental trial, to our knowledge, of whether regular volunteering can reduce cardiovascular risk factors in adolescents.

Objective

To test a novel intervention that assigned adolescents to volunteer with elementary school–aged children as a means of improving adolescents' cardiovascular risk profiles.

Design

Randomized controlled trial, with measurements taken at baseline and 4 months later (postintervention).

Setting

Urban public high school in western Canada.

Participants

One hundred six 10th-grade high school students who were fluent in English and free of chronic illnesses.

Intervention

Weekly volunteering with elementary school–aged children for 2 months vs wait-list control group.

Main Outcome Measures

Cardiovascular risk markers of C-reactive protein level, interleukin 6 level, total cholesterol level, and body mass index.

Results

No statistically significant group differences were found at baseline. Postintervention, adolescents in the intervention group showed significantly lower interleukin 6 levels (log₁₀ mean difference, 0.13; 95% CI, 0.004 to 0.251), cholesterol levels (log₁₀ mean difference, 0.03; 95% CI, 0.003 to 0.059), and body mass index (mean difference, 0.39; 95% CI, 0.07 to 0.71) compared with adolescents in the control group. Effects for C-reactive protein level were marginal (log₁₀ mean difference, 0.13; 95% CI, −0.011 to 0.275). Preliminary analyses within the intervention group suggest that those who increased the most in empathy and altruistic behaviors, and who decreased the most in negative mood, also showed the greatest decreases in cardiovascular risk over time.

Conclusions and Relevance

Adolescents who volunteer to help others also benefit themselves, suggesting a novel way to improve health.

Trial Registration

clinicaltrials.gov Identifier: NCT01698034