Anxiety Disorders: Stein A

Ramchandani PG, Stein A, O'Connor TG, Heron J, Murray L, Evans J. · Section of Child and Adolescent Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, UK. · J Am Acad Child Adolesc Psychiatry. · Pubmed #18388761 links to  free full text

Abstract: OBJECTIVE: Postnatal depression in women is associated with adverse effects on both maternal health and children's development. It is unclear whether depression in men at this time poses comparable risks. The present study set out to assess the association between depression in men in the postnatal period and later psychiatric disorders in their children and to investigate predisposing factors for depression in men following childbirth. METHOD: A population-based cohort of 10,975 fathers and their children from the Avon Longitudinal Study of Parents and Children (ALSPAC) was recruited in the prenatal period and followed for 7 years. Paternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale and later child psychiatric disorder (DSM-IV) with the Development and Well-Being Assessment. RESULTS: Depression in fathers in the postnatal period was significantly associated with psychiatric disorder in their children 7 years later (adjusted OR 1.72, 95% CI 1.07-2.77), most notably oppositional defiant/conduct disorders (adjusted OR 1.94, 95% CI 1.04-3.61), after adjusting for maternal depression and paternal educational level. A history of severe depression and high prenatal symptom scores for depression and anxiety were the strongest predictors of paternal depression in the postnatal period. CONCLUSIONS: Depression in fathers in the postnatal period is associated with later psychiatric disorders in their children, independently of maternal postnatal depression. Further research into the risks associated with paternal psychopathology is required because this could represent an important opportunity for public health intervention.

Fazel M, Doll H, Stein A. · Oxford University, UK. · Clin Child Psychol Psychiatry. · Pubmed #19293324 No free full text.

Abstract: This report describes an exploratory study of a school-based mental health service developed to address the psychological needs of refugee children. The service was made available in three schools and followed a consultative framework. Refugee children were discussed with the mental health team and children at greatest risk were seen. A questionnaire of psychological functioning was completed by teachers before and after the intervention. Data were collected on 47 refugee children and two control groups (ethnic minority and indigenous white children). Subgroup analyses compared children who were seen directly by the service with those for whom only consultation was provided. Refugee children had poorer overall adjustment at baseline particularly in the emotional and peer problem domains. The greatest improvements following the intervention were seen in hyperactivity for the refugee group and in peer problems for the refugees directly seen by the service. While further studies are necessary to assess its efficacy, this exploratory study indicates that an intervention which involves collaboration with teachers and parents, in an environment where children spend much of their time, can benefit vulnerable children.

Lehtonen A, Jakub N, Craske M, Doll H, Harvey A, Stein A. · Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom. · Depress Anxiety. · Pubmed #18833582 No free full text.

Abstract: BACKGROUND: The aim of this pilot study was to examine whether priming preoccupation (rumination) in healthy participants adversely affects the processing of interpersonal information. METHODS: Sixty female undergraduates with moderate or marked preoccupation proneness (selected on the basis of their high preoccupation on eating, shape, and weight issues) were randomized to receive either a general preoccupation prime, a standardized preoccupation prime, or a control prime. Following the prime, participants watched an 8-min videotape of a family interaction and then were asked free recall questions about the tape. RESULTS: Participants who received the general preoccupation prime scored lower than the other two groups in response to free recall questions regarding emotion-related topics. CONCLUSIONS: These findings suggest that when primed by everyday worries and concerns, individuals prone to preoccupation may have their capacity to recall emotion-related interpersonal information compromised.

Ramchandani PG, Fazel M, Stein A, Wiles N, Hotopf M. · Department of Psychiatry, Oxford University, Oxford, UK. · Acta Paediatr. · Pubmed #17462061 links to  free full text

Abstract: AIM: Recurrent abdominal pain is one of the commonest complaints of childhood, affecting approximately 10% of children at any one time. This study aims to describe the outcome of recurrent abdominal pain amongst 6-year-old children, and to identify risk factors (in both the children and their parents), which predict these outcomes. METHODS: 7128 6-year-old children in the Avon Longitudinal Study of Parents and Children (ALSPAC) were followed up for 1 year. The principle outcomes were abdominal pain, number of days missed from school in the preceding year and psychiatric diagnoses. RESULTS: Children with recurrent abdominal pain at age 6 years had higher rates of further abdominal pain [odds ratio 4.88 (95% CI: 4.01, 5.95)], school absence (10 or more days off school in a year) [OR 1.89 (1.53, 2.33)] and anxiety disorders [OR 2.36 (1.68, 3.32)] at age 7 years. Maternal anxiety was the most consistent predictor of subsequent adverse outcomes for these children. CONCLUSION: Children with recurrent abdominal pain are at significant and continuing risk of adverse functioning. It is important for clinicians to take a whole family perspective, and particularly to consider parental anxiety, when a child with recurrent abdominal pain presents to them.

Nicol-Harper R, Harvey AG, Stein A. · Section of Child and Adolescent Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom. · Infant Behav Dev. · Pubmed #17292789 No free full text.

Abstract: The aim of the study was to examine the impact of anxiety in the postnatal year on maternal contribution to mother-infant interaction. Participants were 32 mothers with high anxiety and 32 mothers with low anxiety, when their infants were aged 10-14 months. Mother-infant interaction was videotaped during a standardized play situation and coded blind to group status. High trait anxiety mothers showed less sensitive responsivity (p<.05) and reduced emotional tone (p<.05) during interaction. When participants scoring high in depressive symptomatology were removed for a subgroup analysis, the same pattern of results was obtained, suggesting that the observed differences in mother-infant interaction were due to group differences in anxiety.

Fazel M, Stein A. · University Department of Psychiatry, University of Oxford, UK. · Arch Dis Child. · Pubmed #12390902 links to  free full text

Abstract: The UK is facing a major increase in the number of people seeking asylum each year, of whom approximately a quarter are children. The stressors to which refugees are exposed are described in three stages: (1) while in their country of origin; (2) during their flight to safety; and (3) when having to settle in a country of refuge. The evidence concerning the impact of displacement on children's mental health is reviewed and a framework for conceptualising the risk factors is proposed. The available literature shows consistently increased levels of psychological morbidity among refugee children, especially post-traumatic stress disorder, depression, and anxiety disorders. The principles underlying the delivery of mental health care for these children are also considered. It is argued that much primary prevention can be undertaken in the school context. Some key aspects of British immigration law are examined and the tension between the law and the best interests of the child principle is discussed. There is particular concern for the plight of unaccompanied children. Attention to the mental health needs of this vulnerable group is urgently required.