Association between abnormal psychosocial situations in childhood, generalised anxiety disorder and oppositional defiant disorder

Objective: Psychosocial stressors are important in the pathogenesis of most mental disorders. However, little is known about the way psychosocial stressors uniquely combine to create risk for different expressions of child and adolescent psychopathology. The purpose of this study was to determine whether core dimensions of stressful psychosocial situations are differentially associated with childhood generalized anxiety disorder and oppositional defi ant disorder.

Method: A case-control design conducted in Trondheim (Norway) from 2002 to 2004 comparing exposure to ICD-10-defi ned abnormal psychosocial situations (Z-codes) among 21 children with oppositional defi ant disorder (ODD) and 22 children with generalized anxiety disorder (GAD) recruited from a university outpatient clinic with 42 non-patient school controls.

Results: Multigroup discriminant analysis extracted two signifi cant dimensions within the psychosocial variables assessed. Function 1 was characterized by overprotection, parental pressures and acute life events and was associated with GAD. Function 2 was characterized by parental abuse/hostility and interpersonal stress and was associated with ODD. Both dimensions were able to correctly classify 89.7% of the cases, compared to 35.9% by chance.

Conclusions: The results indicate that specifi c psychosocial dimensions are differentially related to childhood GAD and ODD. This may be useful in targeting at-risk populations for preventive intervention as well as informing more accurate alignment of psychosocial resources for treatment.

An application of RST in understanding social anxiety and alcohol use

By employing revised-Reinforcement Sensitivity Theory (r-RST) this thesis was the first study to provide important information beyond that afforded by current motivational models in both the social anxiety and alcohol use literature. Specifically, the Fight Flight Freeze system was the most important variable in understanding social anxiety and o-BAS in understanding co-morbid hazardous alcohol use.

Anxiety is more common in children with asthma

Objective There are a variety of reasons why there may be an association between asthma and anxiety in children. Research into the relation between asthma and anxiety has been limited by the sole use of parent-reported or self-reported asthma symptoms to define asthma status. The objective of this study was to determine if children with physician-defined asthma are more likely to suffer anxiety than children without asthma.

Design A population-based, cross-sectional assessment, of self-reported anxiety symptoms.

Setting and participants Children aged 5–13 years from Barwon region of Victoria, Australia. Asthma status was determined by review with a paediatrician. Controls were a sample of children without asthma symptoms (matched for age, gender and school).

Outcome measure The Spence Children's Anxiety Scale (SCAS) written questionnaire. The authors compared the mean SCAS score, and the proportion of children with an SCAS score in the clinical range, between the groups.

Results Questionnaires were issued to 205 children with asthma (158 returned, response rate 77%), and 410 controls (319 returned, response rate 78%). The SCAS scores were higher in asthmatics than controls (p<0.001); and were more likely to be in the clinical range (OR=2.5, 95% CI 1.1 to 5.8, p=0.036). There was no evidence that these associations could be explained by known confounding factors.

Conclusions Children with asthma are substantially more likely to suffer anxiety than children without asthma. Future studies are required to determine the sequence of events that leads to this comorbidity, and to test strategies to prevent and treat anxiety among children with asthma.

Trait motivation and emotion regulation as predictors of anxiety

This thesis demonstrates that high avoidance motivation, low approach motivation, and maladaptive emotion regulation contribute to the prediction of anxiety, within groups at low risk for an anxiety disorder. High avoidance motivation is largely the sole predictor of anxiety for those at high risk for an anxiety disorder.

Precursors and correlates of anxiety trajectories from late childhood to late adolescence

The present research employed a prospective, multi-informant design to examine precursors and correlates of differing anxiety profiles from late childhood to late adolescence. The sample consisted of 626 boys and 667 girls who are participants in the Australian Temperament Project, a large, longitudinal, community-based study that has followed young people's psychosocial adjustment from infancy to adulthood. The present research analyzes data collected from the first 12 waves of data, from 4–8 months to 17 years. Parents, primary school teachers, maternal and child health nurses, and from the age of 11 onward, the young people themselves have provided survey data. Trajectory analyses revealed three distinct patterns of self-reported anxiety from late childhood to late adolescence, comprising low, moderate, and high (increasing) trajectories, which differed somewhat between boys and girls. A range of parent- and teacher-reported factors was found to be associated with these trajectories, including temperament style, behavior problems, social skills, parenting, negative family events, and peer relationships. Compared with male trajectories, female trajectories were associated with a greater variety of psychosocial variables (including parenting and externalizing problems), which may partially account for the higher prevalence of anxiety in adolescent girls compared with boys. Findings shed light on gender-specific pathways to anxiety and the need for comprehensive, integrative approaches to intervention and prevention programs.

Psychosocial mechanisms underlying the emergence of social anxiety in youth

This research illustrates that social anxiety likely emerges in middle childhood in light of developments in social perspectiove-taking ability. Once these abilities develop children experience social anxiety when self-monitoring and doubting their social abilities. This occurs even in children who are relatively well integrated and happy with their social relationships.

Cannabis use and related harms in the transition to young adulthood: a longitudinal study of Australian secondary school students

The current study documents the changing rates of cannabis use, misuse and cannabis-related social harms among Australian adolescents as they grow into young adulthood. It utilised data from a longitudinal study of young people at ages 15, 16, 17, and 19. The rates of cannabis use were found to increase as participants aged; past year use increased from 7.5% at age 15 to 29.8% at age 19. Further, at ages 17 and 19, cannabis use was more prevalent among males than females. Among those who reported cannabis use, the rates of cannabis-related harms were low to moderate, and did not increase with age in the same manner as rates of cannabis use. The most prevalent self-reported cannabis-related harm was anxiety/depression; affecting between 20–30% of the cannabis users at each age. These findings may assist in understanding the extent of cannabis-related problems among youth, and in planning relevant services.

Non-suicidal self-Injury and mindfully coping with anxiety

The present thesis found support for trait anxiety and experiential avoidance playing a part in repetitive non-suicidal self-injury. A cost-effective mindfulness and acceptance-based intervention was also found to be efficacious in improving trait anxiety; life disruption; mindfulness skills; ability to take action; emotional distress tolerance; and avoidant coping.

Depression, anxiety and metabolic syndrome in farm men and women

This research found that Depression was associated with the development of metabolic syndrome, whilst both Depression and Anxiety are associated with the maintenance of metabolic syndrome in Farm men and women. Future interventions in metabolic syndrome should consider screening for and treating these psychological factors to improve health outcomes.

The role of impulsivity in co-occurring social anxiety and substance misuse

The findings of this thesis suggest that a subset of socially anxious individuals are characterised by a paradoxical symptom profile, including elevated levels of impulsivity and co-occurring substance use problems. These findings enhance knowledge regarding the co-occurrence of social anxiety and substance misuse and may inform prevention and treatment practices.

Does gender matter? A one year follow-up of autistic, attention and anxiety symptoms in high-functioning children with autism spectrum disorder

Gender differences in autism spectrum disorder (ASD) symptoms and associated problem behaviours over development may provide clues regarding why more males than females are diagnosed with ASD. Fifty-six high-functioning children with ASD, and 44 typically developing controls, half of the participants female, were assessed at baseline (aged 7–12 years) and one-year later, collecting measures of autism, attention and anxiety symptoms, school placement and support information. Findings indicated no gender differences in autistic symptoms. Males were more hyperactive and received more integration-aide support in mainstream schools, and females were more socially anxious. Overall, similar gender profiles were present across two time points. Lower hyperactivity levels in females might contribute to their under-identification. Implications are discussed using a biopsychosocial model of gender difference.

A case-control study of emotion regulation and school refusal in children and adolescents

The current study aimed to investigate emotion regulation (ER) strategy use in a sample of 21 clinic-referred children and adolescents (10-14 years old) presenting with school refusal, all of whom were diagnosed with at least one anxiety disorder. Being the first known study to examine ER and school refusal, hypotheses were guided by previous research on anxiety. It was hypothesized that the school refusal sample would report less healthy ER strategy use compared to an age- and sex-matched nonclinical sample (n = 21). As expected, the school refusal sample reported less use of cognitive reappraisal and greater use of expressive suppression to regulate their emotions than did the nonclinical sample. Although preliminary, the findings provide important information regarding the emotional functioning of children and adolescents presenting with school refusal. Future directions for research and implications for improved prevention and intervention programs are discussed.

Cigarette smoking and increased anxiety symptoms and disorders

 This research project demonstrated that exposure to cigarette smoke in adolescence, childhood and in utero is prospectively associated with increased levels of anxiety later in life. The results suggest smoking is a plausible risk factor for developing higher levels of anxiety, informing multiple areas for future research into anxiety pathogenesis.

Anxiety, depression, impulsivity and substance misuse in violent and non-violent adolescent boys in detention in China

The present investigation aims to identify the factors which differentiate violent from non-violent juvenile offenders, with a particular emphasis on the association between internalizing psychiatric morbidity (i.e. anxiety and depression), impulsivity, substance misuse, and violence. A total of 323 incarcerated male juvenile offenders from one of three Youth Detention Centers (YDCs) in China were recruited between August 2007 and November 2008. Interviews were conducted by trained psychiatrists using the Barratt Impulsivity Scale (BIS-11), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Birleson Depression Self-Rating Scale (DSRS) to assess impulsivity, anxiety and depression, respectively. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was also used to assess psychiatric diagnoses. Violent offenders had significantly higher BIS-11 total scores, and attention and nonplanning subscale scores (p<0.05). In the multiple logistic regression model, substance use disorders (SUD) and BIS-11 total scores independently predicted violence. Prison-based treatment services designed to reduce impulsivity and substance misuse in juvenile detention facilities should be prioritized.

HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents

BACKGROUND: The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake.

METHODS/DESIGN: HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.

DISCUSSION: This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased.