Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed ...to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables.
Since its development, the Strengths and Difficulties Questionnaire (SDQ) has been widely used in both research and practice. The SDQ screens for positive and negative psychological attributes. This ...review aims to provide an overview of the psychometric properties of the SDQ for 4- to 12-year-olds. Results from 48 studies (N = 131,223) on reliability and validity of the parent and teacher SDQ are summarized quantitatively and descriptively. Internal consistency, test-retest reliability, and inter-rater agreement are satisfactory for the parent and teacher versions. At subscale level, the reliability of the teacher version seemed stronger compared to that of the parent version. Concerning validity, 15 out of 18 studies confirmed the five-factor structure. Correlations with other measures of psychopathology as well as the screening ability of the SDQ are sufficient. This review shows that the psychometric properties of the SDQ are strong, particularly for the teacher version. For practice, this implies that the use of the SDQ as a screening instrument should be continued. Longitudinal research studies should investigate predictive validity. For both practice and research, we emphasize the use of a multi-informant approach.
Background: Smoking cessation during pregnancy and preventing relapse postpartum is a pivotal public health priority. Objectives: This study examined the risk and protective indicators of women who ...(a) smoke before pregnancy, (b) smoke during the entire pregnancy, (c) successfully quit smoking during pregnancy, and (d) relapse postpartum. Method: This paper reports secondary analyses of the Dutch population-based Monitor on Substance Use and Pregnancy (2016). A representative sample of mothers of young children ( n = 1,858) completed questionnaires at youth health care centers. Bivariate and multivariate logistic regression analyses were conducted. Results: Main results showed that women’s smoking around pregnancy was strongly associated with the partner’s smoking status before pregnancy, partner’s change in smoking during pregnancy, and partner’s change in smoking postpartum. Women’s educational level and cannabis use before pregnancy were also related with women’s smoking before and during pregnancy. Women’s intensity of alcohol use before pregnancy was ambiguously related with women’s smoking before and during pregnancy. Conclusions: One of the key findings of this study suggests that it is essential that partners quit smoking before pregnancy and do not smoke during pregnancy. If partners continue smoking during pregnancy, they should quit smoking postpartum. Health care professionals can play an important role in addressing partners’ smoking and giving them evidence-based cessation support before, during, and after pregnancy.
Depressive symptoms and disorders are major public health concerns, affecting many adolescents and young adults. Despite extensive research, depression prevention programs for youth show limited ...effectiveness. Moreover, the maximal potential of youth psychotherapy - on which depression prevention programs are based - may have been reached. Commercial video games may offer an engaging alternative vehicle for youth to practice emotional and social skills vital to mental health. The current study investigated the potential for the commercial video game Journey to prevent the exacerbation of depressive symptoms. A pre-registered randomized controlled trial tested the effectiveness of Journey as an indicated depression prevention approach compared to a control game condition and a passive control condition (Dutch Trial Register: NL4873, https://www.trialregister.nl/trial/4873). Additionally, potential action mechanisms for depression prevention using video games were examined. Participants aged 15 to 20 years old with elevated depressive symptoms (
= 244,
= 17.11,
= 1.76, 66.4% female) were given 4 weeks to play Journey (
= 3 h 20 min) or the control game, Flower (
= 2 h 36 min). Results showed no beneficial effects of playing the commercial video game, Journey, on youth's change in depressive symptoms above and beyond the active and passive control conditions up to 12-months after the intervention. Additionally, no action mechanisms were found specifically for Journey. Nevertheless, over the whole study, participants decreased in depressive symptoms, became less sensitive to rejection, and experienced more hope and optimism. Moreover, participants who during the study decreased in rejection sensitivity or rumination or who increased in hope and optimism or in distraction and problem solving showed the strongest decrease in depressive symptoms. Although results do not support the use of the studied commercial game as an effective indicated depression prevention strategy, our results do suggest that rejection sensitivity, hope, optimism, rumination, distraction, and problem solving are promising targets for future depression prevention efforts. We conclude with important lessons for future research on games to promote mental health. Particularly, encouraging careful consideration of research designs to explore for whom and how potential action mechanisms and associated game mechanics may be effective.
Abstract
Background
Recently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement ...this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool.
Methods
Child healthcare professionals (
N
= 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data.
Results
The data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service.
Conclusions
Although healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.
Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as "complex". Yet it ...remains vague what this supposed complexity entails at the individual level. This case-study used a three-step mixed-methods analytical strategy, inspired by complex systems theory. First, we construed a holistic summary of relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential change-inducing mechanisms between different phases.
A woman, living at a residential facility, diagnosed with mild intellectual disability and borderline personality disorder, who shows a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to self-rate challenging behaviors daily for 560 days.
A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care or compliments. Coercive measures increased the chance of challenging behavior the day after and psychological therapy sessions decreased the chance of self-injury the day after. The majority of contemporaneous and lagged associations between these 11 factors and self-reported challenging behaviors were non-significant, indicating that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline 11 distinct stable phases were identified that alternated between four unique states: high levels of aggression and self-injury, average aggression and self-injury, low aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were triggered by extraordinary events in her environment, or preceded by increased fluctuations in her self-ratings, or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when she experiences bad times, keeping in mind that better times lie ahead is hopeful and realistic.
In the study of synchronization dynamics between interacting systems, several techniques are available to estimate coupling strength and coupling direction. Currently, there is no general ‘best’ ...method that will perform well in most contexts. Inter-system recurrence networks (IRN) combine auto-recurrence and cross-recurrence matrices to create a graph that represents interacting networks. The method is appealing because it is based on cross-recurrence quantification analysis, a well-developed method for studying synchronization between 2 systems, which can be expanded in the IRN framework to include N > 2 interacting networks. In this study we examine whether IRN can be used to analyze coupling dynamics between physiological variables (acceleration, blood volume pressure, electrodermal activity, heart rate and skin temperature) observed in a client in residential care with severe to profound intellectual disabilities (SPID) and their professional caregiver. Based on the cross-clustering coefficients of the IRN conclusions about the coupling direction (client or caregiver drives the interaction) can be drawn, however, deciding between bi-directional coupling or no coupling remains a challenge. Constructing the full IRN, based on the multivariate time series of five coupled processes, reveals the existence of potential feedback loops. Further study is needed to be able to determine dynamics of coupling between the different layers.
Studies have linked the use of corporal punishment of children to the development of mental health disorders. Despite the recommendation of international governing bodies for a complete ban of the ...practice, there is little European data available on the effects of corporal punishment on mental health and the influence of laws banning corporal punishment. Using data from the School Children Mental Health Europe survey, the objective of this cross-sectional study was to examine the prevalence and legal status of corporal punishment across six European countries and to evaluate the association between parental use of corporal punishment and children's mental health. The study found that odds of having parents who reported using occasional to frequent corporal punishment were 1.7 times higher in countries where its use is legal, controlling for socio-demographic factors. Children with parents who reported using corporal punishment had higher rates of both externalized and internalized mental health disorders.
Background: Attachment theory's original formulation was substantially driven by Bowlby's (1969/1982) quest for a meaningful model of the development of psychopathology. Bowlby posited that aberrant ...experiences of parenting increase the child's risk of psychopathological outcomes, and that these risks are mediated by the quality of the attachment relationship. To empirically examine this hypothesis, the current study explores the associations between the development of toddler behavior problems and a) maternal unresolved attachment representations, b) maternal interactive behavior, and c) infant attachment relationships. Second, we test the mediating role of disorganized attachment in the association between disruptive behavior and toddler behavior problems, as well as unresolved attachment and behavior problems.
Method: Sixty‐four adolescent mother–infant dyads participated in this longitudinal study. The Adult Attachment Interview was administered at 6 months, the Strange Situation procedure was conducted at 12 months, disrupted behavior was assessed during play interactions at 12 months using the AMBIANCE measure, and the Child Behavior Checklist (CBCL) was used to assess behavior problems at 24 months of age.
Results: Maternal reports of externalizing problems were significantly associated with unresolved representations of attachment, disrupted maternal behavior, and disorganized attachment. Inclusion of these variables in a path analytic model suggested that disorganized attachment mediated the associations between disrupted maternal behavior and externalizing problems. Although the association between unresolved attachment representations and externalizing problems was no longer significant when mediation by disrupted behavior and disorganized attachment was taken into account, this indirect pathway was not significant.
Conclusions: The results are consistent with Bowlby's (1969/1982) original conceptualization of the explanatory role of the attachment relationship in the development and manifestation of behavioral maladaptation. Effects of unresolved attachment on externalizing problems await further explanation.
Background
Clients with severe to profound intellectual disabilities (SPID) and challenging behavior (CB) and the professional caregivers that support them are vulnerable to high stress levels, which ...negatively impact their well-being and the quality of care. CB is thought to result from an increase in the intensity and frequency of clients’ stress experiences. In turn, staff members experience stress in dealing with this behavior, and stressed staff members might behave in ways that increase clients’ stress levels, contributing to the origin and maintenance of CB. Research into these dyadic interactions between clients and staff is scarce for people with SPID, especially in real-life situations. The barriers of studying stress in this population include clients’ difficulties in communicating stress experiences and the lack of an objective continuous measure of stress.
Objective
This paper presents a protocol for studying patterns of physiological stress in 15 client-caregiver dyads in the 30 minutes preceding incidents of CB compared to control periods without CB and the interplay between the stress levels of clients and professional caregivers.
Methods
We will conduct 15 single-case studies to assess patterns of physiological stress in dyads of clients with SPID and professional caregivers prior to CB in several Dutch residential institutes. Client-caregiver dyads will wear the Empatica E4 wristband for 20 sessions of 3 to 8 hours without interruptions of daily routines while caregivers report clients’ CB. The physiological measures obtained will be electrodermal activity (microsiemens) and heart rate (beats per minute). A multilevel model with repeated measures at the incident level nested within the person level will be applied, employing separate models for electrodermal activity and heart rate to compare stress levels in the 30 minutes prior to incidents with control epochs. Covariates in the models include movement, temperature, and gender. In addition, cross-recurrence quantification analyses will be performed to study the synchronization between the stress levels of clients and professional caregivers.
Results
The Ethics Committee of the Radboud University (NL-number: NL71683.091.19) approved the study on February 12, 2020. In total, 15 organizations have declared their commitment to participate in the study. The first result is expected in the spring of 2022.
Conclusions
Study results will demonstrate whether changes in patterns of electrodermal activity and heart rate are apparent in the 30 minutes preceding an incident of CB compared to baseline levels when the client does not engage in CB. The synchronization between caregivers’ and clients’ physiological stress levels will be explored with cross-recurrence quantification analyses. Insights into the physiological stress levels of clients and caregivers may contribute to a reduction of CB and an improvement of both clients’ and caregivers’ safety and well-being.
International Registered Report Identifier (IRRID)
DERR1-10.2196/24911
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