Feeling Not Wanted/Loved and Depression: Does Gender Matter?

Depression affects over 17 million American adults yearly and has been identified as the leading cause of disability in people between the ages of 15 and 44 years. There is evidence that feeling neglect or a lack of parental attachment during childhood is associated with depression. One construct that has been overlooked is love from a parent. The purpose of this study was to analyze the association between individuals who felt not wanted/loved during adolescence and lifetime depression and to examine this association by gender. We examined 5114 participants aged 24–32 years at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health) public use dataset. We used logistic regression analysis to determine the association between an individual feeling not wanted/loved by their parent/caregiver prior to age 18, covariates, and lifetime depression. We then stratified by gender and ran logistic models for both men and women separately. Overall, 16.2% ( n = 827) reported lifetime depression diagnosis, while 16.5% of the participants reported feeling not wanted/loved “often,” while 29.8% reported it as “sometimes.” Feeling not wanted/loved “often” was associated with higher odds of depression (AOR = 3.00; 95% CI, 2.45–3.66; p < .001) versus “sometimes” (AOR = 1.59; 95% CI, 1.31–1.90; p < .001). When stratified by gender, feeling not loved/wanted was associated with depression among both men (AOR = 3.70; 95% CI, 2.60–5.25; p < .001) and women (AOR = 2.73; 95% CI, 2.13–3.48; p < .001). Feeling not loved or wanted by a parent/caregiver during adolescence has serious implications, for both men and women. Future studies should further examine this construct and identify family-based interventions that focus on parent/caregiver and child relationships.

Widening the reach of family-based interventions for Anorexia Nervosa: autism-adaptations for children and adolescents

Family-based interventions are widely recommended as a first line treatment for children and young people with Anorexia Nervosa. There is clear evidence that model-adherent delivery of specific eating disorder focused family interventions has the potential to help adolescents with Anorexia Nervosa, who have typically engaged in extreme dietary restriction and lost a significant amount of weight over a relatively short period of time. Nevertheless, there remains a significant number of young people with restrictive eating disorders for whom family-based interventions for Anorexia Nervosa prove less effective, suggesting adaptations may be indicated for some. In this paper we provide a rationale and structure for considering a number of possible adaptations to the delivery of family-based therapy for anorexia nervosa specifically intended to enhance its relevance and potential effectiveness for children and adolescents on the autism spectrum; a subgroup known to represent a significant minority in eating disorder populations who have been identified as having relatively poor outcomes. Plain English summary Past research has shown that certain family-based treatments are effective for many children and adolescents who develop Anorexia Nervosa. At the same time this type of treatment approach in its current form does not work for everyone. Recent research has highlighted the overlap between anorexia and autism and the need for the development of adaptations to existing treatments to better meet the requirements of people on the autism spectrum who develop anorexia. With this in mind we propose a number of autism-related adaptations that could be made to family-based treatments for anorexia. We hope that these might be formally tested in the future to see if these adaptations improve outcomes for this group of individuals.

Determinants of changes in women’s and men’s eating behavior across the transition to parenthood: a focus group study

Background During the pregnancy and postpartum period, both women and men experience physiological and psychological changes, which may negatively impact their eating behavior. A clear understanding of determinants of changes in eating behavior during this period is needed to facilitate the development of targeted family-based interventions countering unfavorable dietary changes during this critical life period. Methods Thirteen focus group discussions targeting determinants of changes in eating behavior during pregnancy and postpartum were conducted, involving a total of 74 expecting and first-time parents. A semi-structured question guide was used to facilitate the discussions. An inductive thematic approach was used to derive main and sub-categories of determinants from the data. The Determinants of Nutrition and Eating (DONE)-framework was employed to systematically organize and label the categories and determinants. Results Two frameworks were developed; one for the pregnancy and one for the postpartum period, comprising determinants of changes in eating behavior in both women and men. Three main levels of determinants were identified: (1) the individual level, including psychological (e.g., ‘health consciousness’), situational (e.g., ‘effort and convenience’) and biological (e.g., ‘discomfort’); (2) the interpersonal level (e.g., ‘social influence’) and (3) the environmental level, including micro- and meso/macro (e.g., ‘home/environment food availability’). Determinants acting as barriers (e.g., ‘time constraints’) or facilitators (e.g., ‘being a role model’) were identified. Many determinants were mentioned during both (e.g., ‘food knowledge’) or just one investigated period (e.g., ‘physiological changes’ during pregnancy, ‘influence of the baby’ postpartum). Finally, some were described by both parents (e.g., ‘self-regulation’), whereas others were mentioned by women (e.g., ‘(perceived) food safety’) or men (e.g., ‘other priorities’) only. Conclusion The developed frameworks set the foundation for the development of future family-based interventions and may be used already by healthcare providers to provide dietary guidance and support for women and men transitioning into parenthood. A focus on the interplay of individual factors at the biological and psychological level together with situational difficulties during pregnancy is recommended. Postpartum, focus should go to support first-time parents to obtain balance of both maintaining one’s own health and taking care of the baby, on improving self-regulation skills, and on coping with related situational constraints.

Qualitative Exploration of Mealtime Routines and Parental Stress of Children with Pediatric Feeding Disorders: Analysis of Occupational Performance

Pediatric feeding disorders (PFD) affect approximately 25-35% of children with typical development, 40-80% of children with developmental disabilities, and 90% of children with autism spectrum disorder (ASD). Feeding disorders affect families by disrupting mealtime routines, changing family dynamics, and increasing parental stress. Occupational therapy (OT) focuses on client-centered care that facilitates independence in meaningful occupations, including feeding and eating. OTs also play an essential role in assisting, training, and educating parents on effective mealtime strategies that can be implemented and carried over into the home environment. Few research studies show how parents manage behaviors and stress during mealtime routines, and little attention has been placed on how PFD can affect parental stress. This study reinforces the value of OT services that focus on family-based interventions and family-based training, considering rituals, routines, and environment to help decrease parental stress during mealtime routines. Data was collected during face-to-face interviews with parents of children diagnosed with PFD. The data gathered was used to identify and analyze how parents of children with PFD manage behaviors and stress during mealtimes. This study benefits families of children with PFD because it will provide additional resources and advocacy for parents. The benefit of having more resources available for parents regarding mealtime stress and mealtime behaviors is that parents will have more opportunities to find a strategy that will benefit the family routine and dynamic. This study will benefit OT practitioners because it will help guide OT family-based interventions reinforcing the importance of carry-over strategies for parents. Analysis of the data suggested that parents of children with PFD perceive mealtime behaviors as highly stressful. The analysis also showed that parents tend to ignore maladaptive mealtime behaviors during mealtime. However, when this was not successful, they would soothe the child or use punishment such as taking away electronic devices. To relieve stress, parents reported getting outdoors and talking to family or friends as the primary way of reducing stress. The findings from this qualitative study support the need for OTs to incorporate families’ unique habits, routines, and cultural and social norms into parent training to ensure the carry-over of strategies into the respective home environment.

Intervention Programs For Children of Substance Abusing Parents: Realist Review and Program Evaluation Study

Substance abuse is a pervasive issue affecting Canadian families, and a substantial number of children are impacted by alcohol or drug abusing parents. Children exposed to parental substance misuse are at increased risk for negative psychological, emotional, developmental, and behavioural outcomes, and a substantial proportion will go on to experience substance use issues later in life. Early intervention is key to providing support for these children and ultimately disrupting the family cycle of addiction. However, few family-based programs for children of substance abusing families are reported in the literature and information on program theory is lacking. A 2-study dissertation was conducted in order to address these gaps. First, a realist review study was undertaken to systematically review existing evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents. A systematic search of academic and grey literature uncovered over 30 documents spanning 7 different intervention programs. Data were extracted on contexts, mechanisms, and outcomes for each program. Four demi-regularities, or patterns of program functioning, were found to account for the effectiveness of programs included in this review: 1) opportunities for positive parent-child interactions, 2) supportive peer-to-peer relationships, 3) the power of knowledge, and 4) engaging hard to reach families using strategies that are responsive to socio-economic needs and matching services to client lived experience. Second, a program evaluation of the Renascent Children’s Program was conducted in order to determine effective implementation and program outcomes for participating children and parents. A repeated measures, mixed methods design was used with 19 families (26 parents and 26 children) who enrolled in the program over a 16 month period. Results indicate that the Children’s Program yields significant improvements in child emotional and depressive symptoms, child conduct behaviours, parenting skills, parent emotion regulation, family functioning, and family communication. High levels of implementation fidelity were also found. These two dissertation studies shed light on theoretical process of family-based interventions for children of substance abusing parents and provide preliminary evidence of effectiveness of the Children’s Program.

Intervention Programs For Children of Substance Abusing Parents: Realist Review and Program Evaluation Study

Substance abuse is a pervasive issue affecting Canadian families, and a substantial number of children are impacted by alcohol or drug abusing parents. Children exposed to parental substance misuse are at increased risk for negative psychological, emotional, developmental, and behavioural outcomes, and a substantial proportion will go on to experience substance use issues later in life. Early intervention is key to providing support for these children and ultimately disrupting the family cycle of addiction. However, few family-based programs for children of substance abusing families are reported in the literature and information on program theory is lacking. A 2-study dissertation was conducted in order to address these gaps. First, a realist review study was undertaken to systematically review existing evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents. A systematic search of academic and grey literature uncovered over 30 documents spanning 7 different intervention programs. Data were extracted on contexts, mechanisms, and outcomes for each program. Four demi-regularities, or patterns of program functioning, were found to account for the effectiveness of programs included in this review: 1) opportunities for positive parent-child interactions, 2) supportive peer-to-peer relationships, 3) the power of knowledge, and 4) engaging hard to reach families using strategies that are responsive to socio-economic needs and matching services to client lived experience. Second, a program evaluation of the Renascent Children’s Program was conducted in order to determine effective implementation and program outcomes for participating children and parents. A repeated measures, mixed methods design was used with 19 families (26 parents and 26 children) who enrolled in the program over a 16 month period. Results indicate that the Children’s Program yields significant improvements in child emotional and depressive symptoms, child conduct behaviours, parenting skills, parent emotion regulation, family functioning, and family communication. High levels of implementation fidelity were also found. These two dissertation studies shed light on theoretical process of family-based interventions for children of substance abusing parents and provide preliminary evidence of effectiveness of the Children’s Program.