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Background Schools are natural environments in which to enhance young people’s social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to. Methods A three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ). Discussion The current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group. Trial registration ISRCTN ISRCTN64245549. Retrospectively registered on 10 June 2020

Objective: To identify within-family groups according to sleep schedule, problems, and impact, reflecting similarities or differences in adolescents, mothers, and fathers and to examine how mental health and attachments associate with these triadic sleep groups. Background: Family relationships shape sleeping, but within-family research in adolescence is scarce. Method: Adolescents (17–18 years; 60% girls; n = 438), mothers (n = 448), and fathers (n = 358) filled in the Pittsburgh Sleep Quality Index. The adolescents reported mental health problems by the Behavior Assessment System and the parents by the General Health Questionnaire. All reported attachments by the Experiences in Close Relationships. Results: Cluster analysis identified four triadic sleep groups: “Good family sleep” (47%), “Poor adolescent and maternal sleep” (29%), “Poor paternal sleep” (16%), and “Poor family sleep” (8%). Adolescents in the “Poor family sleep” group had more mental health problems than they did in other groups, and fathers in the “Poor paternal sleep” group showed higher psychiatric symptoms than in the “Good family sleep” or “Poor adolescent and maternal sleep” groups. Adolescents in the “Poor family sleep” group reported higher insecure–anxious attachments than they did in other groups, and fathers reported higher insecure–avoidant and insecure–anxious attachments in the “Poor paternal sleep” than they did in other groups. Conclusion: A family systems approach provides new insight into sleep, mental health, and attachments. Implications: Interventions to improve sleep quality should consider family dynamics that may underlie potential sleep problems, and sleep as a public health issue can benefit from knowledge about family mental health and attachments. publishedVersion

Mothers with prenatal substance use disorder (SUD) often show broad deficits in their reflective functioning (RF), implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF (AAI-RF), regarding parent's own childhood experiences, and parenting-focused RF (PRF) regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview (during pregnancy/pre-intervention), and with Parent Development Interview at 4 months (during intervention). Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months (post-intervention), and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions. publishedVersion

Optimal sleep quality fosters adolescents' wellbeing and, therefore, learning about its developmental determinants is essential. We examined how early family environment (i.e., parent-reported parenting, marital relationship quality, and mothers' mental health), obstetric factors (i.e., infertility history and assisted reproductive treatments, and pre- and perinatal complications and health risks), and children's emotion regulation in middle childhood predicted adolescents' sleep quality. We also tested the mediating role of emotion regulation in linking early determinants to adolescent sleep. Finnish families (N = 984) participated during pregnancy, infancy, middle childhood, and late adolescence. Results showed that only early maternal mental health problems predicted poor adolescent sleep quality. Contrary to hypotheses, emotion regulation did not mediate the effects of early family environment and obstetric factors on later sleep quality. Supporting the early family environment through improving maternal mental health can have long-term positive developmental impacts, including sleep. publishedVersion

Parenting beliefs are important to infant wellbeing, but there is a lack of research into their role in war conditions. We examined (1) how maternal traumatic experiences (war events and childhood abuse) and mental health would be associated with parenting beliefs about good childrearing practices (ethnotheories) and desirable child characteristics (socialization goals) and (2) whether parenting beliefs mediate the impact of traumatic experiences and mental health on mother–infant interaction and infant development. Palestinian mothers (N = 510) participated during pregnancy and at four and 12 months postpartum. They reported current traumatic war events, emotional and physical abuse in their own childhood and mental health (posttraumatic stress disorder, depression, and anxiety symptoms), their ethnotheories and socialization goals and the quality of dyadic mother–infant interactions and infant developmental skills (language, fine-motor, and gross-motor). High maternal exposure to traumatic war events was associated with higher autonomy-enhancing—and lower relatedness-enhancing—socialization goals. Conversely, maternal childhood abuse was associated with higher relatedness-enhancing—and lower autonomy-enhancing—socialization goals. High maternal exposure to traumatic war events was associated with high levels of positive dyadic interaction, whereas high emotional and physical abuse and mental health problems were associated with low levels of positive dyadic interaction. Parenting beliefs did not mediate the impact of maternal traumatic experiences and mental health on dyadic interaction or infant development. The nature of maternal traumatic experiences was central for the socialization goals in unique and specific ways. The findings emphasize the meaningfulness of parenting values, goals, and practices among mothers caring for their infants in war conditions.

Abundant research has shown that traumatic war experiences can interfere with the mental health and wellbeing of children and adolescents, but less is known about the subjective experiences and views of war survivors. The present study identified and described the different types of war experiences of young refugees in an African context and analyzed how they perceived the meanings and impact of war on their lives. The participants were 13 Liberian 25–35-year-old male and female refugees living in Ghana who agreed to take part in semi-structured interviews based on the life history approach. The transcripts were analyzed using a phenomenological method to detect themes incorporating multiple subthemes. The results revealed five main themes about war experiences, all negative in nature: pain and humiliation, loss of close relationships, horrific scenes, threats to life, and fleeing for one’s life. Concerning the perceived meanings and impact of war, the results identified six main themes. Three of them were positive in nature: increased awareness of life, compassion for life, and identification with those suffering. The negative main themes incorporated vivid horrific memories, deprivation of age-appropriate opportunities, and self-harm and destructive behavior. Our findings suggest that young war survivors may be highly motivated to participate in nation- and peace-building and should be provided opportunities to contribute to broader political and civic life.

Background: Schools are considered natural environments in which to enhance students’ social–emotional skills and mental health in general, but they can be especially important for students with refugee and immigrant backgrounds. The current study tested the effectiveness of two school-based interventions in enhancing the mental health and wellbeing of adolescents of native, refugee, and immigrant backgrounds. It further analyzed the role of age, gender, daily stressors, and discrimination in affecting the interventions’ effectiveness. Methods: A three-arm cluster RCT with parallel assignment was applied among the 16 schools. Schools were randomized to three conditions of two active interventions and a waiting-list control condition. Students (n = 1974) filled in an online questionnaire at baseline before the interventions, after the interventions, and at follow-up an average of 9 months after the interventions. The effectiveness criteria were internalizing and externalizing problems, resilience, and prosocial behavior. Results: Interventions were generally not effective in decreasing mental health problems and increasing psychosocial resources. The expected positive intervention effects were dependent on students’ age and gender and exposure to socioeconomic daily stressors. Conclusion: Interventions enhancing teacher awareness and peer relationships at school should be carefully tailored according to the strengths and vulnerabilities of participating students, especially their daily stress exposure, but also age and gender. publishedVersion

Families mobilize psychosocial resources to attune negative consequences of economic hardship, but research is lacking among youth. We propose an Economic Stress Model in Emerging Adulthood ( ESM-EA) conceptualizing age-salient social relationships and financial capability as mediators between economic hardship and well-being. The ESM-EA was tested in a three-wave prospective study following the 2008 economic recession, as part of the Finnish Educational Transitions studies. The sample consisted of 551 emerging adults (55.5% female) who participated at ages 23, 25, and 28. Economic pressures and financial capability mediated the effect of economic hardship on well-being, whereas social relationships did not. Individuals with an unfavorable financial situation at age 25 were more likely to show lower life satisfaction and higher depressive symptoms at 28 when they reported a higher level of economic pressures and a lower level of financial capability. Findings emphasize emerging adults’ age-salient financial adjustments and management in enhancing well-being.

Children share their emotional experiences through narratives, and high-quality narratives are beneficial for their wellbeing and development. This research investigated whether narrative-based interventions in the school context can increase children's emotional intelligence (EI). It tested three intervention settings' effect in their oral and written narrative elements: 1) oral co-narration, 2) literary narrative, and 3) merging co-narrating and literary narrative. The sample consisted of 91 female Iranian students (age = 12±.21), who were selected randomly to these three intervention groups where they received a two-month training and one control conditions with treatment as usual. The Emotional Quotient inventory, the youth version (EQ-i: yv) test, was used to measure the students' EI levels before and after the intervention. The results demonstrated that oral and written narrative have different effects on student's EI. The results revealed a significant increase in the EI score among children who participated in the oral co-narrating group and merged co-narrating and literary narrative intervention group. In contrast, the literary narrative intervention was not effective enough to increase children's EI. In conclusion, oral and written language modes and their merged narrative elements are crucial when tailoring effective school-based interventions to impact students' EI with language minority. Educators need to apply the oral and written narrative elements in their instructional design of the EI interventions considering the narrative style of students. In particular, oral language as the developmentally and socio-culturally appropriate tool can involve student's more with making sense of text and thereby support the learning process in EI interventions. publishedVersion

BackgroundResearch on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways.MethodsWe conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low‐ and middle‐income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review.ResultsWe included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient −0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%.ConclusionsFindings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self‐efficacy and agency.

Adolescence is an important developmental period for social relationships, identity formation and future planning. Traumatic experiences, such as war and persecution, may interfere with optimal development, including the future orientation of adolescents. The present study examines how young adult war survivors construct, make sense of, and narrate their future goals, plans, and expectations. The participants were 13 Liberian 25-35-year old male and female refugees living in Ghana. This qualitative study is based on semi-structured interviews with prompting questions. By applying a phenomenological approach the interview transcripts were categorized into themes and subthemes about future orientations. Results revealed three main themes, two of them desired a positive future orientation, indicating optimism and determination to improve one's own life and to contribute to a flourishing nation and to peacebuilding. The third theme illustrated a failure to reconstruct war-shattered lives and involved pessimistic views of the future. The results are discussed in relation to peacebuilding and the developmental challenges of young adults as war survivors.

Background People in war zones are exposed to heavy metal contamination deriving from new-generation weapons, in addition to exposure to psychologically traumatizing war events. Pregnant women and their children-to-be are particularly vulnerable to both biological and psychological war effects. Objective The aim of the current study was to analyse the impact of maternal prenatal heavy metal contamination on infant emotional development and to examine the potential moderating role of maternal symptoms of post-traumatic stress disorder (PTSD) in the association between heavy metal load and infant emotional development. Methods The participants were 502 Palestinian mothers, pregnant in their first trimester during the 2014 War on Gaza. The mothers were recruited at their delivery (T1) and followed at the infants’ age of 6–7 months (T2; N = 392). The load of five weapon-related heavy metals (chromium, mercury, vanadium, strontium, and uranium) was analysed by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) from mothers’ hair samples at childbirth (T1). Assessment of maternal PTSD symptoms was based on the Harvard Trauma Questionnaire (HTQ) and infant emotional development on the Infant Behavior Questionnaire (IBQ), both reported by mothers (T2). Results Two of the analysed metals, chromium and uranium, adversely predicted children’s early emotional development, indicated by decreased positive affectivity, increased negative emotionality, and problems in early orientation and regulation. Mother’s PTSD did not moderate the impact of heavy metal contamination on children’s emotional development. Conclusions Adverse impact of war is not limited to those who experience it directly, but is passed on to future generations through multiple mechanisms. International organizations are obliged to protect parents and infants from the modern weaponry in wars.

Researchers agree that early marriage (EM) and adolescent pregnancy (AP) can form severe risks for women's somatic, mental, and reproductive health, as well as on educational and social status. Yet, less is known about factors that may moderate or mediate these associations. This study examined, first, retrospectively the impacts of EM and AP on self-reported mental and somatic health among multicultural group of women living in Eastern Anatolia, Turkey. Second task was to analyze whether and how the partner violence would mediate and/or moderate between EM and AP and mental health problems. The participants were 1569 women (16-72 years of age), who reported their age of being married, first pregnancy, and demographic characteristics. They described their mental health status through General Health Questionnaire (GHQ-28: depressive, anxiety, social dysfunction, and somatization symptoms) and symptoms of posttraumatic stress disorder (PTSD; DSM-5). Women's reports of somatic illnesses were classified according to WHO-ICD-10. The revised conflict tactics scale, short form was used as a proxy to partner violence. Women who gave birth at 13-19 years of age reported more anxiety and somatization symptoms than later delivered, and those married younger than 25 showed a higher level of depressive symptoms than later married. Both AP and EM formed a heightened risk for somatic illnesses. The partner violence functioned as a moderator; AP was associated with especially high levels of depressive and anxiety symptoms among women exposed to sexual coercion in their marriage. Non-significant mediation analysis indicates that partner violence did not explain the severe impacts of the AP and EM on women's mental health. Yet, the AP and EM were associated with heightened level of partner violence. Adolescent pregnancy forms a comprehensive mental health risk, and both AP and EM were risks for somatic illnesses, such as cardiovascular problems. The mental health risk of AP further intensified if women experienced sexual coercion in their partnership. Our fundamental work is to abolish these patriarchal phenomena.

In the case of a mother with dysregulating attachment experiences and current enrolment in a parent-infant psychotherapy process, we explored which insecure, hostile/helpless, and prementalizing risk features were similar in her attachment and caregiving representations; which risk features were specific to her caregiving representations; and how these theory-defined features overlapped in detecting caregiving risks. Risk features in the attachment representations were assessed from the adult attachment interview and risk features in the caregiving representations from written psychotherapy notes. We found similar insecure (preoccupied and disorganized), prementalizing and hostile/helpless instances from both the attachment and the caregiving representations. However, confusion between self and child, greater variance in lapses into prementalizing, and specific and concrete fears and helplessness were unique to the caregiving representations. Hostile/helpless instances were found in tandem with almost all insecure and prementalizing instances, indicating this conceptualization captured risks in the caregiving representations most comprehensively. Fearful and helpless caregiving representations occurred somewhat independently from other risk conceptualizations, suggesting they need to be identified as independent phenomena. The results imply that detecting specific manifestations of intergenerational risks from caregiving representations is possible. peerReviewed

Background Maternal prenatal substance use disorder (SUD) represents a dual risk for child wellbeing due to teratogenic impacts and parenting problems often inherent in SUD. One potential mechanism transferring this risk is altered development of children's emotion regulation (ER). The present study examines how mother's prenatal SUD and early mother-infant interaction quality predict children's ER in middle childhood. Method The participants were 52 polysubstance using mothers and 50 non-users and their children. First-year mother-infant interaction quality was assessed with the Emotional Availability (EA) Scales and children's ER with the Children's Emotion Management Scales (CEMS), and its parent version (P-CEMS) at 8–12 years. Results Mother's prenatal SUD predicted a low level of children's adaptive ER strategies, whereas early mother-infant interaction problems predicted a high level of emotion dysregulation. The dyadic interaction also mediated the effect of SUD on emotion dysregulation. In the SUD group, more severe substance use predicted high emotion inhibition. Conclusion Early mother-infant interaction quality is critical in shaping children's ER, also in middle-childhood. Interventions aimed for mothers with prenatal SUD should integrate parenting components to support the optimal development of multiply vulnerable children., Maternal substance use; Prenatal exposure; Emotion regulation; Mother-infant interaction; Prospective study; Middle childhood.

Background Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees’ social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers’ cultural competence and capacity for supporting refugee youths in schools. Methods This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI). Discussion This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools. Trial registration ISRCTN, ISRCTN48178969, Retrospectively registered 20/12/2019.

This prospective longitudinal study examined how maternal prenatal substance use disorder (SUD) and early mother–infant interaction quality are associated with child social cognition (emotion recognition and mentalization) at school age. A sample of 52 poly-substance-using mothers receiving early interventions and 50 non-users, along with their children, was followed from pregnancy to school age. First-year mother–infant interaction quality was measured with EA scales. At school age, child facial emotion recognition was measured with DANVA and mentalization with LEAS-C. SUD group children did not differ from comparison children in social cognition, but higher severity of maternal prenatal addiction predicted emotion recognition problems. High early mother–infant interaction quality predicted better emotion recognition and mentalization, and mother–infant interaction quality mediated the effect of prenatal SUD on emotion recognition. The results highlight the need for early treatments targeting both parenting and addiction, as well as long-term developmental support for these children. Highlights: We examined how mother's prenatal substance use disorder (SUD) and early mother–infant interaction predict child social cognition at school age. Questionnaires, observational and computer tasks were used. Maternal prenatal addiction severity and early parenting problems predicted problematic child social cognition. Early interventions should simultaneously target addiction and parenting. Attention should also be paid to the long-term developmental support of children. publishedVersion

This chapter presents developmental and attachment theory approaches to understanding the impacts of political violence on children and families. It argues that each developmental period provides unique resources and vulnerabilities. The chapter focuses particularly on infancy and adolescence. Both are periods in human life when the most intensive socioemotional, neurocognitive, and psychophysiological reorganizations take place. The chapter suggests an attachment theory approach as a way of increasing the understanding of fetal and infant well-being, dyadic interaction, and parenting in conditions of war and political violence. Research based on attachment theory also guides our understanding of adolescents’ socioemotional, cognitive, and behavioral responses to political violence and trauma. The chapter discusses the developmental and attachment theoretical implications for interventions with victims of violence and trauma-affected infants, adolescents, and their families.

Background: Taking care of infants in conditions of war is highly demanding and a few studies reveal the negative impact of war trauma on maternal and infant well-being. Yet, little is known regarding the influence of trauma on infant development and the potential explanatory mechanisms. First, the present study examines how mothers’ prenatal exposure to traumatic war events is associated with infant cognitive, motor, and socioemotional development. Second, it analyses the mediating roles of maternal postpartum mental health problems, quality of dyadic mother-infant interaction, and earlier infant development (at six months) in the association between prenatal traumatic war events and infants’ developmental skills at 18 months. Method: This prospective three-wave study involved 502 Palestinian pregnant females in their first trimester during the 2014 Gaza War and participated at delivery (T1) and when the child was six (T2;N = 392) and eighteen (T3; N = 386) months of age. Mothers reported their exposure to traumatic war events (human and material losses, horrors, and threat to life) at T1 and T2, and researchers photo-documented the extent of destruction at T1. Mothers reported infants’ language, fine- and gross-motor, and socioemotional skills at T2 and researchers tested infants’ motor, cognitive-language and socioemotional skills using the Bayley Scales of Infant development (BSID-II) at T3. Mothers reported their mental health problems (symptoms of post-traumatic stress disorder [PTSD], depression and somatization) at T2 and T3 as well as dyadic interaction quality (the emotional availability self-report, [EA-SR] brief) at T2. Results: First, the structural equation model (SEM) on direct effects indicated, in contrast to our hypotheses, that maternal prenatal exposure to traumatic war events did not associate with infants’ developmental skills at T2 and predicted higher level of developmental skills at T3. Second, as hypothesized, we found two negative underlying mechanisms (paths) between high exposure and low levels of motor, cognitive-language, and socioemotional skills at T3: (1) through increased maternal mental health problems at T2, which then were associated with problems at T3, and (2) through increased maternal mental health problems at T2, which then were associated with a low quality of mother-infant-interaction and low level of infant developmental skills at T2. Conclusion: Improving maternal mental health and encouraging close and positive dyadic interaction can be critical for infant sensorimotor, cognitive, and socioemotional development in war conditions. publishedVersion

This study investigates the protective mental health function of high emotional intelligence (EI), and cognitive skills (CS) among Ghanaian adolescents when exposed to stressful life-events and violence. It examines, first, how exposure to stressful life-events and violent experiences is associated with mental health, indicated by depressive and psychological distress symptoms, and, second, whether EI and CS could serve as possible moderators between stress, violence and mental health problems. Participants were 415 Ghanaian secondary education students. They reported about their depressive symptoms (Bireleson), psychological distress (Strength and Difficult Questionnaire, SDQ), and emotional intelligence (Trait Emotional Intelligence Question-naire, TEIQue), cognitive skills (The Amsterdam Executive Function Inventory). They also reported their stressful life-events and violent experiences. Statistical analyses were conducted using structural equation modeling (SEM). As hypothesized, high level of stressful life events were associated with high levels of depressive symptoms and psychological distress. Yet violent experiences did not associate with mental health problems. Against hypothesis, high levels of EI and CS could not protect adolescents mental health from negative effects of stressful life events or violent experiences. A direct effects were found between low level of EI and CS and high level of mental health problems. The results are discussed in relations to psychological and cultural factors present in EI and CS in adolescence., Psychology, Emotional intelligence, Social skills, Adolescents, Mental health, Stressful life events, Violent experiences, African context.

Supplemental Material, Badges_Ranta for The Economic Stress Model in Emerging Adulthood: The Role of Social Relationships and Financial Capability by Mette Ranta, Raija-Leena Punamäki, Angela Chow and Katariina Salmela-Aro in Emerging Adulthood

Supplemental Material, sup._online_material_2 for The Economic Stress Model in Emerging Adulthood: The Role of Social Relationships and Financial Capability by Mette Ranta, Raija-Leena Punamäki, Angela Chow and Katariina Salmela-Aro in Emerging Adulthood

BSTRACT Theraplay® is a short-term parent–child interaction therapy combining structured, attachment-based, joyful and adult-led playful sessions with reflective guidance work with the parents. This pilot study evaluates the impact of Theraplay® therapy in improving the quality of parent–child interaction and decreasing the internalizing and externalizing symptoms of children diagnosed with emotional and/or behavioral disorders. Participants were eighteen 4–8 year-old children (M = 4.42, SD = 1.54) from two outpatient child psychiatric clinics whose mothers, and in 13 of those cases fathers also participated in the Theraplay® therapy together with the child. Pre- and post- treatment measures included videotaped observations of parent–child interaction quality, and child psychiatric symptoms (CBCL). The results showed improvements in parent–child interaction quality as well as decreases in children’s internalizing and externalizing symptoms. The results of this pilot study indicate that Theraplay® therapy may be an effective treatment among children diagnosed with emotional and/or behavioral psychiatric disorders. Theraplay® is a short-term parent–child interaction therapy combining structured, attachment-based, joyful and adult-led playful sessions with reflective guidance work with the parents. This pilot study evaluates the impact of Theraplay® therapy in improving the quality of parent–child interaction and decreasing the internalizing and externalizing symptoms of children diagnosed with emotional and/or behavioral disorders. Participants were eighteen 4–8 year-old children (M = 4.42, SD = 1.54) from two outpatient child psychiatric clinics whose mothers, and in 13 of those cases fathers also participated in the Theraplay® therapy together with the child. Pre- and post-treatment measures included videotaped observations of parent–child interaction quality, and child psychiatric symptoms (CBCL). The results showed improvements in parent–child interaction quality as well as decreases in children's internalizing and externalizing symptoms. The results of this pilot study indicate that Theraplay® therapy may be an effective treatment among children diagnosed with emotional and/or behavioral psychiatric disorders.

Risk features in mothers' caregiving representations remain understudied in dangerous environments where infants most urgently need protective parenting. This pilot study examines the feasibility of a novel coding system for the Parent Development Interview (PDI) interview (ARR, Assessment of Representational Risk) in assessing 50 war-exposed Palestinian mothers' caregiving representations. First, we explored the content and structure of risks in the representations. Second, we examined associations between the high-risk representations, mothers' pre- and postnatal exposure to traumatic war events (TWE), depressive and post-traumatic stress disorder (PTSD) symptoms, and self-rated emotional availability (EA) with their 1-year-old infants. Following three dimensions of high-risk caregiving representations were identified: self/dyadic dysregulation, unavailable, and fearful. Mothers' prenatal depressive symptoms were associated with dysregulating and fearful representations, and their postnatal PTSD with fearful representations. TWE were not associated with the high-risk representations. Moreover, mothers of boys reported more fearful representations, and mothers with financial difficulties reported more unavailable representations. TWE and high-risk representations were not associated with EA. However, qualitative analysis of the representations indicated risks in the mother-infant relationship. Further, older mothers and mothers with postnatal PTSD reported lower EA. Cultural variance in caregiving representations and the use of self-report measures among traumatized mothers are discussed.

Toxicant, teratogen and carcinogen metal war remnants negatively affect human health. The current study analyzes, first, the persistence of heavy metal contamination in newborn hair in four cohorts across time in Gaza Palestine, second, the change in mothers&rsquo, and infants&rsquo, heavy metal contamination from birth to toddlerhood, and third, the impact of heavy metal contamination on infants&rsquo, and toddlers&rsquo, growth and development. The hair of newborns was analyzed for twelve heavy metals by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) in cohorts recruited at delivery in 2011, 2015, 2016, and 2018&ndash, 2019. In the 2015 cohort, mothers&rsquo, hair samples were taken at delivery, and toddlers and mothers hair were also analyzed 18 months later. Growth levels of infants at six months and toddlers at 18 months were assessed according to World Health Organization (WHO) standards according to a mother report and pediatric check-up, respectively. 1. The level of metal contamination in utero was persistently high across 8 years, 2011, 2015, 2016, 2019, following three major military attacks (2009, 2012, 2014). 2. The 2015 cohort babies exposed in utero to attacks in 2014 at six months showed association of high load at birth in mother of arsenic and in newborn of barium with underweight, of barium and molybdenum in newborn with stunting. 3. Eighteen months after birth, toddlers had a higher level of metals in hairs than when they were born, while, in their mothers, such levels were similar to those at delivery, confirming persistence in the environment of war remnants. Underweight and stunting, both in infants and toddlers, were higher than reported for previous years, as well as being progressive within the cohort. Severe environmental factors, metal contamination and food insecurity put Gaza&rsquo, s infant health at risk.

Based on the ecological-transactional model by Bronfenbrenner, this study tested the mediating roles of school, family, and child characteristics between academic achievement and both traum...

Aim:This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother–infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms.Background:Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities.Methods:The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n= 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby’s age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants’ 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs).Findings:The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.