BackgroundSince the introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, a limited prosocial emotion (LPE) specifier has been added to the conduct disorder (CD)... Show moreBackgroundSince the introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, a limited prosocial emotion (LPE) specifier has been added to the conduct disorder (CD) diagnosis in addition to the age of onset specifier. It was suggested that this would identify a subgroup with severe antisocial and/or aggressive behavior with serious current and future (mental health) impairment. Research in recent years has shown that this is indeed a subgroup with severe antisocial behavior; however, mental health problems do not appear to differ from those of youth with CD without LPE. Most research to date has been cross-sectional. However, longitudinal research is urgently needed to better understand the predictive value of the LPE specifier. The aim of the current longitudinal study is to examine future offending behavior of youth with CD with compared to youth without the LPE specifier. In addition, the predictive value of the categorical LPE specifier and the dimensional LPE score will be examined beyond factors that are strongly associated with future offending (i.e., gender, age, and prior offending).MethodsAdolescents and young adults (12-25) with CD (assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]) with (N = 61) and without (N = 75) the LPE specifier (assessed with the Callous-Unemotional [CU] dimension of the Youth Psychopathic traits Inventory [YPI]) (in line with Jambroes et al., 2016) were compared on sociodemographic characteristics, mental health problems and offending behavior. Future (general and violent) offending was based on official conviction data.ResultsOur results showed that youth with CD with and without the LPE specifier did not differ in self-reported and informant-reported mental health problems. However, youth with CD with the LPE specifier showed more offending behavior and personality pathology at baseline. In addition, the categorical LPE specifier was associated with future general offending, but not with future violent offending. The dimensional LPE score was associated with both future general and violent offending. However, after adjustment for gender, age, and prior delinquency, these associations disappeared, with the exception of the association between the dimensional LPE score and violent offending, which remained significant even after controlling for gender, age, and prior violent offending.DiscussionIn conclusion, there seems to be evidence of a relationship between limited prosocial emotions and future offending behavior in youth with CD. This relationship, however, should not be overestimated, as there are other (static) factors (e.g. gender and prior offending behavior) that also have a strong influence on future (violent) offending behavior. Still, from a clinical point of view, a dynamic factor like prosocial emotional skills is a good focus for reducing the risk of future offending behavior. Show less
Varghese, N.; Buergin, D.; Boonmann, C.; Stadler, C.; Schmid, M.; Eckert, A.; Unternaehrer, E. 2023
Children in institutional care have a high risk to experience childhood adversities (CAs), with consequences for physical and mental well-being. The long-term effects of CAs on the brain, including... Show moreChildren in institutional care have a high risk to experience childhood adversities (CAs), with consequences for physical and mental well-being. The long-term effects of CAs on the brain, including consequences for neuronal plasticity and sleep, are poorly understood. This study examined the interplay between stress (including CAs), sleep, and brain-derived neurotrophic factor (BDNF), a prominent marker for neuronal plasticity. Participants (N = 131, mean age = 26.3 +/- 3.4 years, 40 females) with residential youth-care history completed questionnaires measuring CAs (Childhood Trauma Questionnaire, CTQ), psychological well-being (World Health Organization-Five Well-Being Index, WHO-5), and sleep disturbances (Pittsburgh Sleep Quality Inventory, PSQI). Hair cortisol and serum BDNF concentration were measured using enzyme-linked immunosorbent assays. The analyses were conducted by using bootstrap regression models. There was no association of stress parameters or sleep with BDNF concentration. However, we found a significant association of CAs and well-being with sleep disturbances. Last, we found an association between CAs and BDNF in sleep-healthy but not sleep-disturbed participants. Our findings indicated a role of sleep disturbance in the association between stress and BDNF. Still, further studies are warranted using vulnerable groups at-risk to understand long-term effects on mental health and sleep. Show less
Bürgin, D.; Witt, A.; Seker, S.; d'Huart, D.; Meier, M.; Jenkel, N.; ... ; Schmid, M. 2023
Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at... Show moreChildhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care. Show less
Background: Care leavers transitioning into adulthood represent a highly vulnerable population, confronted with usual developmental tasks under difficult predisposing conditions. Early-risk and... Show moreBackground: Care leavers transitioning into adulthood represent a highly vulnerable population, confronted with usual developmental tasks under difficult predisposing conditions. Early-risk and persistent substance use may be an obstacle for care leavers transitioning from youth residential care settings into an independent adult life.Objectives: This study aims to address the following questions: (1) How stable is high-risk substance use from within care to after youth residential care? (2) Are there differences between longitudinal substance use risk pathways and sociodemographic characteristics, placement history, and adverse exposures? (3) Is the persistency of high-risk substance use associated with impaired young adult psychosocial functioning?Method: In a prospective longitudinal design, with a baseline in youth residential care (t1) and a follow-up ten years later (t2), we investigated the courses of substance use in 182 young adult care leavers in Switzerland (32.4 % women; Mean age = 26.7 years). Psychosocial functioning was assessed across health, legal, educational, and financial domains.Results: We found large prevalence rates of high-risk substance use in and after residential youth care (41.2 % in residential care; 46.2 % after leaving care). Of those care leavers who reported earlier high-risk substance use, 61.3 % persisted, while 38.7 % remitted. Four substance risk pathways were identified longitudinally: low (N = 69, 37.9 %), remitted (N = 29, 15.9 %), newly-developed (N = 38, 20.9 %), and persistent risk (N = 46, 25.3 %). Persistent high-risk substance use was associated with higher rates of adverse functional outcomes in young adulthood.Conclusions: Findings of this study shed light on the high prevalence of earlier and persistent high-risk substance use in youth residential care leavers. High-risk substance use appears to have the potential to coincide with impaired psychosocial functioning during and after the transition to young adulthood. Implications for educational and vocational paths as well as harm-reducing interventions are discussed. More research disentangling risk pathways and intervention research in at-risk populations is warranted. Show less
Emde, L. von der; Mallwitz, M.; Vaisband, M.; Hasenauer, J.; Sassmannshausen, M.; Terheyden, J.H.; ... ; MACUSTAR Consortium 2023
This study aimed to determine the retest variability of quantitative fundus autofluorescence (QAF) in patients with and without age-related macular degeneration (AMD) and evaluate the predictive... Show moreThis study aimed to determine the retest variability of quantitative fundus autofluorescence (QAF) in patients with and without age-related macular degeneration (AMD) and evaluate the predictive value of patient reliability indices on retest reliability. A total of 132 eyes from 68 patients were examined, including healthy individuals and those with various stages of AMD. Duplicate QAF imaging was conducted at baseline and 2 weeks later across six study sites. Intraclass correlation (ICC) analysis was used to evaluate the consistency of imaging, and mean opinion scores (MOS) of image quality were generated by two researchers. The contribution of MOS and other factors to retest variation was assessed using mixed-effect linear models. Additionally, a Random Forest Regressor was trained to evaluate the extent to which manual image grading of image quality could be replaced by automated assessment (inferred MOS). The results showed that ICC values were high for all QAF images, with slightly lower values in AMD-affected eyes. The average inter-day ICC was found to be 0.77 for QAF segments within the QAF8 ring and 0.74 for peripheral segments. Image quality was predicted with a mean absolute error of 0.27 on a 5-point scale, and of all evaluated reliability indices, MOS/inferred MOS proved most important. The findings suggest that QAF allows for reliable testing of autofluorescence levels at the posterior pole in patients with AMD in a multicenter, multioperator setting. Patient reliability indices could serve as eligibility criteria for clinical trials, helping identify patients with adequate retest reliability. Show less
Purpose: Both the resting heart rate (RHR) and the callous-unemotional (CU) traits have been associated with juvenile delinquency, however the effect of their interaction is not yet clear.Methods:... Show morePurpose: Both the resting heart rate (RHR) and the callous-unemotional (CU) traits have been associated with juvenile delinquency, however the effect of their interaction is not yet clear.Methods: Four hundred and twenty-three institutionalized adolescents divided into early adolescents (10-14 years, n = 133), late adolescents (15-17 years, n = 286), and young adults (18-22 years, n = 136) participated in the study. RHR was measured using a wristband, and CU traits and delinquency history were assessed using self-reported questionnaires. Moderation analysis was performed to understand how the combination between RHR and CU is associated to offending.Results: CU traits were associated with offending at all ages. The interactions between RHR and CU traits were significantly related to the likelihood of offending in the early and the late adolescent. The highest likelihood of offending is related to high CU traits combined with low RHR in early adolescents and with high RHR in late adolescents.Conclusions: These findings provide further insight in the relationship between psychopathic traits and bio-physiological maturation in explaining juvenile delinquency. Show less
The gendered general strain theory posits that differences in delinquency across gender are due to differences in coping with negative emotions. The present study tests its validity over a 10-year... Show moreThe gendered general strain theory posits that differences in delinquency across gender are due to differences in coping with negative emotions. The present study tests its validity over a 10-year follow-up. We measured exposure to strain, levels of anxiety/depression, anger/irritability, and delinquent behaviors through questionnaires and interviews during residential care (T1) and then 10 years later (T2) in a sample of 80 men and 54 women who were placed in youth welfare and juvenile justice institutions in Switzerland during childhood/adolescence. We observed that, in men, less delinquency at T1 and more symptoms of anxiety/depression at T1 are related to less delinquency at T2. In women, none of the emotional variables nor strain predicted delinquency over time. Results give important insights regarding the risk factors related to long-term delinquency in men but only partially support the gendered general strain theory. Show less
Background: While the psychopathological sequalae of childhood maltreatment are widely acknowledged, less is known about the underlying pathways by which childhood maltreatment might lead to an... Show moreBackground: While the psychopathological sequalae of childhood maltreatment are widely acknowledged, less is known about the underlying pathways by which childhood maltreatment might lead to an increased risk for mental health problems. Recent studies indicated that impaired personality functioning might mediate this relationship. The aim of the present paper was to extend the current literature by investigating the mediating effect of impaired personality functioning between different types of childhood maltreatment and self-reported mental health problems in a high-risk sample. Methods: Overall, 173 young adults (mean age = of 26.61 years; SD = 3.27) with a history of residential child welfare and juvenile justice placements in Switzerland were included in the current study. The Childhood Trauma Questionnaire (CTQ-SF), Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1) and the self-report questionnaires of the Achenbach System of Empirically Based Assessment scales (ASEBA) were used. Mediation analyses were conducted through structural equation modeling. Results: Overall, 76.3% (N = 132) participants indicated at least one type of childhood maltreatment, with emotional neglect being most commonly reported (60.7%). A total of 30.6% (N = 53) participants self-reported mental health problems. Emotional abuse (r = 0.34; p < .001) and neglect (r = 0.28; p < .001) were found to be most strongly associated with mental health problems. In addition, impaired personality functioning was fond to be a significant mediator for overall childhood maltreatment (beta = 0.089; p = 0.008) and emotional neglect (beta = 0.077; p = 0.016). Finally, impaired self-functioning was found to be a significant mediator when both self-functioning and interpersonal functioning were included as potential mediators in the relationship between overall childhood maltreatment (beta(1) = 0.177, p(1) = 0.007) and emotional neglect (beta(1) = 0.173, p(1) = 0.003). Conclusion: Emotional neglect may be particularly important in the context of childhood maltreatment, personality functioning, and mental health problems and, therefore, should not be overlooked next to the more "obvious " forms of childhood maltreatment. Combining interventions designed for personality functioning with trauma-informed practices in standard mental health services might counteract the psychopathological outcomes of maltreated children and adolescents. Show less
