New Research From Clinical Psychological Science

Maternal Depression and Parenting-Related Distress: Pathways of Transmission to Early Childhood Development in Chile
María Francisca Morales, Marigen Narea, Pamela Soto-Ramírez

Maternal mental-health problems during early childhood can affect child development. However, most research has focused on depressive symptoms. We aimed to examine two distinct presentations of mental-health problems (depressive and parenting-related-distress symptoms) during early childhood and their indirect associations with infants’ cognitive, expressive, and receptive language at 3 years old via maternal sensitivity, intrusiveness, and cognitive stimulation in Chile. Using data from Mil Primeros Días, the study involved 940 families. Maternal mental-health problems and mother–child interactions were assessed in 2019 using self-reports and observational scales. Children’s outcomes were evaluated at age 3 in 2021. Findings support significant combined indirect effects of parenting-related distress on children’s expressive language. Conversely, no significant pathways were found for maternal depressive symptoms and child outcomes. We offer suggestions for health and early childhood policies focused on early identification of mental-health issues and mother–child interaction styles that promote children’s development.

The Role of Parent–Child Attachment in the Association Between Loneliness and Self-Harm Thoughts and Behaviors in Daily Life
Julie J. Janssens, Ginette Lafit, Benjamin Šimsa, et al.

Adolescence is a critical period for self-harm thoughts and behaviors (SHTBs), and loneliness is an important risk factor. However, no research has investigated how loneliness is associated with adolescent SHTBs in real time and whether this association is influenced by parent–child attachment relationships, which correlate with both loneliness and SHTBs. We used experience-sampling methodology and self-report questionnaires to examine the role of loneliness and parent–child attachment in SHTBs in a general-population adolescent sample (N = 1,602). Multilevel analyses provide evidence for loneliness as a short-term risk factor for self-harm thoughts and the emotion-regulation function of self-harm behaviors (i.e., downregulation of loneliness). The relationship between loneliness and SHTBs was stronger for participants with more insecure paternal and maternal attachment relationships. These results illuminate when (i.e., moments of loneliness) and why (i.e., loneliness downregulation) adolescents think about and engage in self-harm, offering critical guidance to clinicians and researchers.

Machine-Learning Applications in Eating-Disorder-Outcome Prediction: A Systematic Scoping Review
Zoe McClure, Matthew Fuller-Tyszkiewicz, Mariel Messer, Jake Linardon

Eating disorders (EDs) are complex and debilitating conditions. Prior efforts to predict outcomes (onset, prognosis, treatment response) have yielded inconsistent findings. Machine-learning (ML) techniques have shown promise to improve outcome prediction, but a systematic literature synthesis is missing. We conducted a systematic scoping review to summarize extant literature on ML applications in ED-outcome-prediction research, identifying 75 studies. ML has mostly been used to predict ED diagnostic status (k = 45); other studies have predicted escalation of ED risk and symptoms (k = 13), treatment outcomes (k = 12), and ED onset (k = 6). Decision trees, random forest, and support-vector machines were the most common models used. Although many studies reported moderate to high predictive performance, the benefits of ML over traditional statistical techniques remains unclear in light of inconsistent findings. We make several recommendations for future research (i.e., integrating multiple data types, external validation) to encourage continued progress in this developing field.

Clinical Psychology in the Post- Dobbs Era: Navigating Clinical Practice, Research, and Advocacy in a Changing Sexual- and Reproductive-Health Landscape
Alexandra R. Tabachnick, Christine C. Call, Irene Tung, et al.

Since 2022, following the Dobbs decision by the U.S. Supreme Court, abortion restrictions have increased throughout the country. This represents the most recent phase of decades of political and legal restrictions on abortion access, including the 1976 Hyde Amendment restricting federal funds for abortion services. Limiting access to legal abortion and safe reproductive health care has serious implications for the mental health of people who can become pregnant and, thus, for clinical psychology. However, there are gaps in competence around sexual and reproductive health (SRH) for clinical psychologists in research and practice. In this article, we (a) review empirical evidence regarding abortion and mental health, (b) discuss barriers to SRH competence for clinical psychology, and (c) present guiding principles for psychologists and institutions/training programs to address these competence gaps across research, clinical practice, and advocacy. We focus on clinical psychology, but the content is applicable to behavioral-health disciplines broadly.

Perseverative Negative Thinking, Self-Control, and Executive Functioning in Symptoms of Depression and Anxiety: A Comprehensive Meta-Analysis of Competing Models
Janet M. Lopez, Sophie Lohmann, Yara Mekawi, et al.

In this meta-analysis, we synthesized existing research on perseverative negative thinking, self-control, and executive functioning to better define their etiologic role in symptoms of depression and anxiety. After a review of leading models of perseverative negative thinking, self-control, executive functioning, and depressive and anxious symptoms, the relevant associations were meta-analyzed as reported in cross-sectional and longitudinal studies. A total of 223 studies met the inclusion criteria, providing 239 independent samples (28 of which provided longitudinal data), N = 50,987. According to both longitudinal and cross-sectional path analyses, self-control deficits predict depression and anxiety symptoms, and these symptoms then predict perseverative negative thinking. In the present research synthesis, we identified evidence that reduced self-control predicts increases in depressive and anxious symptoms, which, in turn, lead to perseverative negative thinking. All in all, this finding suggests an opportunity to treat depression and anxiety through training of self-control and emotional-regulation strategies.

Aging and the Self-Regulation of Sadness: A Longitudinal Study of Individuals With and Without Histories of Depression
Andrew J. Seidman, Charles J. George, Maria Kovacs

Based on models of emotional aging, we hypothesized that as individuals grow older, they are increasingly likely to regulate sadness in ways that attenuate it (adaptive responses) while pruning responses that prolong/magnify that affect (maladaptive responses) and that depressive psychopathology disrupts those normative developmental trajectories. Under the auspices of several consecutive studies, participants with (n = 217) or without (n = 151) histories of depression, ages 16 to 58 years, were assessed repeatedly (mean interassessment interval: 4.5 years) for up to 21 years (M = 12.5 years). Participants’ reports of their usual regulatory responses to sadness were categorized as adaptive or maladaptive and as reflecting primarily social, cognitive, or behavioral processes. We found that aging signaled increasing use of adaptive regulatory responses regardless of depression history but did not predict pruning of maladaptive responses. Across adulthood, individuals who had been ever depressed (versus those never depressed) consistently deployed maladaptive regulatory responses to sadness more frequently and adaptive responses less frequently, but depression history did not significantly alter the developmental trajectories of response deployment. Among the ever depressed, age 35 signaled a breakpoint: Responses to sadness that maintained/exacerbated it increased significantly and remained so, suggesting difficulties meeting the challenges of “established adulthood.” Our longitudinal findings support models of adult development according to which improved emotion regulation is one benefit of aging, underscore the persistent detrimental effects of depression, and indicate that proactive interventions to foster adaptive sadness regulation among adults at high risk for depression may be particularly fruitful before age 35.

Affective Mechanisms of Moral Injury in Trauma Recovery Among Asylum Seekers: Exploring the Protective Effects of Mindfulness and Compassion Training
Amit Bernstein, Anna Aizik-Reebs, Yotam Phung, Kim Yuval, S. Gebreyohans Gebremariam, Anka A. Vujanovic

We aimed to investigate and then therapeutically mitigate the affective-risk mechanisms of moral injury (MI) on trauma recovery among asylum seekers. Study aims were tested in a single-site, randomized, waitlist-controlled trial of mindfulness-based trauma recovery for refugees (MBTR-R) among 158 Eritrean trauma-affected asylum seekers (46.2% female) residing in a high-risk, urban, postdisplacement setting in Israel. First, parallel mediation in PROCESS documented that shame and anger both independently mediated the effects of MI related to moral transgressions committed by the asylum seeker and moral transgressions committed by trusted others (MI-betrayal) on posttraumatic stress disorder (PTSD) and depression. Second, moderated parallel mediation in PROCESS documented that at 1-week postintervention, MBTR-R moderated the mediated pathways between MI-betrayal, anger, PTSD, and depression. Findings contribute to understanding MI-related affective mechanisms in trauma recovery and how mindfulness- and compassion-based training may therapeutically affect these pathways to recovery after displacement.

Emotion Regulation in Daily Life Among Adults With Suicidal Thoughts
Yael Millgram, Daniel D. L. Coppersmith, Gal Sheppes, Rebecca Fortgang, Amit Goldenberg, Matthew K. Nock

Emotion-regulation difficulties are implicated as a risk factor for suicidal thoughts, yet little is known about how adults with suicidal thoughts regulate emotions in daily life or which deficits are specific to suicidality versus shared across psychopathology. In two ecological-momentary-assessment studies (Study 1: N = 396; Study 2, recruited online: N = 195), we compared adults with current suicidal thoughts with adults with past or no suicidal history (Study 1) and with psychiatric and healthy control participants (Study 2). Participants with current (vs. past) suicidal thoughts reported greater substance use and self-injury to regulate emotions (Study 1). Compared with psychiatric control participants, participants with suicidal thoughts reported higher regulatory effort and substance use, and compared with healthy control participants, they additionally reported greater distraction and rumination and lower regulatory success (Study 2). Self-injury and substance use uniquely predicted momentary suicidal thinking (Study 2). Findings highlight substance use, self-injury, and heightened regulatory effort as potentially distinct emotion-regulation processes associated with suicidal thoughts.

Prospective Relations Between Cortical Thickness and Change in Internalizing Symptoms Are Moderated by Chronic Stress Exposure in Adolescents With Depression and Anxiety
Adrienne L. Romer, Nicholas A. Hubbard, Randy P. Auerbach, et al.

Brain structural alterations have been associated with internalizing symptoms concurrently. Less is known about whether these alterations relate to change in internalizing psychopathology during adolescence, a sensitive period for the effects of stress on neurodevelopment and internalizing symptoms. We examined whether cortical thickness (CT) was prospectively related to change in an internalizing factor in 203 adolescents (ages 14–17) with depression and/or anxiety diagnoses or no diagnosis from the Boston Adolescent Neuroimaging of Depression and Anxiety study. We conducted residualized-change-regression models to determine whether baseline CT was associated with 1-year change in internalizing-factor scores and whether exposure to chronic stress moderated these relations. Lower bilateral temporal pole and left insula CT were associated with 1-year increases in internalizing-factor scores and were moderated by chronic stress. These novel results identify specific features of cortical structure that might contribute to worsening depression and anxiety, particularly in adolescents with high chronic stress.

A Framework for Estimating Posttreatment Moderation of Treatment-by-Dosage Effects in Individual-Patient Meta-Analysis: An Illustration Using Project Harmony
Antonio A. Morgan-López, Shannon M. Blakey, Stephen G. West, Skye Fitzpatrick, Sonya B. Norman, Therese K. Killeen, Sudie E. Back, Lissette M. Saavedra, Alexander C. Kline, Teresa López-Castro, Denise A. Hien

Making causal statements regarding dose-response in treatments for posttraumatic stress disorder (PTSD) and alcohol/other drug use disorders (AODs; PTSD+AOD) is difficult because (a) dosage is rarely randomized and (b) self-selected dosage can be affected by treatment assignment. In the present study, we sought to clarify causal inferences regarding treatment-by-dosage interactions in PTSD+AOD treatment using Project Harmony, an individual-patient meta-analytic data set of behavioral, pharmacological, and combination PTSD+AOD treatments (k = 36; N = 4,046). Using propensity score weighting and moderated multilevel “net treatment difference” modeling, trauma-focused (TF) treatments, whether integrated or nonintegrated with AOD treatment, outperformed treatment as usual by greater margins on reductions in PTSD and alcohol use as dosage increased. Furthermore, appropriately treating dosage as a posttreatment covariate and moderator revealed effects for TF treatments on drug use that had not been detected in previous studies. Implications for approaches to increasing TF-treatment attendance and greater use of causal-inference methodologies with dose-response analyses are discussed.

Unveiling the Uniqueness of Parental Burnout and Parenthood Regret: Impact on Parents and Children
Isabelle Roskam, Moïra Mikolajczak, Konrad Piotrowski

Recent research has uncovered significant associations between parental burnout (PB) and parenthood regret (PR), challenging their historical isolation in studies. In this preregistered, multimethod, multisample investigation, we aimed to explore the distinctiveness of PB and PR and their impacts on escape ideation, parental neglect, and violence. The study involved 973 Polish-speaking parents (Study 1) and 1,429 French- and English-speaking parents (Study 2). Analyses identified four profiles based on levels of PB and PR. Confirmatory factor analyses supported a two-factor latent model (PB and PR) over a one-factor model (parental distress). PB, rather than PR, showed cross-sectional and prospective associations with escape ideation, parental neglect, and violence. No exacerbating effect of PR on the relationship between PB and its consequences was found. These findings were consistent across studies and samples, establishing PB and PR as distinct constructs. Further research is needed to understand the consequences of PR.

Feedback on this article? Email [email protected] or login to comment.