Copenhagen infant mental health project: study protocol for a randomized controlled trial comparing circle of security -parenting and care as usual as interventions targeting infant mental health risks

Mette Skovgaard Væver, Johanne Smith-Nielsen, Theis Lange, Mette Skovgaard Væver, Johanne Smith-Nielsen, Theis Lange

Abstract

Background: Infant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security-Parenting (COS-P), currently being conducted in Denmark.

Methods/design: In a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2-12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12-16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing.

Discussion: The potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed.

Trial registration: ClinicalTrials.govID: NCT02497677 . Registered July 15 2015.

Keywords: Attachment; Community health services; Early intervention; Indicated intervention; Infant social withdrawal; Maternal sensitivity; Parenting education; Postnatal depression; Preventive intervention.

Figures

Fig. 1
Fig. 1
Enrollment chart for CIMHP

References

    1. Garner AS, Shonkoff JP, Siegel BS, Dobbins MI, Earls MF, McGuinn L, et al. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012;129:e224–e231. doi: 10.1542/peds.2011-2662.
    1. Currie J, Tekin E. Understanding the cycle childhood maltreatment and future crime. J Hum Resour. 2012;47:509–549.
    1. Butchart A, Harvey AP, Mian M, Furniss T. Preventing child maltreatment: a guide to taking action and generating evidence. 2006.
    1. Christensen E, Jørgensen PS. Hvad er omsorgssvigt - og hvor mange børn handler det om. Forlaget Vera. 2008;42:12–19.
    1. Christoffersen MN. Børnemishandling i hjemmet: delrapport 1. SFI-Det Nationale Forskningscenter for Velfærd. 2010.
    1. Thompson RA. Early attachment and later development: Familiar questions, new answers. In: Cassidy J, Shaver PR, editors. Handbook of attachment: Theory, research, and clinical applications. 2. New York: Guilford Press; 2008. pp. 348–365.
    1. Eisenberg N, Sulik MJ. Emotion-related self-regulation in children. Teach Psychol. 2012;39:77–83. doi: 10.1177/0098628311430172.
    1. Feldman R. Bio-behavioral synchrony: A model for integrating biological and microsocial behavioral processes in the study of parenting. Parenting. 2012;12:154–164. doi: 10.1080/15295192.2012.683342.
    1. Obradovic J. Effortful control and adaptive functioning of homeless children: Variable-focused and person-focused analyses. J Appl Dev Psychol. 2010;31:109–117. doi: 10.1016/j.appdev.2009.09.004.
    1. Groh AM, Roisman GI, Van IJzendoorn MH, Bakermans-Kranenburg MJ, Fearon R. The Significance of Insecure and Disorganized Attachment for Children’s Internalizing Symptoms: A Meta-Analytic Study. Child Dev. 2012;83:591–610.
    1. Fearon RP, Bakermans-Kranenburg MJ, Van IJzendoorn MH, Lapsley A, Roisman GI. The Significance of Insecure Attachment and Disorganization in the Development of Children’s Externalizing Behavior: A Meta-Analytic Study. Child Dev. 2010;81:435–456. doi: 10.1111/j.1467-8624.2009.01405.x.
    1. Regalado M, Halfon N, Fund C. Primary care services: Promoting optimal child development from birth to 3 years. New York: Commonwealth Fund; 2002.
    1. Shonkoff JP. Building a New Biodevelopmental Framework to Guide the Future of Early Childhood Policy. Child Dev. 2010;81:357–367. doi: 10.1111/j.1467-8624.2009.01399.x.
    1. Hesse E, Main M. Frightened, threatening, and dissociative parental behavior in low-risk samples: Description, discussion, and interpretations. Dev Psychopathol. 2006;18:309–343. doi: 10.1017/S0954579406060172.
    1. Ijzendoorn MH, Goldberg S, Kroonenberg PM, Frenkel OJ. The relative effects of maternal and child problems on the quality of attachment: a meta-analysis of attachment in clinical samples. Child Dev. 1992;63:840–858. doi: 10.1111/j.1467-8624.1992.tb01665.x.
    1. Tharner A, Luijk MP, Van IJzendoorn MH, Bakermans-Kranenburg MJ, Jaddoe VW V, Hofman A, et al. Maternal lifetime history of depression and depressive symptoms in the prenatal and early postnatal period do not predict infant-mother attachment quality in a large, population-based Dutch cohort study. Attach Hum Dev. 2012;14:63–81. doi: 10.1080/14616734.2012.636659.
    1. Lyons-Ruth K, Jacobvitz D. Attachment disorganization: Genetic factors, parenting contexts, and developmental transformation from infancy to adulthood. In: Cassidy J, Shaver PR, editors. Handbook of Attachment: Theory, Resarch, and Clinical Applications. 2. New York: Guilford Press; 2008. pp. 666–697.
    1. Barlow J, Schrader-McMillan A, Axford N, Wrigley Z, Sonthalia S, Wilkinson T, et al. Review: Attachment and attachment-related outcomes in preschool children - a review of recent evidence. Child Adolesc Ment Health. 2016;21:11–20. doi: 10.1111/camh.12138.
    1. Ainsworth MDS, Blehar MC, Waters E, Wall S. Patterns of attachment: A psychological study of the strange situation. Hillsdale NJ: Erlbaum; 1978.
    1. Main M, Solomon J. Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. Attachment in the preschool years: Theory, research, and intervention. 1990;1:121–160.
    1. Bowlby J. Attachment, Vol. 1 of Attachment and loss. New York: Basic Books; 1969.
    1. Guedeney A, Matthey S, Puura K. Social withdrawal behavior in infancy: a history of the concept and a review of published studies using the Alarm Distress baby scale. Infant Ment Health J. 2013;34:516–531. doi: 10.1002/imhj.21412.
    1. Dollberg D, Feldman R, Keren M, Guedeney A. Sustained withdrawal behavior in clinicΓÇÉreferred and nonreferred infants. Infant Ment Health J. 2006;27:292–309. doi: 10.1002/imhj.20093.
    1. Guedeney A, Fermanian J. A validity and reliability study of assessment and screening for sustained withdrawal reaction in infancy: the alarm distress baby scale. Infant Ment Health J. 2001;22:559–575. doi: 10.1002/imhj.1018.
    1. Braarud HC, Slinning K, Moe V, Smith L, Vannebo UT, Guedeney A, et al. Relation between social withdrawal symptoms in full-term and premature infants and depressive symptoms in mothers: a longitudinal study. Infant Ment Health J. 2013;34:532–541. doi: 10.1002/imhj.21414.
    1. Puura K, Guedeney A, Mantymaa M, Tamminen T. Detecting infants in need: Are complicated measures really necessary? Infant Ment Health J. 2007;28:409–421. doi: 10.1002/imhj.20144.
    1. Guedeney A, Wendland P, Dugravier R, Saias T, Tubach F, Welniarz B, Guedeney N, Greacen T, Tereno S, Pasquet B. Impact of a randomized home-visiting trial on infant social withdrawal in the CAPEDP prevention study. Infant Ment Health J. 2013;34(6):594-601.
    1. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression - A systematic review of prevalence and incidence. Obstet Gynecol. 2005;106:1071–1083. doi: 10.1097/01.AOG.0000183597.31630.db.
    1. Banti S, Mauri M, Oppo A, Borri C, Rambelli C, Ramacciotti D, et al. From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the Perinatal DepressionΓÇôResearch & Screening Unit study. Compr Psychiatry. 2011;52:343–351. doi: 10.1016/j.comppsych.2010.08.003.
    1. Hewitt CE, Gilbody SM, Mann R, Brealey S. Instruments to identify post-natal depression: Which methods have been the most extensively validated, in what setting and in which language? Int J Psychiatry Clin Pract. 2010;14:72–U82. doi: 10.3109/13651500903198020.
    1. Cox JL, Murray D, Chapman G. A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry. 1993;163:27–31. doi: 10.1192/bjp.163.1.27.
    1. Lovestone S, Kumar R. Postnatal psychiatric illness: the impact on partners. Br J Psychiatry. 1993;163:210–216. doi: 10.1192/bjp.163.2.210.
    1. Boath EH, Pryce AJ, Cox JL. Postnatal depression: the impact on the family. J Reprod Infant Psychol. 1998;16:199–203. doi: 10.1080/02646839808404568.
    1. Murray L, FioriCowley A, Hooper R, Cooper P. The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. Child Dev. 1996;67:2512–2526. doi: 10.2307/1131637.
    1. Righetti-Veltema M, Bousquet A, Manzano J. Impact of postpartum depressive symptoms on mother and her 18-month-old infant. Eur Child Adolesc Psychiatry. 2003;12:75–83. doi: 10.1007/s00787-003-0311-9.
    1. Væver MS, Krogh MT, Smith-Nielsen J, Harder S, Køppe S. Measuring spatial proximity in mother-infant interaction: A kinematic approach for an examination of the effects of maternal postpartum depression. Infant Behav Dev. 2013;36:427–431. doi: 10.1016/j.infbeh.2013.03.007.
    1. Væver MS, Krogh MT, Smith-Nielsen J, Christensen TT, Tharner A. Infants of Depressed Mothers Show Reduced Gaze Activity During Mother-Infant Interaction at 4 Months. Infancy. 2015;16(1):69–90.
    1. Murray L, Arteche A, Fearon P, Halligan S, Goodyer I, Cooper P. Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J Am Acad Child Adolesc Psychiatry. 2011;50:460–470. doi: 10.1016/j.jaac.2011.02.001.
    1. Paulden M, Palmer S, Hewitt C, Gilbody S. Screening for postnatal depression in primary care: cost effectiveness analysis. BMJ. 2009;339.
    1. Murray L, Woolgar M, Briers S, Hipwell A. Children’s social representations in dolls’ house play and theory of mind tasks, and their relation to family adversity and child disturbance. Soc Dev. 1999;8:179–200. doi: 10.1111/1467-9507.00090.
    1. Feldman R, Eidelman AI. Maternal postpartum behavior and the emergence of infant-mother and infant-father synchrony in preterm and full-term infants: The role of neonatal vagal tone. Dev Psychobiol. 2007;49:290–302. doi: 10.1002/dev.20220.
    1. Tronick E, Reck C. Infants of Depressed Mothers. Harv Rev Psychiatry. 2009;17:147–156. doi: 10.1080/10673220902899714.
    1. Weinberg MK, Tronick EZ. The impact of maternal psychiatric illness on infant development. J Clin Psychiatry. 1998;59:53–61.
    1. Mills-Koonce WR, Appleyard K, Barnett M, Deng M, Putallaz M, Cox M. Adult attachment style and stress as risk factors for early maternal sensitivity and negativity. Infant Ment Health J. 2011;32:277–285. doi: 10.1002/imhj.20296.
    1. Cox JL, Holden JM, Sagovsky R. Detection of Postnatal Depression - Development of the 10-Item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–786. doi: 10.1192/bjp.150.6.782.
    1. Berle JØ, Aarre TF, Mykletun A, Dahl AA, Holsten F. Screening for postnatal depression: validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for postnatal depression. J Affect Disord. 2003;76:151–156. doi: 10.1016/S0165-0327(02)00082-4.
    1. Chaudron LH, Szilagyi PG, Tang W, Anson E, Talbot NL, Wadkins HI, et al. Accuracy of depression screening tools for identifying postpartum depression among urban mothers. Pediatrics. 2010;125:e609–e617. doi: 10.1542/peds.2008-3261.
    1. Adouard F, Glangeaud-Freudenthal NMC, Golse B. Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France. Arch Womens Ment Health. 2005;8:89–95. doi: 10.1007/s00737-005-0077-9.
    1. Boyce P, Stubbs J, Todd A. The Edinburgh postnatal depression scale: validation for an Australian sample. Aust N Z J Psychiatry. 1993;27:472–476. doi: 10.3109/00048679309075805.
    1. Murray L, Carothers AD. The validation of the Edinburgh Post-natal Depression Scale on a community sample. Br J Psychiatry. 1990;157:288–290. doi: 10.1192/bjp.157.2.288.
    1. Murray L, Cooper PJ, Wilson A, Romaniuk H. Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression 2. Impact on the mother-child relationship and child outcome. Br J Psychiatry. 2003;182:420–427. doi: 10.1192/bjp.182.5.420.
    1. Cooper PJ, Murray L, Wilson A, Romaniuk H. Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression 1. Impact on maternal mood. Br J Psychiatry. 2003;182:412–419. doi: 10.1192/bjp.182.5.412.
    1. Forman DR, O’Hara MW, Stuart S, Gorman LL, Larsen KE, Coy KC. Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship. Dev Psychopathol. 2007;19:585–602. doi: 10.1017/S0954579407070289.
    1. Cicchetti D, Rogosch FA, Toth SL. The efficacy of toddler-parent psychotherapy for fostering cognitive development in offspring of depressed mothers. J Abnorm Child Psychol. 2000;28:135–148. doi: 10.1023/A:1005118713814.
    1. Cooper PJ, Tomlinson M, Swartz L, Landman M, Molteno C, Stein A, et al. Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial. Br Med J. 2009;338:997.
    1. Bieling PJ, McCabe RE, Antony MM. Cognitive-behavioral therapy in groups. New York: Guilford Press; 2013.
    1. Griffiths P, Barker-Collo S. Study of a group treatment program for postnatal adjustment difficulties. Arch Womens Ment Health. 2008;11:33–41. doi: 10.1007/s00737-008-0220-5.
    1. Hoffman KT, Marvin RS, Cooper G, Powell B. Changing toddlers’ and preschoolers’ attachment classifications: The circle of security intervention. J Consult Clin Psychol. 2006;74:1017–1026. doi: 10.1037/0022-006X.74.6.1017.
    1. Cassidy J, Ziv Y, Stupica B, Sherman LJ, Butler H, Karfgin A, et al. Enhancing attachment security in the infants of women in a jail-diversion program. Attach Hum Dev. 2010;12:333–353. doi: 10.1080/14616730903416955.
    1. Cassidy J, Woodhouse SS, Sherman LJ, Stupica B, Lejuez CW. Enhancing infant attachment security: An examination of treatment efficacy and differential susceptibility. Dev Psychopathol. 2011;23:131–148. doi: 10.1017/S0954579410000696.
    1. Dehghani A, Malekpour M, Abedi A, Amiri S. The efficacy of circle of security on attachment and well-being in preschool children. Management Science Letters. 2014;4:607–612. doi: 10.5267/j.msl.2013.12.031.
    1. Zanetti CA, Powell B, Cooper G, Hoffman KT. The Circle of Security intervention: Using the therapeutic relationship to ameliorate attachment security in disorganized dyads. Disorganized attachment and caregiving. 2011;318:342.
    1. Powell B, Cooper G, Hoffman K, Marvin B. Circle of Security Intervention: Enhancing Attachment in Early Parent–child Relationships. New York: Guilford Publications; 2013.
    1. Bakermans-Kranenburg MJ, Van IJzendoorn MH, Juffer F. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull. 2003;129:195. doi: 10.1037/0033-2909.129.2.195.
    1. Sundhedsstyrrelsen. Anbefalinger for svangreomsorgen. . 22-8-2013. Ref Type: Online Source.
    1. Dansk Sygeplejeråd . Fremtidens Sundhedspleje. New York: Dansk Sygeplejeråd; 2010.
    1. Cassidy J. The Nature of the Child’s Ties. In: Cassidy J, Shaver PR, editors. Handbook of Attachment. 2. London: The Guilford Press; 2008.
    1. Wolff MS, Ijzendoorn MH. Sensitivity and attachment: A meta−analysis on parental antecedents of infant attachment. Child Dev. 1997;68:571–591. doi: 10.1111/j.1467-8624.1997.tb04218.x.
    1. McElwain NL, Booth-LaForce C. Maternal sensitivity to infant distress and nondistress as predictors of infant-mother attachment security. J Fam Psychol. 2006;20:247. doi: 10.1037/0893-3200.20.2.247.
    1. Feldman R. Coding interactive behavior (CIB) manual. Newbury Park: Unpublished Manual Bar-Ilan University; 1998.
    1. Feldman R, Masalha S. Parent–child and triadic antecedents of children’s social competence: Cultural specificity, shared process. Dev Psychol. 2010;46:455. doi: 10.1037/a0017415.
    1. Feldman R, Eidelman AI. Neonatal state organization, neuromaturation, mother-infant interaction, and cognitive development in small-for-gestational-age premature infants. Pediatrics. 2006;118:e869–e878. doi: 10.1542/peds.2005-2040.
    1. Feldman R, Klein PS. Toddlers’ self-regulated compliance to mothers, caregivers, and fathers: implications for theories of socialization. Dev Psychol. 2003;39:680. doi: 10.1037/0012-1649.39.4.680.
    1. Keren M, Feldman R, Namdari-Weinbaum I, Spitzer S, Tyano S. Relations between parents’ interactive style in dyadic and triadic play and toddlers’ symbolic capacity. Am J Orthopsychiatry. 2005;75:599. doi: 10.1037/0002-9432.75.4.599.
    1. Feldman R, Masalha S, Nadam R. Cultural perspective on work and family: Dual-earner Israeli Jewish and Arab families at the transition to parenthood. J Fam Psychol. 2001;15:492. doi: 10.1037/0893-3200.15.3.492.
    1. Groh AM, Fearon RP, Bakermans-Kranenburg MJ, Van IJzendoorn MH, Steele RD, Roisman GI. The significance of attachment security for children’s social competence with peers: a meta-analytic study. Attach Hum Dev. 2014;16:103–136. doi: 10.1080/14616734.2014.883636.
    1. Fraley RC, Spieker SJ. Are infant attachment patterns continuously or categorically distributed? A taxometric analysis of strange situation behavior. Dev Psychol. 2003;39:387. doi: 10.1037/0012-1649.39.3.387.
    1. Jansen J, Weerth C, Riksen-Walraven JM. Breastfeeding and the mother-infant relationship - a review. Dev Rev. 2008;28:503–521. doi: 10.1016/j.dr.2008.07.001.
    1. Roisman GI, Fraley RC, Belsky J. A taxometric study of the Adult Attachment Interview. Dev Psychol. 2007;43:675. doi: 10.1037/0012-1649.43.3.675.
    1. Van IJzendoorn MH, Kroonenberg PM. Cross-cultural consistency of coding the strange situation. Infant Behav Dev. 1990;13:469–485. doi: 10.1016/0163-6383(90)90017-3.
    1. Luijk MPCM, Roisman GI, Haltigan JD, Tiemeier H, Booth-LaForce C, Van IJzendoorn MH, et al. Dopaminergic, serotonergic, and oxytonergic candidate genes associated with infant attachment security and disorganization? In search of main and interaction effects. J Child Psychol Psychiatry. 2011;52:1295–1307. doi: 10.1111/j.1469-7610.2011.02440.x.
    1. Tharner A, Luijk MP, Raat H, Ijzendoorn MH, Bakermans-Kranenburg MJ, Moll HA, et al. Breastfeeding and its relation to maternal sensitivity and infant attachment. J Dev Behav Pediatr. 2012;33:396–404. doi: 10.1097/DBP.0b013e318257fac3.
    1. Guedeney N, Fermanian J. Validation study of the French version of the Edinburgh Postnatal Depression Scale (EPDS): new results about use and psychometric properties. Eur Psychiatry. 1998;13:83–89. doi: 10.1016/S0924-9338(98)80023-0.
    1. Luyten P, Mayes LC, Sadler L, Fonagy P, Nicholls S, Crowley M, et al. The Parental Reflective Functioning Questionnaire-1 (PRFQ-1) Leuven: University of Leuven; 2009.
    1. Luyten P, Mayes L, Nijssens L, Fonagy P. The Parental Reflective Functioning Questionnaire: Development and Preliminary Validation. 2015.
    1. Abidin RR. arenting Stress Index (PSI) Charlottesville: Pediatric Psychology Press; 1990.
    1. Squires J, Bricker D, Twombly E. The ASQ: SE user’s guide: For the Ages & Stages Questionnaires: Social-emotional. Baltimore: Paul H Brookes Publishing; 2002.
    1. First MB, Williams JBW, Karg RS, Spitzer RL. Structured Clinical Interview for DSM-5 Disorders - Research Version (SCID-5-RV) Arlington: American Psychiatric Association; 2015.
    1. Olsen LR, Mortensen EL, Bech P. The SCL-90 and SCL-90R versions validated by item response models in a Danish community sample. Acta Psychiatr Scand. 2004;110:225–229. doi: 10.1111/j.1600-0447.2004.00399.x.
    1. Fraley RC, Waller NG, Brennan KA. An item response theory analysis of selfreport measures of adult attachment. J. Pers. Soc. Psychol. 2000;78(2):350–365. doi: 10.1037/0022-3514.78.2.350.
    1. Mikulincer M, Shaver PR. Attachment in adulthood: Structure, dynamics, and change. New York: Guilford Press; 2010.
    1. Epstein NB, Baldwin LM, Bishop DS. The McMaster family assessment device*. J Marital Fam Ther. 1983;9:171–180. doi: 10.1111/j.1752-0606.1983.tb01497.x.
    1. Thastum M, Watson M, Kienbacher C, Piha J, Steck B, Zachariae R, et al. Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer. Cancer. 2009;115:4030–4039. doi: 10.1002/cncr.24449.
    1. Kabacoff RI, Miller IW, Bishop DS, Epstein NB, Keitner GI. A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples. J Fam Psychol. 1990;3:431–439. doi: 10.1037/h0080547.
    1. Spielberger CD, Gorssuch RL, Lushene PR, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory (Form Y) Palo Alto: Consulting Psychologists Press. Ref Type: Generic; 1983.
    1. Elliott TR, Shewchuk RM, Richards JS. Family caregiver social problem-solving abilities and adjustment during the inital year of the caregiving role. J Couns Psychol. 2001;48:223. doi: 10.1037/0022-0167.48.2.223.
    1. Shewchuk RM, Richards JS, Elliott TR. Dynamic processes in health outcomes among caregivers of patients with spinal cord injuries. Health Psychol. 1998;17:125. doi: 10.1037/0278-6133.17.2.125.
    1. Spielberger CD, Reheiser EC. Measuring anxiety, anger, depression, and curiosity as emotional states and personality traits with the STAI, STAXI, and STPI. Compr handb Psychol Assessment. 2004;2:70–86.
    1. Moran P, Leese M, Lee T, Walters P, Thornicroft G, Mann A. Standardised Assessment of Personality - Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder. Br J Psychiatry. 2003;183:228–232. doi: 10.1192/bjp.183.3.228.
    1. Hesse M, Rasmussen J, Pedersen MK. Standardised assessment of personality - a study of validity and reliability in substance abusers. BMC Psychiatry. 2008;8:7. doi: 10.1186/1471-244X-8-7.
    1. Kongerslev M, Moran P, Bo S, Simonsen E. Screening for personality disorder in incarcerated adolescent boys: preliminary validation of an adolescent version of the standardised assessment of personality - abbreviated scale (SAPAS-AV) BMC Psychiatry. 2012;12:94. doi: 10.1186/1471-244X-12-94.
    1. Hesse M, Moran P. Screening for personality disorder with the Standardised Assessment of Personality: Abbreviated Scale (SAPAS): further evidence of concurrent validity. BMC Psychiatry. 2010;10:10. doi: 10.1186/1471-244X-10-10.
    1. Dunst CJ, Jenkins V, Trivette CM. Family support scale: Reliability and validity. J Individual Fam Community Wellness. 1984;1:45–52.
    1. Dunst CJ, Trivette CM. Toward experimental evaluation of the Family, Infant and Preschool Program. 1988.
    1. Trivette CM, Dunst CJ, Deal AG, Hamer AW, Propst S. Assessing family strengths and family functioning style. Topics in Early Childhood Special Education. 1990;10:16–35. doi: 10.1177/027112149001000103.
    1. Almasri NA, Saleh M, Dunst CJ. Psychometric properties of the Arabic Family Support Scale for families of children and youth with cerebral palsy in Jordan. J Intellect Dev Disabil. 2014;39:223–232. doi: 10.3109/13668250.2014.914474.
    1. Dunst CJ, Trivette CM, Jodry W. Influences of social support on children with disabilities and their families. Eff Early intervention. 1997;499:522.
    1. Nielsen D, Videbech P, Hedegaard M, Dalby J, Secher NJ. Postpartum depression: identification of women at risk. BJOG. 2000;107:1210–1217. doi: 10.1111/j.1471-0528.2000.tb11609.x.
    1. Carpenter JR, Goldstein H, Kenward MG. REALCOM-IMPUTE software for multilevel multiple imputation with mixed response types. J Stat Softw. 2011;45:1–14. doi: 10.18637/jss.v045.i05.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj