Nicole E Mahrer

• PhD
• Professor (Assistant) at University of La Verne

Certain observable parenting behaviors contribute to the risk of children developing internalizing and externalizing problems. Yet parenting behaviors do not affect all children uniformly and effects may depend on identifiable child characteristics. One factor is a child’s biological sensitivity to the caregiving environment, an indicator of which...

Fetal exposure to prenatal stress can increase risk for psychopathology but postnatal caregiving may offset risk. This study tests whether maternal sensitivity and the home environment during early childhood modify associations of prenatal stress with offspring behavior in a sample of 127 mother–child pairs ( n = 127). Mothers reported on perceived...

Residential and nonresidential fathers are taking an increasingly greater role in their children’s lives, and father involvement predicts positive child outcomes across development. This study utilized data from a large sample of racially and ethnically diverse fathers of low to middle income (n = 1,112) to test if paternal stress is associated wit...

Although maternal stress during pregnancy and even before conception shapes offspring risk for mental health problems, relatively little is known about the mechanisms through which these associations operate. In theory, preconception and prenatal stress may affect offspring mental health by influencing child responses to postnatal caregiving. To ad...

The childhood family environment can influence long-term well-being in part by modifying how individuals' respond to and cope with stress across the life span. Theoretical models propose that childhood stress will either exacerbate (stress sensitization) or attenuate (steeling effect) the effects of adult stress on mental health. This study tests w...

Youth with chronic medical conditions need accessible and effective mental health interventions to address high levels of disruption in their psychological, social, and emotional development. Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy based on behavioral interventions that combines the principles of Relational...

The current study investigates whether prepregnancy maternal posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and stress predict children's cortisol diurnal slopes and cortisol awakening responses (CARs) adjusting for relevant variables. Mothers were enrolled after delivering a baby and followed through their subsequent pregnancy...

Background Suicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide. Objective This study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic...

Purpose As a brief, noninvasive, cost-effective, and technology-driven therapy, biofeedback is a promising and welcomed clinical intervention for children and adolescents with pediatric chronic pain conditions. The aim of this pilot study was to explore the application of a brief Heart Rate Variability (HRV) biofeedback intervention supplemented by...

Background Two theoretical frameworks, the cumulative stress and match-mismatch model, propose that patterns of maternal depressive symptoms over early periods of offspring development predict outcomes in opposing ways. Studies have yet to test these theories across the preconception, prenatal, and early postnatal period. Study 1 identified trajec...

The developmental origins of psychopathology begin before birth and perhaps even prior to conception. Understanding the intergenerational transmission of psychopathological risk is critical to identify sensitive windows for prevention and early intervention. Prior research demonstrates that maternal trauma history, typically assessed retrospectivel...

We review evidence that maternal stress during pregnancy and related concepts such as pregnancy anxiety are associated with risks of adverse birth outcomes especially preterm birth and low birth weight, as well as less favorable development in offspring. In addition, we describe the forms of stress, anxiety and distress shown to be harmful, and bri...

Youth with chronic pain have high healthcare utilization and associated costs. Research supports integrated treatment; though, it’s unclear which treatments are used and cost-effective. This study expands on work that found reduced service use and cost savings following participation in an outpatient integrated pediatric pain clinic. We explored wh...

Prenatal exposure to stress increases risk for suboptimal child and adult mental and physical health outcomes, hypothesized to occur via fetal exposure to maternal stress hormones that alter growth and development. One proposed pathway through which stress exposure in utero could affect the offspring is by accelerating cellular aging in the form of...

Background Stress in pregnancy predicts adverse birth outcomes. Stressors occurring prior to conception may also pose risk for the mother and child. The few published studies on preconception stress test a single stress measure and examine only linear associations with birth outcomes. Purpose Guided by findings in the prenatal stress literature, t...

This prospective longitudinal study evaluated multiple maternal biomarkers from the preconception and prenatal periods as time‐sensitive predictors of child executive functioning (EF) in 100 mother–child dyads. Maternal glycated hemoglobin (HbA1C), C‐reactive protein (CRP), and blood pressure (BP) were assayed before pregnancy and during the second...

Background Maternal stress during pregnancy can influence the trajectory of fetal development, shaping offspring physiology and health in enduring ways. Some research implicates fetal programming of the hypothalamic-pituitary-adrenocortical (HPA) axis as a mediator of these effects. The present study is the first to examine child hair cortisol conc...

Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non‐Latina White counterparts. While effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non‐randomized studies to bet...

Background: Pregnancy anxiety predicts adverse developmental outcomes in offspring from infancy through late childhood, but studies have not examined associations with outcomes in early childhood, nor clarified ethnic or cultural variations in these processes. Aims: (1) To examine differences in pregnancy anxiety and related concerns between non...

Authoritative parenting is typically considered the gold-standard parenting approach based on studies with largely European American (EA) samples. The current study evaluated a novel, “no-nonsense” parenting style in Mexican American (MA) and EA families, not captured by traditional classifications. Parenting styles of mothers and fathers, cultural...

Objectives: We examined the prospective association (from Mage = 15.84 to 17.38 years) between bicultural competence and mental health among U.S. Mexican-origin adolescents relative to multiple (a) developmental niches, (b) components of bicultural competence, and (c) indicators of mental health. Method: Participants included 749 adolescents (49% f...

Purpose: Chronic pain is a complex and debilitating chronic health condition that negatively impacts a child's daily function. Previous investigations of coping behaviors in youth with chronic illness have suggested that secondary control/accommodative coping may be more adaptive than primary control/active coping or disengagement/passive coping....

Despite a recent shift in the allocation of parenting time arrangements following divorce, there is no clear consensus regarding the effects of shared parenting on children’s adjustment in high-conflict families. We propose key questions and methodological options to increase the ability of results from well-designed empirical studies to inform pra...

Objective: To conduct a randomized control trial to evaluate the feasibility and efficacy of virtual reality (VR) compared with standard of care (SOC) for reducing pain, anxiety, and improving satisfaction associated with blood draw in children ages 10-21 years. Methods: In total, 143 triads (patients, their caregiver, and the phlebotomist) were...

Chronic pain is characterized by high rates of functional impairment, health care utilization, and associated costs. Research supports the use of comprehensive, interdisciplinary treatment approaches. However, many hospitals hesitate to offer this full range of services, especially to Medi-Cal/Medicaid patients whose services are reimbursed at low...

This study examined whether the New Beginnings Program (NBP), a parenting preventive intervention for divorced mothers that was designed to reduce children’s postdivorce mental health problems, reduced painful feelings about divorce in young adults whose families had participated 15 years earlier. This study also explored whether NBP participation...

The socialization of cultural values, ethnic identity, and prosocial behaviors is examined in a sample of 749 Mexican-American adolescents, ages 9–12; M (SD) = 10.42 years (.55); 49% female, their mothers, and fathers at the 5th, 7th, and 10th grades. Parents’ familism values positively predicted their ethnic socialization practices. Mothers’ ethni...

Dysregulated cortisol is a risk factor for poor health outcomes. Children of distressed mothers exhibit dysregulated cortisol, yet it is unclear whether maternal distress predicts cortisol activity in later developmental stages. This longitudinal study examined the prospective relation between maternal distress during late childhood (9–12 years) an...

This cost-benefit analysis compared the costs of implementing the New Beginnings Program (NBP), a preventive intervention for divorced families to monetary benefits saved in mental healthcare service use and criminal justice system costs. NBP was delivered when the offspring were 9-12 years old. Benefits were assessed 15 years later when the offspr...

Objective: We examined whether an empirically based, randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation. Design: Divorced mothers and children (age 9-12) were randomly assigned to a literature control condition or the 11-week New Beginnings Program, a...

This study evaluates whether the New Beginnings Program (NBP), a parenting intervention for divorced mothers, led to positive parenting attitudes in young adult offspring. Data were collected from 240 mothers (G1) and offspring (G2) at ages 9-12 and again in adolescence and young adulthood. Alternative theoretical models were tested to examine medi...

Stress can have detrimental effects on nurse residents' levels of job satisfaction, compassion, fatigue, and burnout. This can lead to high turnover rates and poor quality of care among novice nurses. Therefore, it is critical to identify protective factors to prevent the onset of negative nurse outcomes (compassion fatigue, burnout, and job dissat...

This review presents findings from an overview of meta-analyses of the effects of prevention and promotion programs to prevent mental health, substance use, and conduct problems. The review of 48 meta-analyses found small but significant changes that reduce depression, anxiety, antisocial behavior, and substance use. Furthermore, the results were s...

Objective: This 15-year follow-up assessed the effects of a preventive intervention for divorced families, the New Beginnings Program (NBP), versus a literature control condition (LC). Method: Mothers and their 9- to 12-year-olds (N = 240 families) participated in the trial. Young adults (YAs) reported on their mental health and substance-relate...

Studies of individuals with obstructive sleep apnea syndrome (OSAS) have shown impairment in neurocognitive function. This study investigated the neurocognitive function in children with OSAS before and after positive airway pressure (PAP) therapy. Twenty-one participants with suspected/documented OSAS were recruited, completing the Epworth Sleepin...

Objectives: We compared the degree of psychosocial impairment in patients seen in the emergency department (ED) for acute complaints with that of patients presenting with chronic complaints using the Youth Pediatric Symptom Checklist (PSC-Y). Our hypothesis was that patients with multiple visits for chronic complaints (>3 health care visits for th...

To further understand the influence of psychological variables on pain and functioning in children with chronic pain by examining the relations between pain, anxiety sensitivity (AS), somatization, and health-related quality of life (HRQOL), and whether they vary as a function of age and gender. 66 children (8-12 years) and adolescents (13-18 years...

This chapter examines quality of parenting following separation and divorce. It considers the most influential factors for high-quality parenting following separation and divorce; the strengths and weaknesses of available studies; and whether the quality of parenting can be improved. Detailed information is presented on the measures used in the res...

The objective of this study was to examine the level of agreement between child- and caregiver-reports of the child’s psychosocial problems presenting to a Pediatric Emergency Department (PED) using a validated screening tool. This was an anonymous, prospective, cross-sectional, multi-informant (child and caregiver) study assessing cognitive, emoti...

To determine the relationship between stress indicators and state anxiety among pediatric emergency department (ED) patients, as a background to develop appropriate psychoeducational and behavioral interventions. Patients with nonchronic conditions aged 10 to 18 years completed questionnaires assessing demographics; (8) life stressors (LSs), such a...

This study was a follow-up of a group of 29 children diagnosed with autism spectrum disorders at age 2 who attended an inclusive toddler program until age 3. Children ranged in age from 4 to 12 years at the time of the parent survey and follow-up testing. The majority of children were placed in a special education (noninclusive) preschool class, bu...

Chronic pain and fatigue are common physical complaints among children and adolescents. Both symptoms can interfere considerably with daily life by affecting sleep and eating habits, engagement in physical and social activities, and school participation. The aim of this study was to examine the potential mediational role of fatigue in the relations...

The aim of this study was to investigate the health-related quality of life (HRQOL) of children and adolescents with chronic pain. Sixty-nine participants (53 girls and 16 boys, 8-18 years old) were recruited, along with their caregivers, from an outpatient pain management clinic. Participants completed questionnaires regarding the child's pain int...

Virtual reality (VR) is a relatively new technology that enables individuals to immerse themselves in a virtual world. This multisensory technology has been used in a variety of fields, and most recently has been applied clinically as a method of distraction for pain management during medical procedures. Investigators have posited that VR creates a...

The increasing prevalence of disasters worldwide highlights the need for established and universal disaster preparedness plans. The devastating events of September 11 and Hurricane Katrina have spurred the development of some disaster response systems. These systems, however, are predominantly focused on medical needs and largely overlook mental he...

The current study aims to compare positive and negative measures of psychosocial functioning among children with sickle cell disease (SCD) and their healthy siblings. Participants were 41 African-American children with SCD, 97 healthy siblings, and their primary caregivers. Primary caregivers completed self-report questionnaires assessing child beh...

Pediatric massage therapy (MT), similar to its younger counterpart infant massage, has a limited number of rigorous studies supporting its clinical application and associated effects. However, clinicians and researchers have been intrigued by the potential benefits of pediatric MT for improving psychological and physiologic states in children who h...