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Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: A randomized, double-blind, placebo-controlled, stratified, parallel-group trial
Abstract
Background
While limited evidence suggests that omega-3 supplementation may reduce antisocial behavior in children, studies have not reported on posttreatment follow-up and most treatment periods have been of short duration. This study tests the hypothesis that omega-3 supplementation over 6 months will reduce behavior problems in children both at the end of treatment and at 6 months post treatment.Methods
In this randomized, double-blind, placebo-controlled, stratified, parallel-group trial, a community sample of 8–16 year old children were randomized into a treatment group (N = 100) and a placebo-control group (N = 100). The supplementation consisted of a fruit drink containing 1 g/day of omega-3 or a placebo consisting of the same fruit drink without omega-3. Participants, caregivers, and research assistants were blinded to group assignment. The primary outcome measures of externalizing and internalizing behavior problems were reported by both caregivers and their children in a laboratory setting at 0 months (baseline), 6 months (end of treatment) and 12 months (6 months post treatment), together with the secondary outcome measures of parental antisocial behavior. Data were analyzed on an intention-to-treat basis including all participants. Trial registration: ClinicalTrials.gov: http://clinicaltrials.gov/ct2/show/NCT02016079?term=mauritius&rank=2ResultsSignificant group × time interactions were observed with the treatment group showing long-term improvements in child behavior problems. The average posttreatment effect size was d = −.59. Effects were documented for parent reports, but with the exception of proactive and reactive aggression, child-report data were nonsignificant. Parents whose children took omega-3 showed significant posttreatment reductions in their own antisocial and aggressive behavior. This improvement in caregiver behavior partly mediated the improvements observed in child behavior.Conclusions
Findings provide initial evidence that omega-3 supplementation can produce sustained reductions in externalizing and internalizing behavior problems. Results are the first to report improvements in caregiver behavior, and to establish this improvement as a part-mechanism for the efficacy of omega-3.
... China [72][73][74][75][76][77] and India [78][79][80][81][82][83] contributed six (5.6%) studies each, and Brazil [84][85][86][87][88] five (4.8%), while Palestine [89][90][91][92], Sri Lanka [93][94][95][96] and Turkey [97][98][99][100] contributed four (3.8%) each. Seven other countries contributed two (1.9%) studies each [101][102][103][104][105][106][107][108][109][110][111][112][113][114], and twelve countries one (0.9%) each [115][116][117][118][119][120][121][122][123][124][125][126]. ...
... Over two-thirds of studies (n = 85; 79%) were randomised clinical trials (RCT) [ [43,78,85,95,125], or combined comparators (e.g., pharmacological interventions combined with placebo [23,33,39,40,58,63,65,125] or with active control [32,50] Table 2 S2 (Appendix 2). ...
... Over two-thirds of studies (n = 85; 79%) were randomised clinical trials (RCT) [ [43,78,85,95,125], or combined comparators (e.g., pharmacological interventions combined with placebo [23,33,39,40,58,63,65,125] or with active control [32,50] Table 2 S2 (Appendix 2). ...
Background
Treatments for mental health problems in childhood and adolescence have advanced in the last 15 years. Despite advances in research, most of the evidence on effective interventions comes from high-income countries, while evidence is scarce in low- and middle-income countries (LMICs), where 90% of world's children and adolescents live. The aim of this review was to identify evidence-based interventions tested in LMICs to treat or prevent child and adolescent mental health problems.
Methods
We conducted a systematic review of seven major electronic databases, from January 2007 to July 2019. We included randomised or non-randomised clinical trials that evaluated interventions for children or adolescents aged 6 to 18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems. Results were grouped according to the studied conditions. Due to the heterogeneity of conditions, interventions and outcomes, we performed a narrative synthesis. The review was registered at PROSPERO under the number CRD42019129376.
Findings
Of 127,466 references found through our search strategy, 107 studies were included in narrative synthesis after the eligibility verification processes. Nineteen different conditions and nine types of interventions were addressed by studies included in the review. Over 1/3 of studied interventions were superior to comparators, with psychoeducation and psychotherapy having the highest proportion of positive results. One-third of studies were classified as presenting low risk of bias.
Interpretation
This review shows that different interventions have been effective in LMICs and have the potential to close the mental health care gap among children and adolescents in low-resource settings.
... | 1 on behavior. Vitamin and mineral deficiencies have been found to play a substantial role in determining behavioral outcomes from the pre-and perinatal period (e.g., Brennan et al., 2003;Neugebauer et al., 1999;Prado & Dewey, 2014;Roza et al., 2010) to childhood (e.g., Al-Ghannami et al., 2019;Choy & Raine, 2018;Duong et al., 2015;Portnoy et al., 2021;Raine et al., 2015) and into adolescence (e.g., Galler et al., 2017;Herbison et al., 2012;Robinson et al., 2018). Importantly, besides the observational evidence of dietary impact on aggressive and antisocial behavior, the results of randomized controlled studies of dietary interventions confirm the connection as well (Al-Ghannami et al., 2019;Bègue et al., 2018;Choy & Raine, 2018;Gesch et al., 2002;Raine et al., 2015;Zaalberg et al., 2010). ...
... Vitamin and mineral deficiencies have been found to play a substantial role in determining behavioral outcomes from the pre-and perinatal period (e.g., Brennan et al., 2003;Neugebauer et al., 1999;Prado & Dewey, 2014;Roza et al., 2010) to childhood (e.g., Al-Ghannami et al., 2019;Choy & Raine, 2018;Duong et al., 2015;Portnoy et al., 2021;Raine et al., 2015) and into adolescence (e.g., Galler et al., 2017;Herbison et al., 2012;Robinson et al., 2018). Importantly, besides the observational evidence of dietary impact on aggressive and antisocial behavior, the results of randomized controlled studies of dietary interventions confirm the connection as well (Al-Ghannami et al., 2019;Bègue et al., 2018;Choy & Raine, 2018;Gesch et al., 2002;Raine et al., 2015;Zaalberg et al., 2010). ...
... Besides observational research, there are several studies that show the effects of specific dietary interventions, especially those that include fatty acids, on the reduction of aggressive behavior (Bègue et al., 2018;Gesch et al., 2002;Raine et al., 2015Raine et al., , 2016Raine et al., , 2020Zaalberg et al., 2010). For example, in a randomized controlled trial, Zaalberg et al. (2010) administered nutritional supplements, including vitamins, minerals, and fatty acids, to a treatment group of 115 young adult prisoners. ...
Research in biosocial criminology and other related disciplines has established links between nutrition and aggressive behavior. In addition to observational studies, randomized trials of nutritional supplements like vitamins, omega‐3 fatty acids, and folic acid provide evidence of the dietary impact on aggression. However, the exact mechanism of the diet‐aggression link is not well understood. The current article proposes that the gut microbiome plays an important role in the process, with the microbiota–gut–brain axis serving as such a mediating mechanism between diet and behavior. Based on animal and human studies, this review synthesizes a wide array of research across several academic fields: from the effects of dietary interventions on aggression, to the results of microbiota transplantation on socioemotional and behavioral outcomes, to the connections between early adversity, stress, microbiome, and aggression. Possibilities for integrating the microbiotic perspective with the more traditional, sociologically oriented theories in criminology are discussed, using social disorganization and self‐control theories as examples. To extend the existing lines of research further, the article considers harnessing the experimental potential of noninvasive and low‐cost dietary interventions to help establish the causal impact of the gut microbiome on aggressive behavior, while adhering to the high ethical standards and modern research requirements. Implications of this research for criminal justice policy and practice are essential: not only can it help determine whether the improved gut microbiome functioning moderates aggressive and violent behavior but also provide ways to prevent and reduce such behavior, alone or in combination with other crime prevention programs.
... Considering early disruptive disorders, CU traits and APD in a neurodevelopmental approach could allow a change of perspective and advocate a need for early interventions [134]. It is thus worthy of considering early health interventions to prevent brain structure abnormalities and impairments in brain functions, with nutrient supplementation in pregnancy and/or childhood (e.g., omega 3, zinc) as well as early environmental enrichment (better nutrition, physical exercise, cognitive stimulation, sleep hygiene) [134,142]. Raine et al. [142] have indeed demonstrated the effects of omega-3 dietary supplementation on the long-term reduction of behavioral problems in children. A significant decrease in aggressive and antisocial behavior of the parents of the supplemented children was also found. ...
... It is thus worthy of considering early health interventions to prevent brain structure abnormalities and impairments in brain functions, with nutrient supplementation in pregnancy and/or childhood (e.g., omega 3, zinc) as well as early environmental enrichment (better nutrition, physical exercise, cognitive stimulation, sleep hygiene) [134,142]. Raine et al. [142] have indeed demonstrated the effects of omega-3 dietary supplementation on the long-term reduction of behavioral problems in children. A significant decrease in aggressive and antisocial behavior of the parents of the supplemented children was also found. ...
... A significant decrease in aggressive and antisocial behavior of the parents of the supplemented children was also found. This improvement in parental behavior is partly responsible for the observed improvements in children's behavior [142], again highlighting the role of person-by-context interactions in the development of CU traits. ...
Numerous studies have shown that youth with behavioral disorders (BD) present an increased risk for developing severe and persistent antisocial behaviors in adulthood. Retrospective research notes that not all children and adolescents follow a negative trajectory and explains this heterogeneity in particular by the severity of CU traits. Our study examines how these traits affect the functioning of children and adolescents with BD.
Method:
A systematic literature review conducted through various databases and using different keywords made it possible to analyze 52 studies published from 2015 to 2020 that measured the bidirectional effects of CU traits on the functioning of young.
Results:
Out of the 52 studies, 47 analyzed links between CU traits and neurobiological or mental health, 20 examined family and school contexts, eight focused on social adjustment, 10 on social interactions and 19 measured links with cognitive functioning, especially executive functions.
Conclusion:
Consistent with previous recommendations in the field, our findings emphasize the importance of assessing the presence of UC traits in early childhood to prevent the emergence of comorbid disorders and to target multimodal (early) interventions to influence the life trajectories of youth with high CU traits.
... Correlational research has also shown that fish consumption has been negatively associated with cross-country homicide rates [4]. More recently, randomized controlled trials (RCTs) have shown some evidence for the efficacy of omega-3 supplementation in reducing antisocial behavior [5,6]. One recent meta-analysis on the efficacy of omega-3 supplementation on aggressive behavior from 30 intervention studies reported an overall effect sizes of d = 0.20, 95% CI 0.14 to 0.26, arguing that omega-3 can successfully reduce aggression and may be a viable intervention [7]. ...
... Treatment duration was six months. This duration was chosen to match that used in our prior studies [5,17] because prior treatment studies have usually been 2-4 months [16], and because a somewhat longer treatment period may be more effective in producing longer-term brain and behavioral change. The omega-3 drink was administered on the morning of each school-day by a research assistant, and by parents on weekends and school holidays. ...
... The primary hypothesis of this study, that omega-3 should reduce overall antisocial behavior, was supported for females but was not observed for males. These more mixed findings lie in contrast to prior omega-3 RCTs which have, taken together, shown somewhat stronger efficacy in reducing antisocial behavior in other countries [5,34,35]. In this context one cross-cultural difference should be considered. ...
While some RCTs have observed efficacy for omega-3 supplementation in reducing antisocial behavior, the role of psychopathic personality and gender in moderating treatment outcome has not been examined. This study examines whether omega-3 supplementation reduces antisocial behavior, and whether any treatment effects are a function of gender and psychopathy. Three hundred and twenty-four schoolchildren with a mean age of 11.9 years were randomized into 3 groups: omega-3 (N = 108), placebo (N = 110), and no-treatment controls (N = 106). Parent and child reports of child antisocial and aggressive behavior and psychopathic-like personality were collected at 0 months (baseline), 6 months (end of treatment), and 12 months (6 months post-treatment). A group × time × gender interaction (p = .016) indicated that only females in the omega-3 group showed a significant reduction in antisocial behavior 6 months post-treatment compared to baseline (d = .35), whereas the females in the two control groups showed no change over time. A group x time x psychopathy interaction (p < .006) was also observed, with psychopathic personality levels moderating treatment outcome. Children in the omega-3 group with high (but not low) psychopathic-like personality showed significant improvements in child-reported antisocial behavior at the end of treatment (d = .19) Results suggest that omega-3 supplementation may be helpful in reducing childhood antisocial and aggressive behavior in females, and those with psychopathic-like personalities.
... Omega-3 has been hypothesized as one nutritional component that could explain the link between poor nutrition and antisocial behavior (Raine, Mellingen, Liu, Venables, & Mednick, 2003). Randomized controlled trials (RCTs) have shown some evidence for the efficacy of omega-3 supplementation in reducing antisocial behavior (Raine, Portnoy, Liu, Mahoomed, & Hibbeln, 2015;Raine et al., 2016). Aggressive behavior in particular has been a focus of studies, with a recent meta-analysis of aggression yielding an effect size of d = 0.24 (Gajos & Beaver, 2016). ...
... Only three omega-3 RCT intervention studies have addressed this question. The first from Mauritius documented significant reductions in both forms of aggression (Raine et al., 2015). The second RCT from the USA documented significant reductions in reactive but not proactive aggression (Raine et al., 2016), while the third RCT from Singapore replicated the significant reductions in reactive but not proactive aggression (Raine et al. 2019). ...
... Based on prior findings for omega-3 RCTs where the primary outcome was antisocial behavior (Raine, Portnoy, Liu, Mahoomed, & Hibbeln, 2015;Raine et al., 2016), together with results of a meta-analysis of omega-3 RCTs on aggression (Gajos & Beaver, 2016), a small to medium effect size was anticipated. The final total sample size of 145 would have power of 0.80 to detect a small to medium effect size of f = 0.219, alpha = 0.05, and critical F(6,282) = 2.13. ...
Objectives
To examine whether omega-3 supplementation reduces antisocial and aggressive behavior in offenders.Methods
In this randomized, double-blind trial, 145 young offenders were randomized into three groups: omega-3 (N = 48), placebo (N = 46), and treatment-as-usual controls (N = 51). Measures of antisocial, aggressive, and psychopathic behavior were collected at 0 months (baseline), 3 months (end of treatment), 6 months (3 months post-treatment), and 12 months (9 months post-treatment).ResultsOmega-3 supplementation resulted in both short-term and long-term declines in self-reported antisocial and aggressive behavior. Findings were stronger for a reactive-impulsive form of aggression than for proactive aggression and psychopathy. Sensitivity analyses documented long-term reductions at 6 and 12 months in the omega-3 group for officer reports.Conclusions
Results suggest that omega-3 supplementation can help reduce antisocial and aggressive behavior over and above regular treatment programs in young offender institutions, particularly for reactive, impulsive aggression.
... Randomized controlled trials (RCTs) have shown some evidence for the efficacy of omega-3 supplementation in reducing antisocial behavior (Raine et al., 2015(Raine et al., , 2016. Aggressive behavior in particular has been a focus of omega-3 supplementation studies (Choy & Raine, 2018), with one meta-analysis of aggression in 20 studies yielding an effect sizes of d = 0.20 (Gajos & Beaver, 2016). ...
... Why would omega-3 be expected to reduce criminal offending? First, our group has to date conducted four other RCTs on omega-3 supplementation which show significant reductions in aggressive and antisocial behavior in different populations of children and adolescents in the USA, Singapore, Hong Kong, and Mauritius, in all cases showing some degree of efficacy (especially with impulsive-aggressive behavior), albeit with variability in findings (Raine et al., 2015(Raine et al., , 2016(Raine et al., , 2019(Raine et al., , 2021. We have also found that omega-3 supplementation reduces intimate partner violence (Portnoy et al., 2018). ...
Objectives
While three randomized controlled trials (RCTs) have been conducted using omega-3 supplementation on prison populations, none have examined effects on recidivism. This study presents pilot findings on recidivism rates following omega-3 and vitamin D supplementation.Methods
Young offenders (N = 145) were randomized into 3 groups: omega-3/vitamin D supplementation (N = 48), placebo (N = 46), and treatment-as-usual controls (N = 51). One-, two-, and three-year recidivism rates were calculated.ResultsThe omega-3 group showed non-significantly reduced recidivism rates compared to both control groups in all three years. Three-year recidivism reduction effect sizes were as follows: omega-3 versus controls (d = .18) and omega-3 versus placebo (d = .17).ConclusionsA future study with a sample size of 237 would have a power of .80 to detect these effect sizes. These pilot data suggest that omega-3 and vitamin D supplementation, a simple and relatively cheap health intervention, could reduce 3-year recidivism by 16.6%.
... To date, one promising study has been shown to be successful at reducing antisocial behavior and schizotypal personality traits. Raine et al. (2015) selected 100 children to receive an early environmental enrichment program compared to 1695 controls in the Mauritius cohort study using a stratified random sampling technique. This 2-year program at age 3 years consisted of three key elements: nutrition, education, and physical exercise (see detailed description in Raine et al. 2001). ...
... Although this program was successful at reducing schizotypal personality traits not schizophrenia itself, the sustained developmental benefits may inform intervention efforts at preventing or delaying the onset of schizophrenia as schizotypal personality disorder is often seem as a prodrome stage of schizophrenia (Raine Lencz and Mednick 1995). Other non-invasive yet promising methods that have been shown to reduce antisocial aggressive behaviors in both aggressive youths and prisoners involve increasing their omega-3 intake (Meyer et al. 2015;Raine et al. 2015). It seems then that treatment for both symptoms of schizophrenia and antisocial behaviors ought to begin early in development. ...
The comorbid relationship between schizophrenia and crime may prove difficult to accept by some researchers, practitioners, and the public alike. However, over the last 50 years, accumulating evidence from several follow-up studies and retrospective studies of birth cohorts, patients, and incarcerated populations globally, have established the schizophrenia and crime link. This chapter reviews the growing empirical evidence to date on the risk-factors and cures associated with schizophrenia, crime, and for both of these conditions. By understanding the etiology of this comorbid relationship, we can reduce the stigma that is associated with these disabling conditions and importantly, begin to direct more resources into developing preventive interventions for individuals at-risk for developing these disabling conditions.
... Omega-3 long-chain polyunsaturated fatty acids (n-3 PUFAs), particularly eicosapentaenoic acid (EPA, 20:5 n-3) and docosahexaenoic acid (DHA, 22:6 n-3), have been widely reported for their health benefits, such as the prevention of chronic inflammatory diseases, cardiovascular diseases, 1 cancer, 2 mental illness, 3 and adolescent antisocial/aggressive behaviour, 4 and potentiation of cellular development and steroid biosynthesis. 5 Despite an increase in the awareness of the health importance of n-3 PUFAs, the consumption of n-3 PUFAs in many countries is still low. ...
... The droplet size distribution of the diluted O/W emulsion was determined using light scattering technology (Mastersizer 2000, Malvern Instruments Ltd, Worcestershire, UK), after the O/W emulsions were further diluted 3 times. The volume surface average diameter, d (3,2) (µm), volume weighted average diameter, d (4,3) (µm) and dispersion index (Span) were calculated using eqn (1), (2) and (3), respectively. ...
Tuna oil was selectively hydrolysed using Thermomyces lanuginosus lipase for 6 h to prepare omega-3 acylglycerol concentrate with the DHA content significantly increased from 24.9% in tuna oil to 36.3% in the acylglycerol concentrate. The acylglycerol concentrate was subsequently encapsulated into the “multi-core” microcapsules using gelatin–sodium hexametaphosphate complex coacervates as the shell material. Rancimat, Oxipres and thermogravimetric analyses all showed that the microencapsulated acylglycerol concentrate had unexpectedly improved oxidation stability, compared to those produced using tuna oil, even though the concentrated oils themselves were significantly less stable than tuna oil. The incorporation of enzymatic tuna oil acylglycerol concentrate also significantly improved the oxidation stability of microencapsulated standard refined unconcentrated tuna oil. A wide range of characteristics including lipid and fatty acid composition, oil-in-water (O/W) emulsion properties, morphology, nanomechanical strength and physicochemical stability of acylglycerol, acylglycerol oil-in-water (O/W) emulsion and final microcapsules were investigated throughout the preparation. The result suggests that high levels of monoacylglycerol (about 35%) and diacylglycerol (about 8.5%) were produced in the acylglycerol. The acylglycerol O/W emulsion exhibited significantly smaller droplet size, lower zeta-potential and higher surface hydrophobicity, which contributed to the formation of the microcapsule with a significantly smoother surface and more compact structure, finally leading to improved oxidative stability compared to those prepared from native tuna oil.
... In addition, the trial duration also varied widely in studies included in this review (6−26 weeks). Since evidence suggested that it takes at least 6 months for PUFA to reach a steady state on the erythrocyte membrane [81] and at least 4 months to demonstrate an effect on cognitive performance [82], it has also been suggested that longer study periods up to one year might be needed to demonstrate n-3 PUFAs supplementation associated behavioural changes [83]. ...
... Generally, the n-3 PUFAs dosage for ADHD, ASD and MDD falls between the range of 750 mg/d to 2,000 mg/d, where a combination of DHA and EPA is recommended [7,12,13,114,116]. The duration of n-3 PUFAs is usually recommended at 16 weeks, however, if the primary outcome include observable/measurable behaviour changes, the duration may extend up to 52 weeks [83]. Of note, lethargy, hyperactivity and stereotypy are specific symptoms in ASD reported to be responsive to n-3 PUFAs treatment [13] ( Table 1). ...
Omega-3 polyunsaturated fatty acids (or omega-3 PUFAs, n-3 PUFAs) are essential nutrients throughout the life span. Recent studies have shown the importance of n-3 PUFAs supplementation during prenatal and perinatal period as a potential protective factor of neurodevelopmental disorders. N-3 PUFAs have been reported to be lower in youth with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD). N-3 PUFAs supplementation has shown potential effects in the improvement of clinical symptoms in youth with ADHD, ASD, and MDD, especially those with high inflammation or a low baseline n-3 index. Moreover, it has been suggested that n-3 PUFAs had positive effects on lethargy and hyperactivity symptoms in ASD. For clinical application, the following dosage and duration are recommended in youth according to available randomized controlled trials and systemic literature review: (1) ADHD: a combination of eicosapentaenoic acid (EPA) ＋ docosahexaenoic acid (DHA) ≥ 750 mg/d, and a higher dose of EPA (1,200 mg/d) for those with inflammation or allergic diseases for duration of 16−24 weeks; (2) MDD: a combination of a EPA ＋ DHA of 1,000−2,000 mg/d, with EPA:DHA ratio of 2 to 1, for 12−16 weeks; (3) ASD: a combination of EPA ＋ DHA of 1,300−1,500 mg/d for 16−24 weeks as add-on therapy to target lethargy and hyperactivity symptoms. The current review also suggested that n-3 index and inflammation may be potential treatment response markers for youth, especially in ADHD and MDD, receiving n-3 PUFA.
... In addition, low levels of cholesterol associated with aggression are frequently reported [19][20][21][22]. Recently, many studies have found dietary omega-3 supplementation can reduce violent behaviours in children, young men and schizophrenia patients [23][24][25][26][27][28]. ...
... Although earlier studies have reported the serum cholesterol, a subclass of lipid [60], is uncorrelated with violence [61,62], more recent studies have consistently found the increased violence risk is correlated with low cholesterol concentration [19,20,63] and polyunsaturated fatty acid [26,59]. Omega-3 supplement can reduce violent behaviours in children [25], young men [64], schizophrenia patients [26] and adult prisoners [23]. Our research also proves the important role of lipid metabolism in regulating violence. ...
Background:
Many studies have related biochemical characteristics to violence and have reported schizophrenia could elevated the risk of violent behaviour. However, the metabolic characteristics of schizophrenia patients with violence (V.SC) are unclear.
Methods:
To explore the metabolic characteristics of schizophrenia with violence and to identify potential biomarkers, untargeted metabolomics was performed by using gas chromatography time-of-flight mass spectrometry to analyse the plasma metabolites of fifty-three V.SC and twenty-four schizophrenia patients without violence (NV.SC). Multivariate and univariate analyses were performed to identify differential metabolites and biomarkers. Violence was assessed by the MacArthur Violence Assessment Study method. Psychiatric symptoms were assessed by the Positive and Negative Syndrome Scale.
Results:
Multivariate analysis was unable to distinguish V.SC from NV.SC. Glycerolipid metabolism and phenylalanine, tyrosine and tryptophan biosynthesis were the differential metabolic pathways between V.SC and NV.SC. We confirmed ten metabolites and five metabolites as metabolic biomarkers of V.SC by random forest and support vector machine analysis, respectively. The biomarker panel, including the ratio of L-asparagine to L-aspartic acid, vanillylmandelic acid and glutaric acid, yielded an area under the receiver operating characteristic curve of 0.808.
Conclusions:
This study gives a holistic view of the metabolic phenotype of schizophrenia with violence which is characterized by the dysregulation of lipids and amino acids. These results might provide information for the aetiological understanding and management of violence in schizophrenia; however, this is a preliminary metabolomics study about schizophrenia with violence, which needs to be repeated in future studies.
... In a small (n = 20) randomized trial of children aged 6-12 years with major depressive disorder (MDD), those supplemented with eicosapentaenoic acid (22:5n-3, EPA)+DHA for 16 weeks had a reduction in depressive symptoms compared with children who received a placebo composed mostly of LA [17]. During adolescence, supplementation with n-3 PUFA resulted in improved behavior in trials from the United Kingdom [18] and Mauritius [19]. Meta-analyses of randomized trials conducted in adults with depressive disorders showed that the benefits of long chain n-3 PUFA supplementation against depressive symptoms were greater when the supplements contained a higher percentage of EPA than DHA; this suggests that a potential effect might be through EPA [20,21]. ...
... Only a handful of investigations have addressed the potential effect of DHA on behavior problems during adolescence. DHA supplementation of schoolchildren in Mauritius and the United Kingdom was related to decreased aggressive and disruptive behavior, respectively [18,19]. The apparent discrepancy between the positive association we found and the protective effect of supplementation trials might be related to other PUFA present in the supplement. ...
We sought to determine the associations of n-3 and n-6 polyunsaturated fatty acids (PUFA) in middle childhood with externalizing and internalizing behavior problems in adolescence.
Using gas-liquid chromatography, we quantified n-3 and n-6 PUFA in serum samples of 444 Colombian schoolchildren aged 5–12 years at the time of enrollment into a cohort study. After a median 6 years, adolescent externalizing and internalizing behavior problems were determined with the Youth Self Report (YSR) questionnaire. We estimated adjusted mean behavior problem score differences with 95% confidence intervals (CIs) between quartiles of each PUFA using multivariable linear regression. We also considered as exposures the Δ6-desaturase (D6D) and Δ5-desaturase (D5D) enzyme activity indices.
Docosahexaenoic acid (DHA) was positively associated with externalizing problems; every standard deviation (SD) of DHA concentration was associated with an adjusted one unit higher externalizing problem score (95% CI: 0.1, 1.9). The D5D enzyme activity index was inversely related to externalizing problem scores. Alpha-linolenic acid concentration was positively associated with internalizing problem scores, whereas adrenic acid was inversely related to this outcome.
Serum PUFA in middle childhood were related to behavior problems in adolescence. Some of these associations might reflect the role of D5D enzyme activity.
... The same group of authors failed to confirm this benefit in non-stressful situations [119,120]. In a 6-month study on 200 school children aged 8-16 years old, omega-3 supplementation caused a significant reduction in several measures of aggression [121]. ...
With the increasing interest in health and nutrition for longevity of life and more performance ability, the idea of health foods and nutrients has attracted more research and studies. Omega-3 fatty acid docosahexaenoic acid (DHA) is a nutrient molecule with various diverse roles and health benefits in the human body. Though DHA originally comes from microalgae and sea plants, the main source of DHA is fish, shellfish, and fish oils. DHA is a key nutrient with a structural and functional role in the cell membrane and cell organelles, and abundant in brain and eye. It is good for the heart, and protective against heart diseases. It is rather a very ancient molecule with more modern concepts. Really, DHA has been proven to be a key nutrient that is required in the processes of physical and mental development and health, and prevention of diseases throughout the life span. Driven by the values of physical and mental health, the demand for DHA in the international market is expected to grow. This review is an attempt to update the research findings about DHA and its health benefits in an easy and lucid way.
... A recently conducted review in both animal and human studies has shown that excessive consumption of sugar or high palatable foods may cause neurochemical and neurobiological changes, modifying behaviors through the alteration of emotional processing [43]. Furthermore, randomized clinical trials demonstrated the role of micronutrients in emotional regulation and social behavior [44][45][46], underlying the important role of a balanced supply of all essential nutrients through diet on emotional and behavioral well-being. Last but not least, a common characteristic of the overwhelming majority UPFs is their high content of chemicals either in the form of preservatives, coloring, flavoring, stabilizing ingredients, or substances in food contact materials. ...
Citation: Gketsios, I.; Tsiampalis, T.; Kanellopoulou, A.; Vassilakou, T.; Notara, V.; Antonogeorgos, G.; Rojas-Gil, A.P.; Kornilaki, E.N.; Lagiou, A.; Panagiotakos, D.B.; et al. The Synergetic Effect of Soft Drinks and Sweet/Salty Snacks Consumption and the Moderating Role of Obesity on Preadolescents' Emotions and Behavior: A School-Based Epidemiological Study. Life 2023, 13, 633. https:// Abstract: The consumption of ultra-processed foods (UPFs) is high along with the prevalence of emotional and behavioral problems among children and adolescents. The present study sought to investigate the synergetic effect of soft drinks and sweet/salty snacks consumption, and the moderating role of obesity on preadolescents' emotions and behavior. A cross-sectional study was conducted among 1728 Greek preadolescents aged 10-12 and their parents, during the school years 2014-2016. Parental and child characteristics were collected anonymously, through self-administered and validated questionnaires. Among others, soft drinks and sweet/salty snacks consumption was recorded, classifying preadolescents as low or at least moderate consumers, while anthropometric characteristics (height, weight, Body Mass Index (BMI)) were also recorded. Approximately 6 out of 10 preadolescents were characterized by at least moderate consumption of either sweet/salty snacks, or soft drinks, while 22.7% of the participants had at least moderate consumption of both soft drinks and sweet/salty snacks. Boys and preadolescents with a lower level of adherence to the Mediterranean diet, as well as those living in a more obesogenic family environment were more likely to be in the higher consumption groups. When compared to just either the moderate consumption of sweet/salty snacks, or the moderate consumption of soft drinks, the combination of both unhealthy eating habits was associated with significantly higher odds of both aggressiveness and loneliness, while the examined relationships were significantly stronger in overweight/obese children. The positive synergistic effect of soft drinks and sweet/salty snacks consumption on preadolescents' emotions of loneliness and aggressive behavior is even burdened by obesity status highlighting the urgent need for policymakers to take preventive measures to halt the detrimental consequences of UPFs consumption on health outcomes, particularly in overweight/obese children. The importance of the improvement of children's unhealthy eating habits by emphasizing the association between food intake and emotional and behavioral status is highlighted.
... A defective supply of DHA from ω3-PUFA, an integral part of astrocytic cell membrane, caused an impaired Glu clearance, with subsequent altered behavior in adulthood [120]. Several human studies adopted ω3 PUFA to hinder aggression [121][122][123][124][125][126][127]. Omega-3 deficiency favors the production of inflammatory cytokines, disturbing Glu homeostasis (Figure 2) [43,[128][129][130][131][132]. ...
The prevalence of aggression has become an increasing problem that threatens lives, from suicidal ideation to homicide. Multiple factors contribute to such issue, including genetic, psychological, familial, economic, environmental, dietary habits, endocrine disturbances, psychiatric disorders, and neurological disturbances, making it resistant to control. If key targets can be identified, it might be possible to find a cure. To date, glutamate has been one culprit involved in aggression, instigated by inflammatory mediators and reactive oxygen species. Monosodium glutamate as well as omega-3 and-6 polyunsaturated fatty acids -components of our modern diet- modulate the inflammatory state, hence, affecting brain and blood glutamate, the latter is an essential neurotransmitter sharing in the antioxidant capacity of erythrocytes.Hence, the erythrocytic or blood glutamate assay, along with members of the inflammatory cascade, might be a cost-effective diagnostic and prognostic tool for aggressive behavior, especially feasible for assessing the efficacy of the intervening dietary and/or pharmacological measures to prevent such potentially devastating behavior.
... Intervention and review studies suggest that amino acid or micronutrient supplementation may also reduce mental health and behavioral concerns (e.g. aggression, anxiety, depression, inattention) in early childhood and adolescence (10)(11)(12)(13). Berglund et al. (10) found that low birthweight infants aged 6 wk to 6 mo supplemented with iron exhibited fewer behavioral problems at 3 y compared with controls. ...
Background
Prevalence of mental health concerns is growing worldwide, along with lack of access to and receipt of needed treatment. Current gaps in treatment provision have led to exploring alternative methods of prevention, with research linking nutrition and mental health, of particular relevance in low- and middle- income countries with high prevalence of undernutrition.
Objectives
To examine whether exposure to a protein-energy nutritional supplement during the first 1000 days of life decreased odds of mental distress in adulthood among men and women in Guatemala compared to receiving a low energy-no protein supplement or supplementation outside the 1000-day window.
Methods
Data from participants (n = 1249) in a longitudinal cohort protein-energy supplementation trial (early life, supplementation data from 1969–77, ages 0–7 years; life course, outcome data from 2017–2018 follow-up, ages 40–57 years) were analyzed for associations between nutrition in the first 1000 days and mental distress in adulthood (SRQ-20), controlling for early life variables and current life stress; life course variables (e.g., education) were examined as potential mediators of this relationship. Generalized linear mixed models and zero-inflated Poisson generalized linear mixed models were utilized.
Results
Both partial and full supplementation with Atole during the first 1000 days were associated with 63% (95% CI: 0.16, 0.87) and 56% (95% CI: 0.19, 1.03) lower odds, respectively, of experiencing mental distress in adulthood. Results did not differ by sex. These inverse relationships remained relatively unchanged (partial OR = 0.34 [95% CI: 0.14, 0.83]; full OR = 0.38 [95% CI: 0.16, 0.92]) after controlling for early life and life course variables, including life stress.
Conclusions
Protein-energy supplementation during the first 1000 days of life in Guatemala where undernutrition is prevalent may reduce prevalence of later mental distress in adulthood. This effect appears to occur directly, rather than indirectly through pathways of life course variables such as education, wealth, and marital status.
... The Nutrition Guidelines for Primary Schools in Ireland state that research has shown that children benefit nutritionally by eating breakfast (Department of Health and Children, 2003). According to the Irish Primary Principals' Network (O'Brien, 2015) and the 2014 Health Behaviour in School Children (Gavin et al., 2015) one in five children goes to school hungry every day and hunger and malnutrition negatively impact on children's mental health (Galler et al., 2012, Lukowski et al., 2010O'Neil et al., 2014;Raine et al., 2014). ...
The aim was to explore the relationship between children’s psychological well-being and daily breakfast club engagement in primary schools in Ireland. A quantitative survey method was employed using a staged correlational design with regression analysis. Parents and teachers (n=142) completed the Strengths and Difficulties Questionnaire (SDQ) (Goodman & Goodman, 2009) and a breakfast club engagement questionnaire. The analyses revealed that breakfast club attendance, as well as healthy eating and enjoyment at the club, was predictive of psychological well-being, positive peer relationships and engagement in academic activities. This was especially the case among older children. To date, this is the most thorough analysis of the impact breakfast clubs have on psychological well-being in Irish primary schools. These study findings suggest breakfast clubs can support one of the recommendations of the recent Wellbeing Policy Statement and Framework for Practice – the schools purposefully support children’s well-being and to include well-being in their School self-evaluation (DES, 2018).
... За даними літератури, добовий раціон у 65 % підлітків із хронічним гастродуоденітом не відповідає принципам раціонального та збалансованого харчування: нутритивний статус даних дітей характеризується високим рівнем поширеності дефіциту маси тіла [9]. Результати проведених досліджень вказують на деформацію харчових раціонів у дітей [10][11][12][13][14][15]. Саме раціональне харчування є провідним фактором у профілактиці захворювань шлунково-кишкового тракту. ...
Background. It is known that malnutrition significantly affects human life expectancy and leads to the emergence and development of non-communicable diseases. A balanced diet is a leading factor in the prevention of gastrointestinal diseases. The purpose was to investigate the state of actual nutrition, indicators of nutritional status and gastrointestinal morbidity in school-age children. Materials and methods. The study was conducted on the basis of secondary schools in Chernivtsi and MNPE “Chernivtsi Regional Children’s Clinical Hospital”. A questionnaire method was used with the compilation of individual menus and subsequent analysis of the chemical composition of diets in 162 students. Depending on the state of health, children were divided into groups: I (n = 90) — those with chronic gastrointestinal diseases, II (n = 44) — with functional gastrointestinal disorders, III (n = 28) — individuals without gastrointestinal pathology. Results. Chronic gastrointestinal pathology was diagnosed in 55.5 % of the examined children, functional gastrointestinal diseases — in 27.2 %. The most common chronic pathology is chronic gastroduodenitis. The majority of the surveyed children did not follow the diet, namely 56.5 % of children violated the frequency of intake, 69.2 % did not adhere to the intervals between meals. Most of patients (59.2 %) eat 3–5 times a day, 29.1 % of them eat 3–4 times a day, 30.1 % eat 4–5 times, and 11.7 % less than three times a day. One third of children do not have breakfast at home, and 19.5 % do not have a second breakfast at school. The caloric value of daily diets is lower than the normative indicators, it averages 2,337.64 ± 65.16 kcal and is insufficiently provided by the main components: proteins by 12 %, fats by 25 % and carbohydrates by 63 %. Macro- and micronutrient deficiency is also registered in 53.1 % of children, especially of calcium, phosphorus, copper, zinc, and iodine. Children of groups II and III are less likely to eat fast food compared to those of group I (34.1 and 32.1 vs. 53.3 %, p < 0.05). Conclusions. The diet and nutrition of school-age children with gastrointestinal pathology does not meet hygienic requirements and not only does not provide primary prevention of non-communicable diseases, but, on the contrary, is a risk factor for the latter.
... A prior study demonstrated the potential beneficial effects of nutritional supplementation on CU traits. In a double-blind randomized, placebo-controlled trial, supplementation with omega-3 fatty acids resulted in reductions in CU traits six months post-treatment [51]. Given the challenge in treating conduct problems in children with CU traits, nutritional supplementation may be a promising alternative that does not involve the commonly recognized side effects of psychotropic medications. ...
Background
Although researchers increasingly recognize the role of nutrition in mental health, little research has examined specific micronutrient intake in relation to antisocial behavior and callous–unemotional (CU) traits in children. Vitamin B6 and magnesium are involved in neurochemical processes implicated in modulating antisocial behavior and CU traits. The current study examined dietary intakes of magnesium and vitamin B6 in relation to antisocial behavior and CU traits.
Method
: We enrolled 11–12 year old children (n = 446, mean age = 11.9 years) participating in the Healthy Brains and Behavior Study. Magnesium and vitamin B6 dietary intake were assessed with three 24-hour dietary recall interviews in children. CU traits and antisocial behavior were assessed by caregiver-reported questionnaires. We controlled for age, sex, race, total energy intake, body mass index, social adversity, ADHD or learning disability diagnosis, and internalizing behavior in all regression analyses.
Results
Children with lower magnesium intake had higher levels of CU traits, controlling for covariates (β = −0.18, B = −0.0066, SE = 0.0027, p < 0.05). Vitamin B6 intake was not significantly associated with CU traits (β = 0.061, B = 0.19, SE = 0.20, p > 0.05). Neither magnesium (β = 0.014, B = 0.0020, SE = 0.0093, p > 0.05) nor vitamin B6 (β = 0.025, B = 0.33, SE = 0.70, p > 0.05) were significantly associated with antisocial behavior.
Conclusions
Findings suggest that low dietary intake of magnesium may play a role in the etiology of CU traits but not general antisocial behavior. More studies are needed to determine if magnesium supplementation or diets higher in magnesium could improve CU traits in children.
... Our meta-analysis further showed that the duration of most of the trials in this area range between 12 and 16 weeks to show an effect on clinical symptoms (Chang et al., 2018c). Moreover, it has been reported that it requires at least 16 weeks to have an effect on cognitive performance (Stonehouse, 2014), about 24 weeks to reach a steady level in the RBC (Katan et al., 1997), and sometimes up to 52 weeks to show behavioural changes (Raine et al., 2015). ...
Attention deficit hyperactivity disorder, or ADHD, is a common childhood disorder with a prevalence rate of 5–10%. There have been many theories proposed to explain ADHD, and one of them focuses on the deficiency of essential fatty acids (EFA), particularly omega-3 polyunsaturated fatty acids (n-3 PUFAs) including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Studies have shown that there is a positive correlation between EFA deficiency severity and ADHD symptoms, and a negative association between blood PUFAs levels and ADHD symptoms. Moreover, clinical studies have shown a promising effect of n-3 PUFAs in the treatment of both clinical and cognitive symptoms in children with ADHD. In addition, with the more relatively safe and tolerable properties of n-3 PUFAs when comparing with the standard pharmacotherapy, n-3 PUFAs may be a potential treatment option for children with ADHD. Of note, the association between n-3 PUFAs deficiency and ADHD has been suggested to involve several biological systems, including inflammation, dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), and an imbalanced gut-microbiota axis (GBA). Thus, the biomarkers from these biological systems may serve as possible treatment response predictors of n-3 PUFAs in children with ADHD.
... Likewise, in a study on the effect of text message nudges sent to offenders as reminders to attend their court hearings, it might be assumed that every individual has received, read and then internalised the messages (Cumberbatch & Barnes, 2018). Similarly, a trial on the effect of omega-3 supplements on behaviour problems in children might posit that the participants adhered fully to the experimental protocol and took precisely 1 g/day of omega-3 during the days of the experiment (Raine et al., 2015). ...
The fourth book in The SAGE Quantitative Research Kit, this resource covers the basics of designing and conducting basic experiments, outlining the various types of experimental designs available to researchers, while providing step-by-step guidance on how to conduct your own experiment.
As well as an in-depth discussion of Random Controlled Trials (RCTs), this text highlights effective alternatives to this method and includes practical steps on how to successfully adopt them. Topics include:
· The advantages of randomisation
· How to avoid common design pitfalls that reduce the validity of experiments
· How to maintain controlled settings and pilot tests
· How to conduct quasi-experiments when RCTs are not an option
Practical and succinctly written, this book will give you the know-how and confidence needed to succeed on your quantitative research journey.
... Fish intake is associated with omega-3 fatty acids and an early study in Japan and a later review showed that having a high number of behaviour problems is associated with low total omega-3 fatty acid intake. 24,25,26 However, a study conducted in Australia found no association between fatty acids and attention-deficit/hyperactivity disorder symptoms. 27 Furthermore, a randomised controlled trial showed no improvement in children with aggression and disruptive behaviour with fish oil treatment. ...
Objectives:
This study aimed to evaluate food consumption frequency in 1-6-year-olds as an eating behaviour-related predictor of behavioural problems over a span of six years. Eating behaviour in early childhood serves as a foundation for future health outcomes. Diet patterns can have long-term beneficial or adverse effects on social behaviour development.
Methods:
This longitudinal study was performed based on information obtained between July 2011 and August 2017 provided from a project named 'Community Empowerment and Care for Wellbeing and Health Longevity' initiated in 1991; the current study involved 124 mother-child dyads from the project. Children aged 1-6 years were studied in July 2011, with a follow-up assessment in August 2017. The primary exposure examined was the frequency of food items intake. The primary outcome was behaviour problems as assessed by the Strengths and Difficulties Questionnaire (SDQ).
Results:
The adjusted results suggested that a higher intake of leafy green and light-coloured vegetables were significantly associated with decreased odds of conduct problems and prosocial behaviour problems in Japanese children. However, no associations were observed among fruits, milk, small fish, eggs, soybeans, seaweed and any SDQ subscales.
Conclusion:
This study shows that eating leafy green and light-coloured vegetables may have a protective effect on a child's conduct and against prosocial behaviour problems. Due consideration should be given to children's eating habits in the early stages of their lives to ensure better mental health.
... Similar results were observed in a sample of 8-to 16-year-old children who received EPA and DHA supplementation in the form of fruit juice drink during a period of 3 months. In this population, a statistically significant reduction in externalizing and internalizing behavioural problems was observed, with improvement continuing 6 months after treatment cessation [68]. LC n-3 PUFA supplementation was also tested in a large group of 324 schoolchildren with a mean age of 11.9 years, with positive results on early-onset antisocial and aggressive behaviours particularly in females, as well as in children with psychopathic-like traits [69]. ...
: It is the focus of increasing interest to investigate the effects of long-chain n-3 and long-chain n-6 polyunsaturated fatty acids (LC n-3 PUFAs; LC n-6 PUFAs) on psychiatric symptoms in a transdiagnostic perspective. There is some evidence that low levels of LC n-3 PUFAs and a higher ratio of LC n-6 to LC n-3 PUFAs in plasma and blood cells are associated with aggressive and impulsive behaviours. Therefore, implementation of LC n-3 PUFAs may produce positive effects on hostility, aggression, and impulsivity in both psychiatric and non-psychiatric samples across different stages of life. A possible mechanism of action of LC n-3 PUFAs in conditions characterized by a high level of impulsivity and aggression is due to the effect of these compounds on the serotonin system and membrane stability. Studies that evaluated the effects of LC n-3 PUFAs on impulsivity and aggressiveness indicated that addition of rather low doses of these agents to antipsychotic treatment might reduce agitation and violent behaviours in psychosis, attention deficit hyperactivity disorder, personality disorders, and impulsive control and conduct disorders. The present review is aimed at examining and discussing available data from recent trials on this topic.
... Together with findings from other studies in forensic populations relating to different aspects of lifestyle, this could prompt us to promote a healthier lifestyle in youth residing in judicial institutions. For example, it has been found that insufficient sleep is related to violent delinquency (Clinkinbeard et al., 2011), and antisocial and aggressive behavior has been shown to be mitigated through nutrition (Raine et al., 2015). ...
This study examined a biopsychosocial approach on risk assessment in a clinical sample of youth offenders. In search of enhancing the validity of prediction of recidivism through risk factors alone, the added value of protective and neurobiological factors was measured. In 209 male youth offenders (age 15-24), risk and protective factors were assessed with the Structured Assessment of Violence in Youth (SAVRY) and the Structured Assessment of Protective Factors for violence risk-Youth Version (SAPROF-YV). Autonomic nervous system (re)activity was assessed, and cortisol and testosterone levels were measured in saliva. Recidivism data were obtained from official criminal records. As expected, risk factors alone provided moderate predictive validity for general and violent recidivism. Incorporating protective factors and Heart Rate Variability (HRV) reactivity significantly improved prediction models. Risk assessment may gain by adopting a broader, biopsychosocial perspective. Including neurobiology and protective factors in risk assessment could improve release decision-making, offer guidance for better tailored interventions, and enhance chances of successful community reintegration.
... Besides, there is an increasing body of research documenting health and neurobiological-risk factors for aggression and violence, and part of the prevention failure may be due to ignoring biological factors such as impaired neurocognitive and psychophysiological functioning. Omega-3 (a long-chain fatty acid critical for brain structure and function) dietary supplementation is a neurobiological intervention that may help attenuate behavior problems in children [131]. Fung [132] investigated the effectiveness of omega-3 supplements in reducing aggression of school children in Hong Kong. ...
The negative impacts of aggressive bullying behavior by adolescents on both the bullies and victims are being increasingly recognized as social and economic problems. At the same time, there are alarming trends in face-to-face and online aggression and bullying behavior in Hong Kong. Since the 1970s, prevention and intervention programs to reduce bullying behavior have been implemented in schools in Western countries; however, antibullying and antiaggression programs in Hong Kong schools only began in the 2000s. There are two ways of defining the target groups for these intervention programs. Programs using a one-factor model categorize the adolescents who exhibit bullying behavior into a single group, bullies, whereas two-factor models distinguish two subtypes of aggression: reactive and proactive aggression. The former approach is emphasized in the Restorative Whole-school Approach with Shared Concern method, which uses mediation to reduce bullying in schools. The two-factor approach differentiates adolescents' behaviors into reactive, proactive, or occurring reactive-proactive aggression based on the functions and underlying goals of their actions. Specific interventions are then designed to address the particular features and psychosocial correlates of reactive and proactive aggression. The aim is to develop the positive development attributes related to specific types of aggression and thus reduce aggressive behavior in schools.
... Scientists connect their inadequate intake in pregnant women with premature birth, low birth weight, and to hyperactivity in children. [15,17,36] The fatty acids in the composition of phospholipids and triacylglycerols. The presence of polyunsaturated fatty acids defines the biological activity of the phospholipids, the properties of biological membranes, the interaction of phospholipids with membrane-proteins and their transport and receptor activity. ...
REVIEW The fat content of the human body is about 97% saturated and monounsaturated fat, with only 3 % polyunsaturated fats. Half of that three percent is Omega-3 fats, and that balance needs to be kept. Vegetable oils contain very high levels of polyunsaturated fats, and these oils have replaced many of the saturated fats in our diets since the 1950s. The first evidence for the important role of dietary intake of omega-3 essential fatty acids (PUFAs) in inflammation was derived from epidemiological observations of the low incidence of autoimmune and inflammatory diseases such as psoriasis, asthma and type-1 diabetes, as well as the complete absence of multiple sclerosis in a population of Greenland. Most of these diseases are characterized by unexplained activation of T cells resulting from the destruction of host tissues. In the 1980's some evidence suggested that changes in the natural history of hypertensive, atherosclerotic and chronic inflammatory disorders may be achieved by altering availability of eicosanoid precursors. Native Greenland Eskimos and Japanese have a high dietary intake of long chain omega-3 PUFA from seafood and a low incidence of myocardial infarction and chronic inflammatory or autoimmune disorders, even when compared to their Westernized ethnic counterparts. The metabolism of taken omega-3 polyunsaturated fatty acids has important meaning for the prevention of certain socially important diseases.
... Fish oil is a source of long-chain n-3 polyunsaturated fatty acids, such as eicosapentaenoic acid and docosahexaenoic acid which decrease serum triglyceride levels (Breslow, 2006) and reduce the risk of developing cardiovascular disease and hypertension (Mori and Woodman, 2006;Mozaffarian and Wu, 2011). Some studies have also found that n-3 fatty acid supplementation by using fish oil products confers benefits on cognition (thinking, reasoning, memory), behavior, and school performance among healthy children (Al-Ghannami et al., 2019;Kuratko et al., 2013;Raine et al., 2015;Stonehouse, 2014); consequently, fish oil supplements have been marketed towards children with dyslexia, dyspraxia, attention-deficit hyperactivity disorder, and other similar disorders (Fernandes et al., 2006). Also, the popularity of fish oil products has increased concurrently with scientific research showing the benefits of fish oils in addressing a number of disease conditions, including hypertriglyceridemia, peripheral artery disease, cardiovascular disease, stroke, hypertension, renal injury, rheumatoid arthritis, and autoimmune disorders (Mason, 2000;Schmitz and Antony, 2002). ...
Background: Oily fish and their extracted oils may be a source of polychlorinated biphenyls (PCBs) which can induce toxic effects on the consumers. The main aim of this survey was estimation of PCBs intake through fish oil-derived dietary supplements and prescription drugs in the Japanese population.
Methods: PCBs levels were determined in 20 fish oil-derived dietary supplements and 6 oil-derived prescription drugs from the Japanese market using Gas Chromatography-Mass Spectrometry. Then, the daily exposure to PCBs was estimated. Data were statistically analyzed using JMP software suite.
Results: Totally, 17 of the 26 fish oil-derived products were contaminated with PCBs. The median PCB concentrations in the total set of fish oil-derived products was 2.2 ng/g oil wt. with a range of
... They found that index of agitation was significantly decreased, suggesting that n-3 PUFAs might be able to control violent behavior in patients with schizophrenia. Other evidence has also shown that supplementation with omega-3 fatty acids can reduce the incidence of aggressive behavior in persons with or without major mental disorder (Long & Benton, 2013;Raine, Portnoy, Liu, Mahoomed, & Hibbeln, 2015;Zaalberg et al., 2010). Furthermore, several meta-analyses and reviews have examined the available data on role of omega-3 PUFAs in alleviating symptoms of psychopathology from childhood, throughout adulthood (Joy, Mumby-Croft, & Joy, 2003;Sinn et al., 2010;Freeman et al., 2011;Akter et al., 2012;Bozzatello et al., 2016). ...
... As another example, an RCT of an omega-3 dietary supplement for children in Mauritius was followed by significantly lower CBCL Internalizing and Externalizing scores for children receiving omega-3 than for children receiving a placebo [21]. ...
Abstract The purpose of this invited article is to present multicultural norms and related international findings obtained with the Achenbach System of Empirically Based Assessment (ASEBA) by indigenous researchers in over 50 societies. The article describes ASEBA instruments for which multicultural norms are available, plus procedures for constructing the multicultural norms. It presents applications to clinical services, including use of multi-informant data for assessing children and their parents. The Multicultural Family Assessment Module (MFAM) enables mental health providers to view side-by-side bar graphs of child and parent scores on syndromes, DSM-oriented scales, Internalizing, Externalizing, and Total Problems. Evidence-based assessment of progress and outcomes is facilitated by the Progress & Outcomes App (P&O App). Research applications are outlined, including longitudinal and outcomes research. Applications to training mental health providers include having trainees study standardized multi-informant assessment data prior to interviewing children and their parents. Trainees can also sharpen their clinical skills by completing assessment forms to describe children and their parents, and then using ASEBA software to compare their ratings with ratings by children, parents, and other informants. Practical evidence-based assessment instruments with multicultural norms enable mental health providers, researchers, and trainees to perform intake, progress, and outcome assessments of children and their parents in terms of a standardized international clinical data language.
... 93-96 Accordingly, several randomized, placebo-controlled interventional trials reported positive effects of dietary supplementation with n-3 PUFAs in ADHD. 94,95, [97][98][99] However, other trials found only small or no therapeutic effects. Hence, some meta-analyses stated that there is evidence for n-3 PUFAs as a supplement to established therapies while others concluded that the currently available evidence is inconclusive. ...
The prevalence of neurologic and psychiatric diseases has been increasing for decades and, given the moderate therapeutic efficacy and safety profile of existing pharmacological treatments, there is an urgent need for new therapeutic approaches. Nutrition has recently been recognized as an important factor for the prevention and treatment of neuropsychiatric disorders. The omega-3 polyunsaturated fatty acids (n-3 PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) play critical roles in neuronal cell function and neurotransmission as well as inflammatory and immune reactions that are involved in neuropsychiatric disease states. A large number of experimental and epidemiological studies provide a strong basis for interventional clinical trials that assessed the clinical efficacy of n-3 PUFAs in various neurological and psychiatric disorders. Most of these trials found beneficial effects of dietary supplementation with EPA and DHA, and no serious safety concerns have emerged. This review gives an introduction to recent findings on the clinical efficacy of n-3 PUFAs in various neuropsychiatric disorders and the underlying biochemical mechanisms. In addition, the reader will be enabled to identify common methodological weaknesses of clinical studies on n-3 PUFAs, and suggestions for the design of future studies are given.
... Як нейрокримінолог Рейн А. зібрав величезну базу даних, що свідчать про порушен ня у відділах головного мозку, які відповідають за регуляцію емоцій стимуляторів злочину: імпульсивного прийняття рішення, спалахів насильства та ін. Базуючись на власному досвіді та інформації із сучасної наукової літератури, дослідник вивчив можливі вектори зовнішнього впливу на формування поведінкових характери стик, зокрема, корекції дієти, як одного з методів зниження рівня поведінкових проблем [37]. ...
The article offers review of the literature dedicated to the relationship between nutrition and antisocial behavior of teenagers, in particular, their manifestation of aggression. The authors are focused on improper nutrition influence on health and mental activity of teenagers, the role of some nutrients in formation of a child's brain and later intellect and cognitive functions, as well as behavioral responses. The article studies the causes of the «antenatal stress» problem facilitating analysis and substantiation of «nutrition-brain» dependence and currently evolving in neuronutrition science. It is emphasized that the lack of micronutrients leads to reduction in the size of the hippocampus, decrease in proliferation and cell migration activity, which are neuronal precursors in the hippocampus, the part of the brain that is responsible for emotional sphere, memory function, learning ability, etc. Currently there are approaches to reducing the aggressiveness in adolescents by means of diet correction, in particular, by enriching the diet with essential fatty acids, micronutrients, vitamins, which positively affect the manifestations of behavioral reactions in children. The information provided in the literature sources prove the relevancy of scientific researches of improper nutrition role as one of the factors fueling the risk of mental disorder occurrence in teenagers.
... Thus, there is tremendous value in understanding the long-term effects of adversity on executive function, particularly in childhood and adolescence (Blair & Raver, 2015) as well as the proximal effects of poverty, racism, and scarcity on self-controlled decision making (Duckworth, Kim, & Tsukayama, 2012;Mullainathan & Shafir, 2013). We also encourage further investigation of how executive function depends on good nutrition (Raine, Portnoy, Liu, Mahoomed, & Hibbeln, 2015), sleep (Diestel, Rivkin, & Schmidt, 2014;Schilbach, Schofield, & Mullainathan, 2016), aerobic exercise (Hillman, Erickson, & Kramer, 2008), and schooling as well as other common experiences (Diamond, 2013;Piquero, Jennings, Farrington, Diamond, & Gonzalez, 2016;Zhang et al., 2018). 5. More research is needed to test the robustness, effect size, and cost-effectiveness of each of the interventions discussed in this review. ...
Almost everyone struggles to act in their individual and collective best interests, particularly when doing so requires forgoing a more immediately enjoyable alternative. Other than exhorting decision makers to "do the right thing," what can policymakers do to reduce overeating, undersaving, procrastination, and other self-defeating behaviors that feel good now but generate larger delayed costs? In this review, we synthesize contemporary research on approaches to reducing failures of self-control. We distinguish between self-deployed and other-deployed strategies and, in addition, between situational and cognitive intervention targets. Collectively, the evidence from both psychological science and economics recommends psychologically informed policies for reducing failures of self-control.
Excessive aggression in children and youth can lead to impairments in family, social or academic functioning. The aim of the present study was to review the evidence on the effectiveness of nutritional supplements in reducing excessive hetero-aggression in children and youth (up to 18 years). The Cochrane Library, EMBASE, MEDLINE, ProQuest Dissertations & Theses, PsycINFO, and PubMed data bases were searched for relevant studies. Altogether, 22 studies met inclusion criteria; 13 investigated the effect of macronutrients (fatty acids and amino acids), 6 studies investigated the effect of micronutrients (vitamins and minerals), while 3 studies investigated a combination of macro- and micronutrients. Out of the 22 studies, 7 reported a beneficial effect of nutritional supplementation (vitamins and minerals, essential fatty acids, or a certain combination of these); eight studies did not report a significant beneficial effect of nutritional supplementation (essential fatty acids, vitamin D, and L-tryptophan); while 7 studies reported mixed effects (vitamin B6, essential fatty acids alone and in combination with vitamins and minerals, and carnitine). The results overall suggest that there may be a role for broad-range vitamin and mineral supplements in the treatment of hetero-aggression in youth and children, while the evidence for single-nutrient supplements is quite ambiguous.
Within the criminal justice system, one of the most prominent justifications for legal punishment is retributivism. The retributive justification of legal punishment maintains that wrongdoers are morally responsible for their actions and deserve to be punished in proportion to their wrongdoing. This book argues against retributivism and develops a viable alternative that is both ethically defensible and practical. Introducing six distinct reasons for rejecting retributivism, Gregg D. Caruso contends that it is unclear that agents possess the kind of free will and moral responsibility needed to justify this view of punishment. While a number of alternatives to retributivism exist - including consequentialist deterrence, educational, and communicative theories - they have ethical problems of their own. Moving beyond existing theories, Caruso presents a new non-retributive approach called the public health-quarantine model. In stark contrast to retributivism, the public health-quarantine model provides a more human, holistic, and effective approach to dealing with criminal behavior.
Biological perspectives on criminology were widely accepted in the United States in the late 1800s to early 1900s, but quickly fell out of favor due to eugenicists in the field misusing research and sociocriminologists outside of the field vilifying this avenue of investigation. In recent years, the field has rebounded. This review provides a detailed history of biosocial criminology, exploring its development alongside sociocriminology with a focus on the social and personal histories that contributed to the resurgence of biosocial criminology. A brief and selective literature review follows, providing a general overview of methodologies used in the field, key findings, and policy and practice implications. We conclude by discussing the utility of the biosocial perspective in criminology for studying offending and victimization. We also discuss challenges of applying biosocial research to policy and practice, as well as next steps for the field.
Objective
To describe features of nutritional interventions implemented in Small Island Developing States (SIDS) in the past 20 years.
Methods
A rapid scoping review was conducted by searching PubMed and Web of Science databases for interventions conducted in SIDS that sought to improve the nutrition of their populations between 2000 and 2019 inclusive. The Noncommunicable diseases progress monitor 2020 was also examined to assess nutritional policies in SIDS.
Results
A total of 174 interventions were implemented in 49 of the 58 SIDS. The greatest proportion were conducted in the Caribbean (75 interventions; 43%), with the Pacific region, and the Atlantic, Indian Ocean, Mediterranean and South China Sea region each implementing about 30% of interventions. Using the NOURISHING framework, most interventions (67%) were implemented at the community and national or policy level, using multiple components of the framework. The greatest proportion of interventions (35%) were educational and awareness raising. Restrictions on physical availability of and increased taxation on alcohol were the most commonly reported policies that were partially or fully achieved; restrictions on fats were the least commonly reported. These findings were generally consistent across the SIDS regions.
Conclusions
There is a paucity of nutritional policies in SIDS; the reasons may be linked to their social, economic, and environmental vulnerabilities. Interventions should be expanded beyond education to encompass multiple components of the NOURISHING framework, with multisectoral inclusion to ensure stronger stakeholder collaboration and buy-in. A systematic review is warranted using a fuller range of sources to assess the effectiveness of interventions.
Much research has sought to distinguish key interacting factors affecting children as they develop which influence later outcomes. Some factors, notably adverse childhood experiences (ACEs), pose serious risks for later health or mental health problems for the children or predispose them for involvement in offending behaviours. However, other experiences, alongside ACEs, also pose risks and yet others offer protection. A matrix showing interacting influences from the mother's pregnancy onwards was published earlier; a revised matrix has been developed, showing a fresh picture of cumulative risk and protective factors.
Docosahexaenoic acid (C22: 6n-3, DHA) and eicosapentaenoic acid (C20: 5n-3, EPA) have been shown to provide the opportunity to inhibit onset and escalation of chronic diseases. Nevertheless, their undesirable characteristics including poor water solubility, oxidation sensitivity, high melting point and unpleasant sensory attributes hinder their application in the food industry. In recent years, utilizing food-grade delivery systems to deliver DHA/EPA and improve their biological efficacy has emerged as an attractive approach with fascinating prospects. This review focuses on introducing potential delivery systems for DHA/EPA, including microemulsions, nanoemulsions, Pickering emulsions, hydrogels, lipid particles, oleogels, liposomes, microcapsules and micelles. The opportunities, fabrication and characterization of these delivery systems loaded with DHA/EPA are highlighted. Besides, food sources of DHA/EPA, their benefits to the human body and a series of challenges for effective utilization of DHA/EPA are discussed. Promising future research trends of food-grade systems for delivery of DHA/EPA are also presented. Conducting in vivo experiments, applying DHA/EPA-loaded delivery systems into real food, improving the applicability of such delivery systems in industrial production, co-encapsulating DHA/EPA with other substances, seeking measures to improve the performance of existing delivery systems and developing novel food-grade delivery systems inspired by other fields are various future considerations.
Explosive and aggressive behavior in children can pose safety risks, disturb family functioning, and lead to significant impairments. Pharmacologic management should be based on the first-line treatment of the primary psychiatric diagnoses of the patient and initiated in combination with appropriate psychosocial interventions. Review of the literature suggests that risperidone has the most supporting evidence in the treatment of explosive behavior. Stimulants have been shown to be helpful in the treatment of explosive behavior in attention-deficit/hyperactivity disorder. Medication treatment can be associated with significant side effects and therefore the risks and benefits of medication management must be weighed carefully.
Human aggression is typically distinguished in two forms. These are instrumental or proactive and impulsive or reactive. When sufficiently frequent and severe, individuals with impulsive aggression may meet the Diagnostic and Statistical Manual of Mental Disorders‐5th Edition diagnosis of Intermittent Explosive Disorder, a disorder with a lifetime prevalence of 3.6% in general population samples. The influence of neurotransmitters and neuromodulators on aggression is the focus of this chapter. Neurotransmitters, and other molecules that impact neurotransmission, range from simple monoamines and peptides to more sizable proteins and steroid hormones. To date, the tryptamine serotonin (5‐hydroxytryptamine; 5‐HT) has been the most extensively studied neurotransmitter with respect to aggression. Dopamine (DA) is a catecholamine neurotransmitter that is involved in a range of functions including learning, memory, and movement. Compared to 5‐HT, less is known about therelationship between DA functioning and aggression.
Previous research links low levels of self-control with criminal involvement and negative life outcomes. A similar line of inquiry has begun to explore whether low levels of self-control are also associated with developing health problems in adulthood. This paper extends this research by examining associations between adolescent levels of self-control and four different categories of health outcomes in adulthood. In addition, this study examines whether associations between adolescent levels of low self-control and health outcomes in adulthood are moderated by environmental protective factors. The results reveal that low levels of self-control in adolescence are consistently associated with reporting more health problems. In addition, some evidence emerged in support of the role of environmental protective factors in buffering the risk of developing health problems conferred by low levels of self-control in adolescence.
The innate violence inhibition mechanism (VIM) purportedly regulates maladaptive aggressive behavior through motor inhibition, in response to expressions of distress, and is implicated in psychopathy-related aggression. Deficiency in eicosapentaenoic acid (EPA; an omega-3 fatty acid) is implicated in aggression and callous-unemotional (CU) traits, however, its relationship to the VIM remains unknown. Two studies tested relationships between EPA intake, personality (aggression, CU traits), and electrophysiological indices of the VIM. In study one (N = 98), participants completed omega-3 intake (FFQ), CU traits (ICU), and aggression (BPAQ) measures. Physical aggression correlated positively with callousness and negatively with EPA intake. CU traits were unrelated to EPA. In study two (N = 47), participants completed the same measures and an electroencephalography assessment of VIM. Stop-P300 amplitude (motor inhibition success) in response to facial expressions of distress mediated the relationship between EPA intake and physical aggression. This is the first demonstration of an association between EPA intake and electroencephalographic indices of the VIM. Findings support a role of EPA in regulating aggression through networks involved in distress-cued executive control over behavior; and provide supporting data to direct future trial designs for nutritional supplementation in non-clinical, clinical and forensic arenas.
Omega-3 (N3) fatty acids are dietary nutrients which are essential for human health. Arguably one of their most critical contributions to health is their involvement in the structure and function of the nervous system. N3 fatty acids accumulate in neuronal membranes through young adulthood, becoming particularly enriched in a brain region known to be the locus of cognitive control of behavior – the prefrontal cortex (PFC). The PFC undergoes a surge in development during adolescence, coinciding with a life stage when dietary quality and intake of N3 fatty acids tend to be suboptimal. Such low intake may impact neurodevelopment and normative development of cognitive functions suggested to be protective for risk of subsequent substance and alcohol Use Disorders (UD). While multiple genetic and environmental factors contribute to risk for and resilience to substance and alcohol use disorders, mounting evidence suggests that dietary patterns early in life may also modulate cognitive and behavioral factors thought to elevate UD risk (e.g., impulsivity and reward sensitivity). This review aims to summarize the literature on dietary N3 fatty acids during childhood and adolescence and risk of executive/cognitive or behavioral dysfunction which may contribute to risk of subsequent UD. We begin with a review of the effects of N3 fatty acids in the brain at the molecular to cellular levels – providing the biochemical mechanisms ostensibly supporting observed beneficial effects. We continue with a review of cognitive, behavioral and neurodevelopmental features thought to predict early substance and alcohol use in humans. This is followed by a review of the preclinical literature, largely demonstrating that dietary manipulation of N3 fatty acids contributes to behavioral changes which enhance susceptibility to substance abuse. Finally, a review of the available evidence in human literature, suggesting an association between dietary N3 fatty and neurodevelopmental profiles associated with risk of adverse outcomes including UD. We conclude with a brief summary and call to action for additional research to extend the current understanding of the impact of dietary N3 fatty acids and risk of drug and alcohol use disorders.
The innate violence inhibition mechanism (VIM) purportedly regulates maladaptive aggressive behavior through motor inhibition, in response to expressions of distress, and is implicated in psychopathy-related aggression. Deficiency in eicosapentaenoic acid (EPA; an omega-3 fatty acid) is implicated in aggression and callous-unemotional (CU) traits, however, its relationship to the VIM remains unknown. Two studies tested relationships between EPA intake, personality (aggression, CU traits), and electrophysiological indices of the VIM. In study one (N=98), participants completed omega-3 intake (FFQ), CU traits (ICU), and aggression (BPAQ) measures. Physical aggression correlated positively with callousness and negatively with EPA intake. CU traits were unrelated to EPA. In study two (N=47), participants completed the same measures and an electroencephalography assessment of VIM. Stop-P300 amplitude (motor inhibition success) in response to facial expressions of distress mediated the relationship between EPA intake and physical aggression. This is the first demonstration of an association between EPA intake and electroencephalographic indices of the VIM. Findings support a role of EPA in regulating aggression through networks involved in distress-cued executive control over behaviour; and provide supporting data to direct future trial designs for nutritional supplementation in non-clinical, clinical and forensic arenas.
Because criminal behavior has many causes, it is reasonable to assume that some of those causal factors will interact. Interactions occur when the effect of one factor on an outcome depends in some way on the presence or absence of another factor. Although tests for interactions are common, there remains no formal typology of interaction models in criminology generally or biopsychosocial criminology specifically. Empirical studies often overlook some of the challenges of statistically testing for interactions. This review, thus, had three goals: (1) offer a typology of interactions that criminologists are likely to observe; (2) provide an example analysis testing for interactions; and (3) survey the key challenges that arise when empirically assessing interactions. We do so while reviewing research in biopsychosocial criminology, a perspective that has expanded in recent years and has frequently tested for interactions. Implications for theory and policy are discussed.
Objectives
This article summarizes key points made in a panel at the American Society of Criminology (ASC) meeting in Atlanta in November 2018, entitled “20th Anniversary of the Academy of Experimental Criminology (AEC): Looking Back and Forward,” organized by Friedrich Lösel as the AEC president.
Method
Seven (current and former) presidents of AEC contribute short papers about the past and future of experimental criminology, focusing on different and emerging areas of criminological experimentation, as well as identifying topics that require more attention in future, including field experiments and experimental neurocriminology.
Results
This article informs readers about the history of AEC, its links with the Journal of Experimental Criminology, current issues, and potential future developments in experimental criminology. It also briefly deals with arguments that question whether experiments are the “gold standard,” which were addressed by Daniel Nagin and Robert Sampson in another ASC session at Atlanta. Experimental panel members did not view randomized controlled trials (RCTs) as a ritualized and general “gold standard” for criminological research, because many important topics cannot be investigated in this type of design.
Conclusions
This article is not intended to be a missionary statement for RCTs, but it does argue that experiments should be used whenever feasible, because they are most robust in ensuring internal validity as the basis for external validity and for generalizations that are necessary for effective practice and policy making.
Celem niniejszego artykułu jest porównanie sposobów prezentowanie tej samej treści przy użyciu różnych rejestrów językowych, tj. języka naukowego i popularnonaukowego, z zachowaniem spójności informacji. Tło do rozważań stanowi tu antropocentryczna teoria języków ludzkich F. Gruczy (np. 1992) i języków specjalistycznych S. Gruczy (np. 2004). Autorzy ci uważają, iż konkretny język specjalistyczny jest zrozumiały dla członków danej wspólnoty dyskursu, a im bardziej zbieżne są idiolekty specjalistyczne mówców/słuchaczy, tym efektywniejsza będzie komunikacja specjalistyczna. Materiał badawczy stanowią oryginalne artykuły z anglojęzycznych czasopism medycznych oraz angielskie prace popularnonaukowe z czasopisma „What Doctors Don‘t Tell You‖, odwołujące się do oryginalnych prac.
In the penultimate chapter, biosocial interactions are the focus. Very little research has been done directly on the biosocial approach in Japan, but studies from the fields of psychology and psychiatry on Japanese populations indicate promising future avenues in examining these interactions. Psychopathy and sexual offending are examined within the context of biosocial explanations. Specifically, studies have examined the applicability of findings on the brain and personality of psychopaths and sex offenders. Studies of sex offenders have evaluated the effectiveness of prison rehabilitation programmes, in particular, cognitive-behavioural therapy. The effectiveness of omega-3 supplements in reducing violence and offending is discussed, as Japan was found to have the comparatively highest seafood consumption and lowest homicide rate.
The most commonly used method to test an indirect effect is to divide the estimate of the indirect effect by its standard error and compare the resulting z statistic with a critical value from the standard normal distribution. Confidence limits for the indirect effect are also typically based on critical values from the standard normal distribution. This article uses a simulation study to demonstrate that confidence limits are imbalanced because the distribution of the indirect effect is normal only in special cases. Two alternatives for improving the performance of confidence limits for the indirect effect are evaluated: (a) a method based on the distribution of the product of two normal random variables, and (b) resampling methods. In Study 1, confidence limits based on the distribution of the product are more accurate than methods based on an assumed normal distribution but confidence limits are still imbalanced. Study 2 demonstrates that more accurate confidence limits are obtained using resampling methods, with the bias-corrected bootstrap the best method overall.
Intention to treat (ITT) is an analytic strategy for reducing potential bias in treatment effects arising from missing data in randomised controlled trials (RCTs). Currently, no universally accepted definition of ITT exists, although many researchers consider it to require either no attrition or a strategy to handle missing data. Using the reports of a large pool of RCTs, we examined discrepancies between the types of analyses that alcohol pharmacotherapy researchers stated they used versus those they actually used. We also examined the linkage between analytic strategy (ie, ITT or not) and how missing data on outcomes were handled (if at all), and whether data analytic and missing data strategies have changed over time.
Descriptive statistics were generated for reported and actual data analytic strategy and for missing data strategy. In addition, generalised linear models determined changes over time in the use of ITT analyses and missing data strategies.
165 RCTs of pharmacotherapy for alcohol use disorders.
Of the 165 studies, 74 reported using an ITT strategy. However, less than 40% of the studies actually conducted ITT according to the rigorous definition above. Whereas no change in the use of ITT analyses over time was found, censored (last follow-up completed) and imputed missing data strategies have increased over time, while analyses of data only for the sample actually followed have decreased.
Discrepancies in reporting versus actually conducting ITT analyses were found in this body of RCTs. Lack of clarity regarding the missing data strategy used was common. Consensus on a definition of ITT is important for an adequate understanding of research findings. Clearer reporting standards for analyses and the handling of missing data in pharmacotherapy trials and other intervention studies are needed.
Background:
Most methodologists recommend intention-to-treat (ITT) analysis in order to minimize bias. Although ITT analysis provides an unbiased estimate for the effect of treatment assignment on the outcome, the estimate is biased for the actual effect of receiving treatment (active treatment) compared to some comparison group (control). Other common analyses include measuring effects in (1) participants who follow their assigned treatment (Per Protocol), (2) participants according to treatment received (As Treated), and (3) those who would comply with recommended treatment (Complier Average Causal Effect (CACE) as estimated by Principal Stratification or Instrumental Variable Analyses). As each of these analyses compares different study subpopulations, they address different research questions.
Purpose:
For each type of analysis, we review and explain (1) the terminology being used, (2) the main underlying concepts, (3) the questions that are answered and whether the method provides valid causal estimates, and (4) the situations when the analysis should be conducted.
Methods:
We first review the major concepts in relation to four nuances of the clinical question, 'Does treatment improve health?' After reviewing these concepts, we compare the results of the different analyses using data from two published randomized controlled trials (RCTs). Each analysis has particular underlying assumptions and all require dichotomizing adherence into Yes or No. We apply sensitivity analyses so that intermediate adherence is considered (1) as adherence and (2) as non-adherence.
Results:
The ITT approach provides an unbiased estimate for how active treatment will improve (1) health in the population if a policy or program is enacted or (2) health of patients if a clinician changes treatment practice. The CACE approach generally provides an unbiased estimate of the effect of active treatment on health of patients who would follow the clinician's advice to take active treatment. Unfortunately, there is no current analysis for clinicians and patients who want to know whether active treatment will improve the patient's health if taken, which is different from the effect in patients who would follow the clinician's advice to take active treatment. Sensitivity analysis for the CACE using two published data sets suggests that the underlying assumptions appeared to be violated.
Limitations:
There are several methods within each analytical approach we describe. Our analyses are based on a subset of these approaches.
Conclusions:
Although adherence-based analyses may provide meaningful information, the analytical method should match the clinical question, and investigators should clearly outline why they believe assumptions hold and should provide empirical tests of the assumptions where possible.
Major depressive disorder is a common and recur- rent disorder in children. It is frequently accompanied by poor psychosocial outcome, comorbid conditions, and high risk of suicide and substance abuse, indicating the need for treatment. The prevalence of major depressive disorder is estimated to be approximately 2%-4% in chil- dren (1). Several randomized, controlled studies have shown a 50% to 60% response to both selective serotonin reuptake inhibitors and placebo (2, 3). However, these studies included a majority of adolescent children, and the efficacy of biological treatment of prepubertal child- hood depression is almost unknown. We found omega-3 fatty acids to be effective in adult depression as an add-on therapy (4). We therefore performed a controlled study of omega-3 fatty acid in childhood depression, restricting our study to children between the ages of 6 and 12.
This article provides a comprehensive review of the research on the use of callous and unemotional (CU) traits for designating an important subgroup of children and adolescents with severe conduct problems. It focuses on the etiological significance of recognizing this subgroup of youths with severe conduct problems, its implications for diagnostic classification, and the treatment implications of this research. The review highlights limitations in existing research and provides directions for future research. The available research suggests that children and adolescents with severe conduct problems and elevated CU traits show distinct genetic, cognitive, emotional, biological, environmental, and personality characteristics that seem to implicate different etiological factors underlying their behavior problems relative to other youths with severe conduct problems. Recognizing these subgroups could be critical for guiding future research on the causes of severe conduct problems in children and adolescents. Further, children and adolescents with both severe conduct problems and elevated CU traits appear to be at risk for more severe and persistent antisocial outcomes, even controlling for the severity of their conduct problems, the age of onset of their conduct problems, and common comorbid problems, which supports the clinical importance of designating this group in diagnostic classification systems. Finally, although children and adolescents with both severe conduct problems and elevated CU traits tend to respond less positively to typical interventions provided in mental health and juvenile justice settings, they show positive responses to certain intensive interventions tailored to their unique emotional and cognitive characteristics. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Acute tryptophan depletion (ATD) studies indicate that low serotonin can lower mood and also increase aggression, although results vary somewhat between studies with similar participants. Lowering of mood after ATD is related to the susceptibility of the study participants to clinical depression, and some participants show no effect on mood. This indicates that low serotonin can contribute to lowered mood, but cannot-by itself-cause lowered mood, unless other unknown systems interact with serotonin to lower mood. Studies using tryptophan supplementation demonstrate that increased serotonin can decrease quarrelsomeness and increase agreeableness in everyday life. Social interactions that are more agreeable and less quarrelsome are associated with better mood. Thus, serotonin may have direct effects on mood, but may also be able to influence mood through changes in social behaviour. The increased agreeableness and decreased quarrelsomeness resulting from increases in serotonin will help foster congenial relations with others and should help to increase social support. As social support and social isolation have an important relationship with both physical and mental health, more research is needed on the implications of the ability of serotonin to modulate social behaviour for the regulation of mood, and for future physical and mental health.
Around one in four people suffer from mental illness at some stage in their lifetime. There is increasing awareness of the importance of nutrition, particularly omega-3 polyunsaturated fatty acids (n-3 PUFA), for optimal brain development and function. Hence in recent decades, researchers have explored effects of n-3 PUFA on mental health problems over the lifespan, from developmental disorders in childhood, to depression, aggression, and schizophrenia in adulthood, and cognitive decline, dementia and Alzheimer's disease in late adulthood. This review provides an updated overview of the published and the registered clinical trials that investigate effects of n-3 PUFA supplementation on mental health and behavior, highlighting methodological differences and issues.
Background
Conduct disorder (CD) in female adolescents is associated with a range of negative outcomes, including teenage pregnancy and antisocial personality disorder. Although recent studies have documented changes in brain structure and function in male adolescents with CD, there have been no neuroimaging studies of female adolescents with CD. Our primary objective was to investigate whether female adolescents with CD show changes in grey matter volume. Our secondary aim was to assess for sex differences in the relationship between CD and brain structure.
Methods
Female adolescents with CD (n = 22) and healthy control participants matched in age, performance IQ and handedness (n = 20) underwent structural magnetic resonance imaging. Group comparisons of grey matter volume were performed using voxel-based morphometry. We also tested for sex differences using archive data obtained from male CD and control participants.
Results
Female adolescents with CD showed reduced bilateral anterior insula and right striatal grey matter volumes compared with healthy controls. Aggressive CD symptoms were negatively correlated with right dorsolateral prefrontal cortex volume, whereas callous-unemotional traits were positively correlated with bilateral orbitofrontal cortex volume. The sex differences analyses revealed a main effect of diagnosis on right amygdala volume (reflecting reduced amygdala volume in the combined CD group relative to controls) and sex-by-diagnosis interactions in bilateral anterior insula.
Conclusions
We observed structural abnormalities in brain regions involved in emotion processing, reward and empathy in female adolescents with CD, which broadly overlap with those reported in previous studies of CD in male adolescents.
Objective:
In children with conduct problems, high levels of callous-unemotional traits are associated with amygdala hypoactivity to consciously perceived fear, while low levels of callous-unemotional traits may be associated with amygdala hyperactivity. Behavioral data suggest that fear processing deficits in children with high callous-unemotional traits may extend to stimuli presented below conscious awareness (preattentively). The authors investigated the neural basis of this effect. Amygdala involvement was predicted on the basis of its role in preattentive affective processing in healthy adults and its dysfunction in previous studies of conduct problems.
Method:
Functional MRI was used to measure neural responses to fearful and calm faces presented preattentively (for 17 ms followed by backward masking) in boys with conduct problems and high callous-unemotional traits (N=15), conduct problems and low callous-unemotional traits (N=15), and typically developing comparison boys (N=16). Amygdala response to fearful and calm faces was predicted to differentiate groups, with the greatest response in boys with conduct problems and low callous-unemotional traits and the lowest in boys with conduct problems and high callous-unemotional traits.
Results:
In the right amygdala, a greater amygdala response was seen in boys with conduct problems and low callous-unemotional traits than in those with high callous-unemotional traits. The findings were not explained by symptom levels of conduct disorder, attention-deficit hyperactivity disorder, anxiety, or depression.
Conclusions:
These data demonstrate differential amygdala activity to preattentively presented fear in children with conduct problems grouped by callous-unemotional traits, with high levels associated with lower amygdala reactivity. The study's findings complement increasing evidence suggesting that callous-unemotional traits are an important specifier in the classification of children with conduct problems.
Microwave irradiation as the energy source for one-step direct transesterification of fatty acids in human serum lipids was examined in a solvent system of methanol: hexane: acetyl chloride based on a Lepage & Roy assay. Innovative and explosion proof single-mode or multimode microwave accelerated reaction system was employed. Recoveries were calculated as the percentage of fatty acid concentrations measured by microwave assay to those by the reference method of the Lepage & Roy assay that utilized conductive heating at 100 °C for 60 min. Under conditions of 100 °C for 1 min in Single-mode (S4-100 × 1), or 125 °C for 5 min in Multimode (M5-125 × 5), the recoveries were 100-103 % for the total fatty acids and 96-106 % for each categorized fatty acid, including saturates, monounsaturates, n-6 PUFA, and n-3 PUFA. For individual PUFA, the mean recoveries were 102-105 % for 18:2n-6 and 18:3n-3; 99, 109, and 95 % for 20:4n-6, 20:5n-3, and 22:6n-3, respectively. Thus, fatty acid concentrations determined by microwave fatty acid assay were accurate to those results by the reference method, when the microwave conditions were optimal. In summary, the microwave irradiation could replace conductive heating in one-step direct transesterification, and reduce the duration from 60 min to 5 min or less. This methodology may be applied in both the absolute and relative quantification of serum total fatty acids.
Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. Such systematic error is seriously damaging to RCTs, which are considered the gold standard for evaluating interventions because of their ability to minimise or avoid bias.
Randomization as a method of experimental control has been extensively used in human clinical trials and other biological experiments. It prevents the selection bias and insures against the accidental bias. It produces the comparable groups and eliminates the source of bias in treatment assignments. Finally, it permits the use of probability theory to express the likelihood of chance as a source for the difference of end outcome. This paper discusses the different methods of randomization and use of online statistical computing web programming (www.graphpad.com/quickcalcs or www.randomization.com) to generate the randomization schedule. Issues related to randomization are also discussed in this paper.
Histories of violence and of hyperactivity are both characterized by poor cognitive-neuropsychological function. However, researchers do not know whether these histories combine in additive or interactive ways. The authors tested 303 male young adults from a community sample whose trajectories of teacher-rated physical aggression and motoric hyperactivity from kindergarten to age 15 were well defined. No significant interaction was found. In a 1st model, both histories of problem behavior were independently associated with cognitive-neuropsychological function in most domains. In a second model controlling for IQ, General Memory, and test motivation, none of the three Working Memory tests (relevant to executive function) remained associated with physical aggression or hyperactivity. These results support an additive model but no specificity to executive function [corrected].
Poor nutrition is thought to predispose to externalizing behavior problems, but to date there appear to have been no prospective longitudinal studies testing this hypothesis. This study assessed whether 1) poor nutrition at age 3 years predisposes to antisocial behavior at ages 8, 11, and 17 years, 2) such relationships are independent of psychosocial adversity, and 3) IQ mediates the relationship between nutrition and externalizing behavior problems.
The participants were drawn from a birth cohort (N=1,795) in whom signs of malnutrition were assessed at age 3 years, cognitive measures were assessed at ages 3 and 11 years, and antisocial, aggressive, and hyperactive behavior was assessed at ages 8, 11, and 17 years.
In relation to comparison subjects (N=1,206), the children with malnutrition signs at age 3 years (N=353) were more aggressive or hyperactive at age 8 years, had more externalizing problems at age 11, and had greater conduct disorder and excessive motor activity at age 17. The results were independent of psychosocial adversity and were not moderated by gender. There was a dose-response relationship between degree of malnutrition and degree of externalizing behavior at ages 8 and 17. Low IQ mediated the link between malnutrition and externalizing behavior at ages 8 and 11.
These results indicate that malnutrition predisposes to neurocognitive deficits, which in turn predispose to persistent externalizing behavior problems throughout childhood and adolescence. The findings suggest that reducing early malnutrition may help reduce later antisocial and aggressive behavior.
The developmental taxonomic theory proposes that neurodevelopmental factors play a critical role in the etiology of early-onset conduct disorder, whereas adolescent-onset conduct disorder arises as a result of social mimicry of deviant peers. Recent studies have challenged this theory by demonstrating that adolescents with both early- and adolescent-onset forms of conduct disorder show impaired emotional learning and abnormal neural activation during facial expression processing. The present study extends this work by investigating brain structure in both subtypes of conduct disorder.
Voxel-based morphometry was used to compare gray matter volumes in four regions of interest (amygdala, insula, anterior cingulate, and orbitofrontal cortex) in male adolescents with early-onset (N=36) or adolescent-onset (N=27) conduct disorder and in healthy comparison subjects (N=27). Whole-brain structural analyses were also performed.
The combined conduct disorder group displayed gray matter volume reductions in the bilateral amygdala, extending into the insula, relative to healthy comparison subjects. Separate comparisons between healthy subjects and each conduct disorder subgroup revealed lower amygdala volume in both subgroups and reduced right insula volume in the adolescent-onset subgroup. Regression analyses within the conduct disorder subjects alone demonstrated a negative correlation between conduct disorder symptoms and right insula volume.
The results demonstrate that gray matter volume reductions in brain regions involved in processing socioemotional stimuli are associated with conduct disorder, regardless of age of onset. Brain structural abnormalities may contribute to the emergence of adolescent-onset as well as early-onset conduct disorder.
Loss to follow-up is often hard to avoid in randomised trials. This article suggests a framework for intention to treat analysis that depends on making plausible assumptions about the missing data and including all participants in sensitivity analyses
This study reports the development of the Reactive-Proactive Aggression Questionnaire (RPQ), and the differential correlates of these two forms of aggression. Antisocial, psychosocial and personality measures were obtained at ages 7 and 16 years in schoolboys, while the RPQ was administered to 334 of the boys at age 16 years. Confirmatory factor analysis indicated a significant fit for a two-factor proactive-reactive model that replicated from one independent subsample to another. Proactive aggression was uniquely characterized at age 7 by initiation of fights, strong-arm tactics, delinquency, poor school motivation, poor peer relationships, single-parent status, psychosocial adversity, substance-abusing parents, and hyperactivity, and at age 16 by a psychopathic personality, blunted affect, delinquency, and serious violent offending. Reactive aggression was uniquely characterized at age 16 by impulsivity, hostility, social anxiety, lack of close friends, unusual perceptual experiences, and ideas of reference. Findings confirm and extend the differential correlates of proactive-reactive aggression, and demonstrate that this brief but reliable and valid self-report instrument can be used to assess proactive and reactive aggression in child and adolescent samples.
Measure efficacy of eicosapentaenoic acid (EPA) in children with attention deficit hyperactivity disorder (ADHD).
Randomized controlled trial (RCT) of 0.5 g EPA or placebo (15 weeks) in 92 children (7-12 years) with ADHD. Efficacy measure was Conners' Parent/Teacher Rating Scales (CPRS/CTRS). Fatty acids were analysed in serum phospholipids and red blood cell membranes (RBC) at baseline and endpoint with gas chromatography.
EPA improved CTRS inattention/cognitive subscale (p = 0.04), but not Conners' total score. In oppositional children (n = 48), CTRS total score improved ≥25% in 48% of the children receiving EPA vs. 9% for placebo [effect size (ES) 0.63, p = 0.01]. In less hyperactive/impulsive children (n = 44), ≥25% improvement was seen in 36% vs. 18% (ES 0.41, n.s.), and with both these types of symptoms 8/13 with EPA vs. 1/9 for placebo improved ≥25% (p = 0.03). Children responding to treatment had lower EPA concentrations (p = 0.02), higher AA/EPA (p = 0.005) and higher AA/DHA ratios (p = 0.03) in serum at baseline. Similarly, AA/EPA (p = 0.01), AA/DHA (p = 0.038) and total omega-6/omega-3 ratios (p = 0.028) were higher in RBC, probably because of higher AA (p = 0.011).
Two ADHD subgroups (oppositional and less hyperactive/impulsive children) improved after 15-week EPA treatment. Increasing EPA and decreasing omega-6 fatty acid concentrations in phospholipids were related to clinical improvement.
Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. Such systematic error is seriously damaging to RCTs, which are considered the gold standard for evaluating interventions because of their ability to minimise or avoid bias.
In an earlier study, improvement of dietary status with food supplements led to a reduction in antisocial behavior among prisoners. Based on these earlier findings, a study of the effects of food supplements on aggression, rule-breaking, and psychopathology was conducted among young Dutch prisoners. Two hundred and twenty-one young adult prisoners (mean age=21.0, range 18-25 years) received nutritional supplements containing vitamins, minerals, and essential fatty acids or placebos, over a period of 1-3 months. As in the earlier (British) study, reported incidents were significantly reduced (P=.017, one-tailed) in the active condition (n=115), as compared with placebo (n=106). Other assessments, however, revealed no significant reductions in aggressiveness or psychiatric symptoms. As the incidents reported concerned aggressive and rule-breaking behavior as observed by the prison staff, the results are considered to be promising. However, as no significant improvements were found in a number of other (self-reported) outcome measures, the results should be interpreted with caution.
In this study, we assessed the cross-cultural generalizability of the Reactive-Proactive Aggression Questionnaire (RPQ) and tested the hypotheses that boys show higher levels of proactive aggression with increasing age and that a two-factor (reactive-proactive) structure will be observed in an East Asian population. We administered the RPQ to 5,615 male and female 11- to 15-year-old schoolchildren. CFA demonstrated a good fit of the two-factor reactive-proactive model. Proactive aggression increased significantly with age in boys but not girls, whereas reactive aggression showed no gender difference and only a minimal age increase. Results suggest the presence of meaningful differences between these aggression subtypes and the generalizability of the RPQ in an East Asian population.
This study examined the structure of psychopathic traits in 2 samples of children. The nonreferred community sample included 1,136 children recruited from elementary schools in 2 school districts in the southeastern United States. The clinic sample included 160 children referred to an outpatient mental health clinic serving the same geographic region. In both samples, parent and teacher ratings of psychopathic traits were subjected to a principal-axis factor analysis, and the congruence of the factor structure across samples was examined using confirmatory factor analysis. In both samples, 1 dimension that consisted of the callous and unemotional traits that have been hallmarks of most clinical descriptions of psychopathy was isolated. Two other dimensions consisting of narcissistic traits and impulsivity emerged in the community sample. Both the narcissism and impulsivity dimensions were highly related to symptoms of oppositional defiant disorder, conduct disorder, and attention deficit hyperactivity disorder. However, the callous and unemotional traits were only weakly associated with these symptoms after controlling for the other dimensions of psychopathy.
There is evidence that offenders consume diets lacking in essential nutrients and this could adversely affect their behaviour.
To test empirically if physiologically adequate intakes of vitamins, minerals and essential fatty acids cause a reduction in antisocial behaviour.
Experimental, double-blind, placebo-controlled, randomised trial of nutritional supplements on 231 young adult prisoners, comparing disciplinary offences before and during supplementation.
Compared with placebos, those receiving the active capsules committed an average of 26.3% (95% CI 8.3-44.33%) fewer offences (P=0.03, two-tailed). Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks (n=172) was an average 35.1% (95% CI 16.3-53.9%) reduction of offences (P<0.001, two-tailed), whereas placebos remained within standard error.
Antisocial behaviour in prisons, including violence, are reduced by vitamins, minerals and essential fatty acids with similar implications for those eating poor diets in the community.
Context Several observational epidemiological studies report an association
of pregnancy and obstetric complications with development of antisocial personality
disorder (ASPD) in offspring. However, the precise nature and timing of the
hypothesized biological insults are not known.Objective To test whether severe maternal nutritional deficiency early in gestation
is associated with risk for ASPD in offspring.Design and Setting Retrospective cohort study. From October 1944 to May 1945, the German
army blockaded food supplies to the Netherlands, subjecting the western Netherlands
first to moderate (official food rations, 4200-6300 kJ/d) then to severe (<4200
kJ/d) nutritional deficiency. The north and south were subjected to moderate
nutritional deficiency only.Participants Dutch men born in large urban areas in 1944-1946 who were given psychiatric
examinations for military induction at age 18 years (N=100,543) were classified
by the degree and timing of their prenatal exposure to nutritional deficiency
based on their birthdate and birthplace.Main Outcome Measure Diagnosis of ASPD by psychiatric interview at time of medical examination
for military induction, using the International Classification
of Diseases, Sixth Revision (ICD-6).Results Men exposed prenatally to severe maternal nutritional deficiency during
the first and/or second trimesters of pregnancy exhibited increased risk for
ASPD (adjusted odds ratio [OR], 2.5; 95% confidence interval [CI], 1.5-4.2).
Third-trimester exposure to severe nutritional deficiency and prenatal exposure
to moderate nutritional deficiency were not associated with risk for ASPD.Conclusions Our data suggest that severe nutritional insults to the developing brain
in utero may be capable of increasing the risk for antisocial behaviors in
offspring. The possible implications of these findings for both developed
countries and developing countries, where severe nutritional deficiency is
widespread and often exacerbated by war, natural disaster, and forced migration,
warrant study.
Depression is one of the most prevalent disorders in the United States, and rates of depression are higher for women than men. Despite their widespread use, drugs used in the treatment of depression are only moderately more effective than placebo in treating the disorder. Effective treatment of perinatal depression is of particular concern as treatment can influence both the mother and the developing child. Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation may reduce symptoms of major depressive disorder and perinatal depression. The aim of the present review was to evaluate epidemiological studies examining PUFA intake and depressive symptoms in the general population, as well as double-blind, placebo-controlled trials assessing the influence of n-3 PUFA in healthy individuals and those with depression; specific consideration was given to perinatal depression and potential gender differences in the relationship. Although there is some evidence to suggest that n-3 PUFA intake is associated with reduced depressive symptoms, particularly in females, these results are generally limited to epidemiological studies, whereas results from randomized controlled trials are mixed.
This study examined the measurement structure of Child Behavior Checklist internalizing and externalizing syndrome scales in 1,146 eleven-year-old children from a birth cohort in Mauritius. We tested for measurement invariance at configural, metric, and scalar levels by gender and religioethnicity (Creole, Hindu, Muslim). A pared-down model representing five primary factors and two secondary factors met all three forms of invariance, supporting the validity of their use for group comparisons among Mauritian children. As rated by their parents, girls were higher than boys on Somatic Complaints and lower on Aggressive Behavior, Attention Problems, and Externalizing. Creoles were higher than Muslims and Hindus on all seven factors. Hindus were higher than Muslims on Somatic Complaints and lower on Aggressive Behavior. To our knowledge, this is the first study to demonstrate strict invariance of a Child Behavior Checklist-based internalizing and externalizing factor structure among subgroups within a society.
