Lisa Serravalle’s research while affiliated with Concordia University and other places

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Publications (13)


Hypothalamic-pituitary-adrenal axis function in the offspring of parents with bipolar disorder and the impact of the family environment: A pilot study of the Reducing Unwanted Stress in the Home (RUSH) prevention program
  • Article

September 2024

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11 Reads

Psychoneuroendocrinology

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Vanessa Iacono

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Mark A. Ellenbogen

PRISMA flowchart of the article search and selection process for the meta-analysis
Forest plot of effect size (Hedge’s g) for mean cortisol levels at discrete timepoints throughout the day. Offspring of parents with a mood disorder were used as the index group, therefore a positive effect size would indicate greater HPA axis activation in high-risk offspring, where as a negative effect size would indicate lower activation
Funnel plot of each sample’s mean weighted effect size by average variance to assess for publication bias for cortisol measured at discrete timepoints of the day
Forest plot of effect size (Hedge’s g) for total daily cortisol output as measured by AUCg. Offspring of parents with a mood disorder were used as the index group, therefore a positive effect size would indicate greater HPA axis activation in high-risk offspring, where as a negative effect size would indicate lower activation
Funnel plot of each sample’s mean weighted effect size by average variance to assess for publication bias for total cortisol output measured as area under the curve from ground (AUCg)

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Hypothalamic–pituitary–adrenal axis functioning in offspring of parents with a major affective disorder: a meta-analytic review
  • Literature Review
  • Publisher preview available

August 2024

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12 Reads

European Child & Adolescent Psychiatry

Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic–pituitary–adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge’s g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.

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The figure depicts parents‘ satisfaction with their social network (A) and reported network size (B) as moderators of the relationship between risk status (having a parent with bipolar disorder or not) and time 2 outcomes (number of symptoms) in the offspring. Low and high social support are depicted as 1 standard deviation below and above the mean, respectively. A: Offspring of parents with bipolar disorder (OBD) with parents reporting high social support satisfaction developed fewer symptoms of subtance use disoders (SUD) at time 2 compared to OBD with parents reporting low satisfaction with their social support and control offspring. B: OBD with parents reporting a large social network developed more symptoms of major depressive disorder and anxiety disorders at time 2 compared to OBD with parents reporting a small network and control offspring
The perceived social support of parents having bipolar disorder impacts their children’s mental health: a 10-year longitudinal study

July 2024

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45 Reads

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1 Citation

International Journal of Bipolar Disorders

Background The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents’ social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring. Methods During offspring’s middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later. Results Parents’ social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents’ social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents’ coping style were found. Conclusions Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents’ social support may thus have a protective function for children in these high-risk families.


Figure 1. The consort flow diagram describing study recruitment and exclusion into the randomized controlled trial comparing adjunct oxytocin and psychotherapy and placebo and psychotherapy.
Figure 2. a. The administration of intranasal oxytocin, relative to placebo, increased the rate of improvement (slope) on the Inventory of Depressive Symptomatology-Clinician Rated (IDS-C) at post-treatment and at a six-month follow-up in persons with major depressive disorder undergoing interpersonal psychotherapy. b. The administration of intranasal oxytocin, relative to placebo, improved participants' ratings of the therapeutic alliance on the Working Alliance Inventory-Short Form at session 1 (intercept) in persons with major depressive disorder. The rate of improvement (slope) of the placebo group across 16 sessions of interpersonal therapy was greater than that of the oxytocin group.
The effects of intranasal oxytocin on the efficacy of psychotherapy for major depressive disorder: a pilot randomized controlled trial

March 2024

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68 Reads

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1 Citation

Psychological Medicine

Background Although both pharmacotherapy and psychological treatments are considered to be efficacious in the treatment of major depressive disorder (MDD), one third of patients do not respond to treatment and many experience residual symptoms post-treatment. In this double-blind placebo-controlled randomized control trial (RCT), we assessed whether intranasal oxytocin (OT) augments the therapeutic efficacy of psychotherapy for MDD and improves the therapeutic alliance. Methods Twenty-three volunteers (12 female) with MDD underwent 16 sessions of interpersonal therapy. Prior to each session, volunteers self-administered 24 International Units of intranasal OT ( n = 12; Syntocinon ) or placebo ( n = 11). Depressive symptoms were assessed with the Inventory of Depressive Symptomatology at pre- and post-treatment, and at a six month follow-up. Results Multilevel modeling found a significant effect of OT on the negative slope of depressive symptoms over time ( p < 0.05), with medium-large effect sizes at post-treatment (Cohen's d = 0.75) and follow-up (Cohen's d = 0.82). Drug intervention also predicted the intercept when examining the weekly ratings of the therapeutic alliance ( p < 0.05), such that volunteers receiving OT, relative to placebo, reported improved therapeutic alliance at session 1. The agreement of goals between therapists and participants, a facet of the therapeutic alliance, mediated the relationship between drug intervention and clinical outcome. Conclusion In this pilot study, the administration of intranasal OT, relative to placebo, improved the therapeutic alliance at the beginning of therapy and therapeutic efficacy of psychotherapy in persons with MDD. Future RCTs should attempt to replicate these findings in larger samples with different therapeutic modalities ( ClinicalTrials.gov: NCT02405715 ).


Note: Included mediators represent scores yielded from the Parenting Stress Index. Participating in the RUSH program is considered equivalent to having a parent with BD or not (OBD vs. control offspring)
Note: The linear effect of time on all four subscales by intervention group. OBD offspring of parents with bipolar disorder
Reduced parenting stress following a prevention program decreases internalizing and externalizing symptoms in the offspring of parents with bipolar disorder

February 2023

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61 Reads

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3 Citations

International Journal of Bipolar Disorders

Background Offspring of parents with bipolar disorder (OBD) are at risk for developing mental disorders, and the literature suggests that parenting stress may represent an important risk factor linking parental psychopathology to offspring psychopathology. We aimed to investigate whether improvements in parenting stress mediated the relationship between participation in a prevention program and offspring internalizing and externalizing symptoms at follow-up. Methods Families having a parent with BD (N = 25) underwent a 12-week prevention program. Assessments were conducted at pre-intervention, post-intervention, and at 3- and 6-month follow-ups. Families of parents with no affective disorders (i.e., control families) served as a comparison sample (N = 28). The Reducing Unwanted Stress in the Home (RUSH) program aimed to teach communication, problem-solving, and organization skills to improve the rearing environment. Measures included the Parenting Stress Index—4th Edition, the Behaviour Assessment Scales for Children—2nd Edition, and the UCLA Life Stress Interview. Results Families having a parent with BD reported more parenting stress at pre-intervention, and more change across time, than control families. Improvements in parenting stress mediated the relationship between participation in the intervention and reduced offspring internalizing and externalizing symptoms. While families having a parent with BD reported more chronic interpersonal stress at pre-intervention, no intervention effects were found. Conclusions The findings demonstrate that a preventative intervention targeting parenting stress in families may serve to prevent the development of mental disorders in at-risk children.



Improved Parent–Child Interactions Predict Reduced Internalizing Symptoms Among the Offspring of Parents with Bipolar Disorder Undergoing a Prevention Program: A Proof-of-Concept Study

February 2021

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33 Reads

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5 Citations

Research on Child and Adolescent Psychopathology

The offspring of parents with bipolar disorder (OBD) exhibit elevated rates of psychopathology. However, preventative interventions are lacking. Using a quasi-experimental design with an assessment-only control group, we examined if a 12-week program (entitled Reducing Unwanted Stress in the Home, RUSH) decreases internalizing and externalizing symptoms in the OBD (aged 6–11 years) via intervention-related gains in parent–child interaction quality. Participants consisted of 55 offspring (26 OBD; 29 controls) and their parents. Assessments were conducted at four time points up to six months following the end of the RUSH program, during which parent and teacher ratings of child symptoms, and parent–child interaction quality (parental positivity and negativity, and dyadic mutuality) were measured. Multilevel modelling showed improved parental positivity and negativity, and dyadic mutuality among target dyads immediately and six months post-intervention. For the bootstrapping mediation analyses, intervention-related change in parental negativity fully mediated the relations between having participated in the RUSH program and lower parent-reported internalizing problems among the OBD six months later. These data provide evidence of the efficacy of the RUSH program for OBD who exhibited improved interactions with their parents post-intervention. Further investigation via a randomized controlled trial is warranted.


The figure depicts the design of the negative affective priming task, consisting of “prime” and “test” trials. A prime trial (1st and 3rd column) consisted of a target picture with a white border and distractor picture (to be ignored) with a black border, and was always followed by a test trial (2nd and 4th column) 1,000 ms later (“+” fixation between trials). In negative priming test trials, the emotional expression of the target picture (sad face, top picture in the 2nd column) was the same as the emotional expression of the previously ignored picture in the prime trial (top picture in the 1st column). In the control test trials, the emotional expression of the target picture (sad face; top picture in the 4th column) was unrelated to the emotional expression of the previously ignored picture in the prime trial (top picture in the 3rd column). The test trials of the negative priming and control sequences are identical; they only differ in the type of emotion that was ignored in the previous prime trial. The words in each rectangle depict pictures of facial expressions of emotion, which were omitted to limit exposure of these photos beyond their use in research studies.
Comparisons of mean index scores of engagement (i.e., RT valid trials with emotional stimuli—RT valid trials with neutral stimuli) of angry, sad, and happy facial expressions for generic and personally relevant stimuli for 750 ms presentation time. Relative to generic pictures of facial expressions of emotion, participants shifted attention more quickly toward facial expressions of their intimate partner when presented for 750 ms, but not masked presentations. Error bars represent standard errors.
Comparisons of mean inhibition index scores (i.e., mean RT on control trials—mean RT on priming trials) of angry, sad, and happy facial expressions for generic and personally relevant stimuli. Relative to generic pictures of facial expressions of sadness, participants exhibited increased inhibition of the sad face of their intimate partner. Note. Error bars represent standard errors. *p < 0.05.
Simple slopes analyses demonstrating the relation between attentional disengagement of personally relevant sad faces (750 ms) and level of conflict (A) and support (B) in romantic relationship for males and females. Difficulties shifting attention away (increased selective attention) from the sad face of their intimate partner was associated with greater levels of conflict for male participants, but not female participants. Similar findings were observed for relationship support, but neither slope was significantly different than zero. *p < 0.05.
Predicting Interpersonal Outcomes From Information Processing Tasks Using Personally Relevant and Generic Stimuli: A Methodology Study

September 2020

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37 Reads

Despite evidence of differential processing of personally relevant stimuli (PR), most studies investigating attentional biases in processing emotional content use generic stimuli. We sought to examine differences in the processing of PR, relative to generic, stimuli across information processing tasks and to validate their use in predicting concurrent interpersonal functioning. Fifty participants (25 female) viewed generic and PR (i.e., their intimate partner’s face) emotional stimuli during tasks assessing selective attention (using a modified version of the Spatial Cueing Task) and inhibition (using the Negative Affective Priming task) of emotional content. Ratings of relationship quality were also collected. Evidence of increased selective attention during controlled and greater avoidance during automatic stages of processing emerged when viewing PR, relative to generic, emotional faces. We also found greater inhibition of PR sad faces. Finally, male, but not female, participants who displayed greater difficulty disengaging from the sad face of their partner reported more conflict in their relationships. Taken together, findings from information processing studies using generic emotional stimuli may not be representative of how we process PR stimuli in naturalistic settings.


A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners

February 2020

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182 Reads

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9 Citations

International Journal of Bipolar Disorders

Background: Individuals with bipolar disorder (BD) often possess maladaptive traits and present with various difficulties in psychosocial functioning. However, little is known about the intimate partners of adults with bipolar disorder (BD) and how mental illnesses other than BD within couples may further complicate the picture. Such knowledge is needed to inform both couple and family interventions. Methods: Participants were parents whose children were enrolled in a prospective study: 55 with BD and their partners, and 47 healthy control couples. All completed diagnostic interviews, and questionnaires describing personality traits, negative life events, coping skills, social support, marital adjustment and inter-partner verbal aggression. Parents with BD and healthy control parents were compared, as were the intimate partners. A series of exploratory analyses focused on the average measures within couples, with and without BD, and took account of comorbid personality disorders among those with BD and major depressive disorder among their partners. Results: Intimate partners of adults with BD, relative to healthy control partners, presented with more mental disorders, higher neuroticism, lower extraversion, more emotion-focused coping, smaller social networks, less satisfaction with their social networks, and little, satisfying social contact. Additionally, they reported less consensus and satisfaction in their marital relationships, and engaged in more verbal aggression towards their partners. Participants with BD showed similar, more extreme, characteristics. Marital distress and verbal aggression were greatest among couples with an adult having BD and a comorbid personality disorder or a partner with major depressive disorder. Conclusion: This study contributes to the literature by demonstrating that both parents with BD and their intimate partners exhibit high levels of mental illness, maladaptive personality traits and psychosocial difficulties, thus limiting their partners' ability to provide support and stability in the these high risk families. Moreover, mental illnesses other than BD may contribute to marital problems within couples. Some statistical analyses, particularly those involving comorbid conditions, were under-powered in this study. As clinical implications, the current study suggests that both individuals with BD and their partners could benefit from interventions aimed at lowering emotionality and verbal aggression, and increasing social support and effective coping skills.



Citations (8)


... For instance, when a child dies, it affects the father, mother, siblings, and the entire system. In this perspective, the behavior of one member is not only a reaction to the behaviors of other members but also influences them and the whole family system through feedback processes (Trespalacios et al., 2024) Moreover, the family has distinctive rules, capable of adapting to the requirements of its social environment at various stages of its development, either by initiating change itself or evolving in response 130 to incoming information. It also manages to balance two seemingly contradictory functions: achieving harmony and balance with the conflicts it faces for its evolution (Du RocherSchudlich et al., 2008). ...

Reference:

The impact of family dynamics on the evolution of psychopathology
The perceived social support of parents having bipolar disorder impacts their children’s mental health: a 10-year longitudinal study

International Journal of Bipolar Disorders

... Research has shown that parents with BD and SZ are likely to report disturbances associated with their parenting practices (27,28). Research shows that such parents are more likely to have difficulties with discipline and control, dependency on the child, boundary setting, parent-child bonding, and experience higher levels of parenting stress (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Difficulties in providing consistent, high-quality parenting are associated with increased mental health problems in children and may provide a partial explanation for the increased risk of mental health problems in the children of parents diagnosed with BD or SZ (36, 40-42). ...

Reduced parenting stress following a prevention program decreases internalizing and externalizing symptoms in the offspring of parents with bipolar disorder

International Journal of Bipolar Disorders

... These findings have implications for the development and improvement of intervention and prevention strategies for the offspring of families having a parent with BD. In addition to current prevention strategies for the OBD which focus on the functioning of the nuclear family (Miklowitz et al. 2020;Resendes et al. 2023;Serravalle et al. 2021), it would be important to promote general and good quality social support from extended family, friends, and the community, since they may provide further protective value against the development of mental health problems for these high-risk children. ...

Improved Parent–Child Interactions Predict Reduced Internalizing Symptoms Among the Offspring of Parents with Bipolar Disorder Undergoing a Prevention Program: A Proof-of-Concept Study
  • Citing Article
  • February 2021

Research on Child and Adolescent Psychopathology

... Moreover, consistent with a phenomenon known as assortative mating, individuals with an AD often choose romantic partners who also suffer from a mental disorder [80]. In addition to heightening the risk of genetic transmission [88], partners of parents with an AD also exhibit various psychosocial deficits that might impact child outcomes [93]. Therefore, future studies should attempt at including both parents in their research design and investigate how different patterns of parental AD (i.e., the presence of a major affective disorder in the mother, father or both) may influence offspring HPA axis functioning. ...

A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners

International Journal of Bipolar Disorders

... The reductions in depression and anxiety symptoms and improvement in interpersonal relations in the patient receiving OT resonate with previous findings demonstrating a beneficial effect of OT on psychotherapy outcome when given adjacent to psychotherapy (19,20). As the working alliance is considered the most robust predictor of therapy outcome (21), one potential hypothesis that can be made is that OT affects the outcome indirectly through the facilitation of the therapeutic process. ...

Intranasal oxytocin improves subjective ratings of the therapeutic alliance during psychotherapy for major depressive disorder
  • Citing Article
  • July 2019

Psychoneuroendocrinology

... Recently conducted research provides data concerning the possible application of neuropeptides in the treatment of psychiatric disorders [13][14][15][16]. Experimental data suggest that oxytocin (OT) having connections with reproductive and social behavior, might become a novel treatment option for patients suffering from perinatal mood disorders. ...

T142. Intranasal Oxytocin Augments the Efficacy of Psychotherapy for Major Depressive Disorder
  • Citing Article
  • May 2018

Biological Psychiatry

... Based on the theory that OT increases the salience of emotional and social cues, rather than indiscriminately promoting prosocial behavior (Shamay-Tsoory & Abu-Akel, 2016), OT's effects on social behavior might be context-dependent (Bartz, Zaki, Bolger, & Ochsner, 2011;Wong, Cardoso, Orlando, Brown, & Ellenbogen, 2021). In a within-subject placebocontrolled study comparing the effects of OT on perceived emotional support during autobiographical memory recall elicited by a computer (non-social context) or a research assistant (social context), OT increased perceived support by the research assistant in the social context among women motivated to affiliate, but decreased perceived emotional support in men and women in the non-social context (Cardoso, Valkanas, Serravalle, & Ellenbogen, 2016). Thus, while OT may promote prosocial behavior in contexts where social relationships are available, it may decrease the motivation to affiliate when such relationships are untrustworthy or unavailable. ...

Oxytocin and Social Context Moderate Social Support Seeking in Women During Negative Memory Recall
  • Citing Article
  • May 2016

Psychoneuroendocrinology

... Finally, OT release during social support in rats recruits central amygdala neurons to switch fear stimuli to safety stimuli (Hegoburu et al., 2024). In turn, OT's modulation of fear and stress may facilitate positive behaviors in safe contexts, such as maternal and pair bonding (Bosch & Neumann, 2012;Loth & Donaldson, 2021).These findings converge with the effect of OT on social support-seeking in humans, OT release during support, and its contribution to human trust and attachment (Bakermans-Kranenburg & Van IJzendoorn, 2013;Cardoso et al., 2013;Cuyvers et al., 2024;Shorey et al., 2023). ...

Stress-induced negative mood moderates the relation between oxytocin administration and trust: Evidence for the tend-and-befriend response to stress?
  • Citing Article
  • June 2013

Psychoneuroendocrinology