Sibylle M. Winter’s research while affiliated with Charité Universitätsmedizin Berlin and other places
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Zusammenfassung
Emotionale Misshandlung und Vernachlässigung sind häufig, werden aber in medizinischen Einrichtungen unterdiagnostiziert. Die Folge können erhebliche Schäden auf neurophysiologischer Ebene und in der Beziehungs- und Verhaltensentwicklung sein. Frühe Interventionen sind notwendig, um negative Verläufe und wiederholte Traumatisierungen abzuwenden. Kinderärzt:innen können eine Schlüsselrolle in der Erkennung und der Einleitung von Interventionen spielen. Hierbei ist die Erkennung gefährdeter Kinder und die Einleitung angemessener Interventionen notwendig.
Objective: To identify the COVID-19 impact on well-being/mental health, coping strategies and risk factors in adolescent worldwide.
Method: Anonymous online multi-national/language survey in the general population (representative/weighted non-representative samples, 14-17years), measuring change in well-being (WHO-5/range=0-100) and psychopathology (validated composite P-score/range=0-100), WHO-5 <50 and <29, pre- versus during COVID-19 pandemic (26/04/2020-26/06/2022). Coping strategies, nine a-priori defined individual/cumulative risk factors were measured. χ2, penalized cubic splines, linear regression, and correlation analyses were conducted. Results: Analyzing 8,115 of 8,762 initiated surveys (representative=75.1%), the pre-pandemic WHO-5 and P-score remained stable during the study (excluding relevant recall bias/drift), but worsened intra-pandemic by 5.55±17.13 (standard deviation) and 6.74±16.06 points, respectively (effect size d=0.27 and d=0.28). The proportion of adolescents with WHO-5 scores suggesting depression screening (<50) and major depression (<29) increased from 9% to 17% and 2% to 6%. WHO-5 worsened (descending magnitude, with cumulative effect) in adolescents with a mental or physical disorder, female gender, and with school closure. Results were similar for P-score, with the exception of school closure (not significant) and living in a low-income country, as well as not living in a large city (significant). Changes were significantly but minimally related to COVID-19 deaths/restrictions, returning to near-pre-pandemic values after >2 years. The three most subjectively effective coping strategies were internet use, exercise/walking, and social contacts. Conclusion: Overall, well-being/mental health worsened (small effect sizes) during early stages of COVID-19, especially in vulnerable subpopulations. Identified at-risk groups, association with pandemic-related measures, and coping strategies can inform individual behaviours and global public health strategies.
DNA methylation in peripheral tissues may be a relevant biomarker of risk for developing mental disorders after exposure to early life adversity. Genes involved in HPA axis regulation, such as FKBP5, might play a key role. In this study, we aimed to identify the main drivers of salivary FKBP5 methylation in a cohort of 162 maltreated and non-maltreated children aged 3–5 years at two measurement timepoints. We combined data from a targeted bisulfite sequencing approach for fine-mapping 49 CpGs in regulatory regions of FKBP5 and epigenetic scores for exposure to alcohol, cigarette smoke, and glucocorticoids derived from the EPICv1 microarray.
Most variability of methylation in the FKBP5 locus was explained by estimated cell type proportions as well as epigenetic exposure scores, most prominently by the glucocorticoid exposure score. While not surviving correction for multiple testing, we replicated previously reported associations of FKBP5 methylation with CM. We also detected synergistic effects of both rs1360780 genotype and the glucocorticoid exposure score on FKBP5 hypomethylation. These effects were identified in the 3′TAD, a distal regulatory region of FKBP5 which is not extensively covered in Illumina arrays, emphasizing the need for fine mapping approaches. Additionally, the epigenetic glucocorticoid exposure score was associated with childhood maltreatment, maternal mental disorders, and pregnancy complications, thereby highlighting the role of glucocorticoid signaling in the epigenetic consequences of early adversity.
These results underscore the need to assess cell type heterogeneity in targeted assessments of DNA methylation and show the impact of exposures beyond just childhood maltreatment such as glucocorticoid exposure.
Background: The brain and the intestinal microbiota are highly interconnected and especially vulnerable to disruptions in early life. Emerging evidence indicates that psychosocial adversity detrimentally impacts the intestinal microbiota, affecting both physical and mental health. This study aims to investigate the gut microbiome in young children in the immediate aftermath of maltreatment exposure. Methods: Maltreatment exposure was assessed in 88 children (ages 3–7) using the Maternal Interview for the Classification of Maltreatment [MICM]. Children were allocated to three groups according to the number of experienced maltreatment categories: no maltreatment, low maltreatment, and high maltreatment exposures. Stool samples were collected and analyzed by 16S rRNA sequencing. Results: Children subjected to high maltreatment exposure exhibited lower alpha diversity in comparison to those with both no and low maltreatment exposure (Simpson Index, Tukey post hoc, p = 0.059 and p = 0.007, respectively). No significant distinctions in beta diversity were identified. High maltreatment exposure was associated with the enrichment of several genera from the class Clostridia (Clostridium, Intestinibacter, Howardella and Butyrivibrio) and the depletion of the genus Phocaeicola (class Bacteriodia). Conclusions: Severe maltreatment exposure is associated with alterations in the gut microbiota of young children. Longitudinal trajectories of intestinal microbiota composition in the context of maltreatment may reveal important insights related to psychiatric and somatic health outcomes.
There is no multi-country/multi-language study testing a-priori multivariable associations between non-modifiable/modifiable factors and validated wellbeing/multidimensional mental health outcomes before/during the COVID-19 pandemic. Moreover, studies during COVID-19 pandemic generally do not report on representative/weighted non-probability samples. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is a multi-country/multi-language survey conducting multivariable/LASSO-regularized regression models and network analyses to identify modifiable/non-modifiable factors associated with wellbeing (WHO-5)/composite psychopathology (P-score) change. It enrolled general population-representative/weighted-non-probability samples (26/04/2020-19/06/2022). Participants included 121,066 adults (age=42±15.9 years, females=64 %, representative sample=29 %) WHO-5/P-score worsened (SMD=0.53/SMD=0.74), especially initially during the pandemic. We identified 15 modifiable/nine non-modifiable risk and 13 modifiable/three non-modifiable protective factors for WHO-5, 16 modifiable/11 non-modifiable risk and 10 modifiable/six non-modifiable protective factors for P-score. The 12 shared risk/protective factors with highest centrality (network-analysis) were, for non-modifiable factors, country income, ethnicity, age, gender, education, mental disorder history, COVID-19-related restrictions, urbanicity, physical disorder history, household room numbers and green space, and socioeconomic status. For modifiable factors, we identified medications, learning, internet, pet-ownership, working and religion as coping strategies, plus pre-pandemic levels of stress, fear, TV, social media or reading time, and COVID-19 information. In multivariable models, for WHO-5, additional non-modifiable factors with |B|>1 were income loss, COVID-19 deaths. For modifiable factors we identified pre-pandemic levels of social functioning, hobbies, frustration and loneliness, and social interactions as coping strategy. For P-scores, additional non-modifiable/modifiable factors were income loss, pre-pandemic infection fear, and social interactions as coping strategy. COH-FIT identified vulnerable sub-populations and actionable individual/environmental factors to protect well-being/mental health during crisis times. Results inform public health policies, and clinical practice.
Besteht der Verdacht auf Vernachlässigung oder emotionale, körperliche oder sexualisierte
Gewalt gegen ein Kind, entstehen in der Versorgung häufig Unsicherheiten.
Die rechtlichen Rahmenbedingungen sind den beteiligten Ärzt*innen meist nicht
vollständig bekannt. Dabei ist ihre Beachtung wichtig, um auch alle Interessen der
betroffenen Kinder zu berücksichtigen. Der Beitrag stellt die geltenden rechtlichen
Grundlagen dar und bietet mögliche Handlungsoptionen.
Besteht der Verdacht auf Vernachlässigung oder emotionale, körperliche oder sexualisierte
Gewalt gegen ein Kind, entstehen in der Versorgung häufig Unsicherheiten.
Die rechtlichen Rahmenbedingungen sind den beteiligten Ärzt*innen meist nicht
vollständig bekannt. Dabei ist ihre Beachtung wichtig, um auch alle Interessen der
betroffenen Kinder zu berücksichtigen. Der Beitrag stellt die geltenden rechtlichen
Grundlagen dar und bietet mögliche Handlungsoptionen.
... Items 1, 3, 5, 6, 8, 10, 11, and 13 show decreasing severity, and the scoring is 3, 2, 1, 0. On the other hand, items 2, 4, 7, 9, 12, and 14 are scored as 0, 1, 2, and 3. For the anxiety subscale, items 1, 3,5,7,9,11, and 13 were collected; for the depression subscale, the scores of items 2, 4, 6, 8, 10, 12, and 14 were added. The lowest score that patients can get from both subscales is 0, and the highest score is 21. ...
... High levels of body image dissatisfaction, frequent body-checking behaviors, and significant body image disturbances are notably associated with the development and persistence of eating disorders [17][18][19]. These factors are particularly impactful among transgender youth, where they also contribute significantly to the prevalence of gender dysphoria [20,21]. A study reported that 70% of transgender individuals experienced some level of body dissatisfaction [20]. ...
... Zuweisungen von Jugendämtern an die Kinderschutzambulanz der Berliner Charité zeigen, dass auch in der Kinder- und Jugendhilfe der Beitrag der Medizin an der Erkennung emotionaler Misshandlung und Vernachlässigung als nicht sehr hoch eingeschätzt wird: lediglich 8,4 % (n = 117) der Fälle wurden mit der Fragestellung nach emotionaler Misshandlung zugewiesen, während nach Abschluss der Einschätzung in der Kinderschutzambulanz in 34,3 % (n = 477) der Fälle eine solche diagnostiziert worden war [19]. ...
... Another key finding is the potential of ruhiyah attachment to mitigate the adverse effects of insecure attachment patterns, which are prevalent in various demographic groups (Spruit, 2020;Sari et al., 2018). The inclusion of spiritual dimensions in attachment practices offers a new pathway for addressing mental health issues such as depression and anxiety, particularly among adolescents (Wuebken et al., 2023;Brown et al., 2017). This approach provides a nuanced understanding of how spiritual attachment can serve as a protective factor, enhancing the emotional resilience of children and adolescents (Canevska, 2019;Salmoiraghi & Kerti, 2022). ...
... Heritabilitas adalah perkiraan penyebab perbedaan suatu sifat dalam statistik populasi, sedangkan determinasi genetik adalah masalah apa yang menyebabkan suatu sifat diekspresikan pada suatu individu (Sauce & Matzel, 2018 (Joseph et al., 2023). ...
... Also in middle childhood, parental expectations for children's emotion displays and emotion regulation are becoming more gendered while children's regulation abilities are becoming more advanced (Saarni, 1999). In line with efforts to personalize and tailor psychotherapeutic interventions (Elbracht et al., 2023), it is also worthwhile to parse apart mothers' and fathers' unique beliefs related to their emotion socialization-related PSE. ...
... Higher rates of depression and anxiety were reported in Black, Hispanic, and Asian populations during the pandemic [10]. Other vulnerable populations experienced elevated rates of stress and mental disorders during the pandemic, including parents involved in child protective services [11], those with opioid use disorders [7], and those in long-term care settings [12]. ...
... coh-fit.com) is an international survey study conducted in 30 languages in representative/weighted nonrepresentative samples, in adults, adolescents, and children. 3,4 COH-FIT has been measuring well-being and the psychopathology factor (P-score), a validated composite mental health measure, 5 in the general population across all continents since April 26, 2020, including a retrospectively recalled pre-pandemic assessment of comprehensive multidimensional factors relevant to well-being and mental health. Here, we report globally in adolescents findings of the 2 co-primary outcomes, well-being and the P-score, hypothesizing reduced well-being and increased psychopathology globally, with increased impairment in vulnerable subgroups and a relationship to death rates and stringency measures over time, and with cumulative effects across multiple risk factors. ...
... These approaches focus on shared human concerns and conflicts related to trust, dependency, autonomy, shame, guilt, honesty, intimacy, identity, and self-esteem (Nielsen, 2017a(Nielsen, , 2017b. Stressful and pathological changes in couples' relationships can be psychodynamically explained by the unconscious collusion between partners (Akın et al., 2022). ...
... In an exploratory analysis, no differences in experimental pain sensitivity were detected between adolescent girls with and without a family history of psychiatric disorders. Parental psychiatric disorders, such as anxiety, depression, and post-traumatic stress disorder, adversely affect their children's development, increasing the likelihood of cognitiveaffective and behavioral problems as well as chronification of pain [56][57][58][59]. Moreover, children of parents with psychiatric disorders are more susceptible to developing those disorders, which are also known as comorbidities of chronic pain and may even increase the risk of chronic pain onset during adolescence [58][59][60][61]. ...
