Browsing by Author "Racine, Nicole"

Now showing 1 - 7 of 7
  • Thumbnail Image
    ItemOpen Access
    Adverse childhood experiences and maternal anxiety and depression: a meta-analysis
    (2021-01-11) Racine, Nicole; Devereaux, Chloe; Cooke, Jessica E; Eirich, Rachel; Zhu, Jenney; Madigan, Sheri
    Abstract Background It has been proposed that adverse childhood experiences (ACEs) can put women at risk for mental illness in the pregnancy and postpartum periods. While some studies have found strong support for this proposition, others have found weak or no support. This study is a meta-analysis of the association between ACEs and maternal mental health to resolve between-study discrepancies, and to examine potential moderators of associations. Methods Three electronic databases (i.e., MEDLINE, Embase, and PsycINFO) were searched up to November 2018 by a health sciences librarian. A hand search was conducted in January 2020 and relevant studies were added. Included studies reported on associations between ACEs and maternal depression and/or anxiety in the perinatal period (pregnancy to 1-year postpartum). Pregnancy and postpartum outcomes were examined separately for both depression and anxiety. Random-effect meta-analyses were conducted. Moderator analyses were conducted using meta-regression. Study quality was evaluated using a 15-point scale. Results The initial search yielded 4646 non-duplicate records and full text review occurred for 196 articles. A total of 15 studies (N = 7788) were included in the meta-analyses, of which 2 were also described narratively. Publication year ranged from 1998 to 2019. Mothers were approximately 28.93 years of age when they retrospectively reported on their ACEs. All studies had maternal self-report questionnaires for the mental health outcomes. Study quality ranged from 7 to 12. The pooled effect sizes between ACEs and prenatal (N = 12; r = .19; 95% CI= .13, .24) and postpartum (N = 7; r = .23; 95% CI = .06 to .39) depressive symptoms were significant. The pooled effect size between ACEs and prenatal anxiety was also significant (N = 5; r = .14; 95% CI= .07, .21). Moderator analyses indicated that timing of depressive and anxiety symptoms may be important for understanding associations. Conclusions ACEs confer risk to maternal mental health, albeit effect sizes are small to moderate in magnitude. Trauma-informed approaches, as well as increased mental health support during and after pregnancy, may help to offset the relative risk of ACEs on maternal mental health.
  • Thumbnail Image
    ItemOpen Access
    Developing non-response weights to account for attrition-related bias in a longitudinal pregnancy cohort
    (2023-12-14) Pitt, Tona M.; Hetherington, Erin; Adhikari, Kamala; Premji, Shainur; Racine, Nicole; Tough, Suzanne C.; McDonald, Sheila
    Abstract Background Prospective cohorts may be vulnerable to bias due to attrition. Inverse probability weights have been proposed as a method to help mitigate this bias. The current study used the “All Our Families” longitudinal pregnancy cohort of 3351 maternal-infant pairs and aimed to develop inverse probability weights using logistic regression models to predict study continuation versus drop-out from baseline to the three-year data collection wave. Methods Two methods of variable selection took place. One method was a knowledge-based a priori variable selection approach, while the second used Least Absolute Shrinkage and Selection Operator (LASSO). The ability of each model to predict continuing participation through discrimination and calibration for both approaches were evaluated by examining area under the receiver operating curve (AUROC) and calibration plots, respectively. Stabilized inverse probability weights were generated using predicted probabilities. Weight performance was assessed using standardized differences of baseline characteristics for those who continue in study and those that do not, with and without weights (unadjusted estimates). Results The a priori and LASSO variable selection method prediction models had good and fair discrimination with AUROC of 0.69 (95% Confidence Interval [CI]: 0.67–0.71) and 0.73 (95% CI: 0.71–0.75), respectively. Calibration plots and non-significant Hosmer-Lemeshow Goodness of Fit Tests indicated that both the a priori (p = 0.329) and LASSO model (p = 0.242) were well-calibrated. Unweighted results indicated large (> 10%) standardized differences in 15 demographic variables (range: 11 − 29%), when comparing those who continued in the study with those that did not. Weights derived from the a priori and LASSO models reduced standardized differences relative to unadjusted estimates, with the largest differences of 13% and 5%, respectively. Additionally, when applying the same LASSO variable selection method to develop weights in future data collection waves, standardized differences remained below 10% for each demographic variable. Conclusion The LASSO variable selection approach produced robust weights that addressed non-response bias more than the knowledge-driven approach. These weights can be applied to analyses across multiple longitudinal waves of data collection to reduce bias.
  • Thumbnail Image
    ItemOpen Access
    Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: Descriptive Report
    (2020-11-30) McDonald, Sheila; Edwards, Sarah; Hetherington, Erin; Racine, Nicole; Mueller, Melissa; McArthur, Brae Anne; Madigan, Sheri; Dewey, Deborah; Letourneau, Nicole; Tough, Suzanne; Geisbrecht, Gerald
    This report describes data collected from Albertan families on the COVID-19 Impact Survey implemented in May 2020, which built on a unique collaboration across two longitudinal cohorts in Alberta: The All Our Families study (AOF) and the Alberta Pregnancy Outcomes and Nutrition study (APrON). Our objectives were as follows: (1) Describe household infections of COVID-19 in Alberta among families with school-aged children; (2) Describe urban Albertan family experiences of the pandemic within the first 3-4 months of the outbreak across the areas of financial impact, maternal mental health and well-being, school and daily life, and relationships in the home; and (3) Describe associations among key predictor variables (e.g., financial impact) and outcomes (e.g., maternal anxiety, concern for child’s well-being). Study Sample: AOF and APrON Cohort participants reflect families parenting at least one child in between the ages of 8 and 12. While the respondents represent a broad range of income, education and ethnicity, they are typified by adequate income, food and housing security and partnered marital status. Highlighted Results: Physical Impact: At the time of data collection in May, 2020, over 90% of families did not have personal experience with COVID-19, either through personal infection, infection of a child, extended family member or close friend. Vaccine Intentions: Although over 60% of mothers and their children would obtain a COVID-19 vaccine when available, almost 30% are undecided and 8% would not obtain a vaccine. Financial Impact: In 58% of all families, at least one parent experienced job loss, loss of main income source, or reduced employment hours. One in five mothers reported difficulty meeting financial needs for the household, and 5% of families were experiencing food insecurity. Over 40% of respondents reported at least some impact on their ability to meet financial obligations. Mental Health and Wellness Impact: Mothers reported elevated levels of stress (21%), anxiety (25%) and depression (35%). Approximately 26% of mothers reported having limited coping skills. Almost 90% of mothers have undertaken more domestic tasks in the home. Mothers also reported that their children showed increased sadness and behavioural challenges. The COVID-19 pandemic has had profound financial and mental health impact on some families. Investment in strategies to alleviate financial stress, provide parenting supports, and alleviate mental health concerns is critical. Suggested Citation: McDonald S, Edwards S, Hetherington E, Racine N, Mueller M, McArthur BA, Madigan S, Dewey D, Geisbrecht G, Letourneau N, Tough S. Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: A Descriptive Report. Calgary, Alberta: University of Calgary; 2020.
  • Thumbnail Image
    ItemOpen Access
    Interventions to improve well-being among children and youth aged 6–17 years during the COVID-19 pandemic: a systematic review
    (2023-04-03) Moss, Stephana J.; Mizen, Sara J.; Stelfox, Maia; Mather, Rebecca B.; FitzGerald, Emily A.; Tutelman, Perri; Racine, Nicole; Birnie, Kathryn A.; Fiest, Kirsten M.; Stelfox, Henry T.; Parsons Leigh, Jeanna
    Abstract Background The COVID-19 pandemic is an example of a global infectious disease outbreak that poses a threat to the well-being of children and youth (e.g., physical infection, psychological impacts). The consequences of challenges faced during COVID-19 may be longstanding and newly developed interventions are being deployed. We present a narrative synthesis of available evidence from the first 2 years of the COVID-19 pandemic on the feasibility, accessibility, and effects of interventions to improve well-being among children and youth to inform the development and refinement of interventions relevant to post-pandemic recovery. Methods Six databases were searched from inception to August 2022. A total of 5484 records were screened, 39 were reviewed in full text, and 19 studies were included. The definition of well-being and the five domains of well-being as defined by the Partnership for Maternal, Newborn & Child Health and the World Health Organization in collaboration with the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being were used. Results Nineteen studies (74% randomized controlled trials) from 10 countries were identified, involving a total of 7492 children and youth (age range: 8.2–17.2 years; 27.8–75.2% males) and 954 parents that occurred during the COVID-19 pandemic (March 2020 to March 2021). Nearly all interventions (n = 18, 95%) targeted health and nutrition, followed by connectedness (n = 6, 32%), while fewer studies targeted agency and resilience (n = 5, 23%), learning and competence (n = 2, 11%), or safety and support (n = 1, 3%). Five interventions (26%) were self-guided while 13 interventions (68%) were guided synchronous by a trained professional, all of which targeted physical and mental health subdomains within health and nutrition; one intervention (5%) was unclear. Conclusions Studies deploying synchronous interventions most often reported improved well-being among children and youth largely in the domain of health and nutrition, specifically physical and mental health. Targeted approaches will be crucial to reach sub-groups of children and youth who are most at risk of negative well-being outcomes. Further research is needed to determine how interventions that best supported children and youth early in the pandemic are different from interventions that are required now as we enter into the post-pandemic phase.
  • Thumbnail Image
    ItemOpen Access
    Pain in Youth with Cerebral Palsy: The Impact of Caregiver Mental Health, Parenting Style, and Protectiveness
    (2024-06-17) Mueri, Kendra Arina; McMorris, Carly; Racine, Nicole; Kirton, Christopher Adam
    Background: Estimated to affect 2-3 in every 1000 livebirths, Cerebral palsy (CP) is one of the most common neurodevelopmental disabilities (NDDs) and causes of physical disability in childhood. One of the most common secondary conditions associated with CP is pain, which is reported to impact up to 75% of youth with CP. It is well-established that caregivers of youth with CP experience increased levels of stress due to unique caregiving responsibilities. In the general population, parenting elements such as mental health and pain-specific protectiveness have been found to influence youth chronic pain, including pain intensity, chronicity, and interference. Emerging literature in the general population also suggests that parenting style (e.g., authoritarian) may influence the development and maintenance of youth chronic pain. Although it is well known that parents have a profound impact on their children’s development and wellbeing, little is known about the role that parenting, including parenting styles, parent mental health, and pain-specific protectiveness, may have on pain outcomes in children and adolescents with CP. Understanding the associations between these parenting elements and youth pain outcomes provides valuable insight into modifiable factors that influence pain in youth with CP, which could inform targets for future psychoeducation and family-based interventions for these vulnerable youth. Objectives: The present study contributed to the literature on pain in children and adolescents with CP by 1) determining if parental mental health (i.e., depression and anxiety) was associated with child-reported pain (pain severity, pain-interference), 2) determining if parental protectiveness mediated the proposed associations between parent mental health and child pain (pain severity, pain-interference), 3) determining if parenting style (i.e., authoritarian, authoritative, permissive) was associated with child-reported pain (pain severity, pain-interference), and 4) determining if parental protective-responses mediated the proposed associations between parenting styles (i.e., authoritative, authoritarian, permissive) and child-reported pain (pain severity, pain-interference). Methods: Forty-three youth between the ages of 8 and 17 years (M = 11.51, SD = 2.63, 41.02% female) and one of their caregivers completed cross-sectional measures. Caregivers completed measures of caregiver mental health, parenting style, and pain-specific protectiveness, while youth completed measures of pain (e.g., intensity, interference). A series of linear regression analyses were conducted to determine if caregiver mental health (i.e., depression, anxiety) and parenting style (i.e., authoritarian, authoritative, permissive) predicted youth pain outcomes (i.e., pain intensity, pain interference). Lastly, mediation analyses were conducted to examine the mediating role of pain-specific protectiveness in the proposed associations. Results: Youth reported mean pain intensity levels of 3.69/10 (SD = 2.41), and a mean pain interference T-score of 51.75 (SD = 9.66). Most participants reported experiencing pain in their legs (n = 23, 58.97%) and muscles/joints (n = 11, 28.20%). Caregivers reported on the following parenting styles: authoritative parenting style (M = 110.51/135, SD = 9.95, range = 91-131), authoritarian (M = 34.70/100, SD = 6.81, range = 25-52), and permissive (M = 28.49/75, SD = 5.36, range = 18-42). Caregivers reported average anxiety symptoms of 50.60/83.1 (T-score; SD = 8.74, range = 37-67) and average depressive symptoms of 50.74/81.3 (T-score; SD = 8.33, range = 38-69). When controlling for covariates (GMFCS level, youth age, youth sex, and caregiver age), authoritarian parenting style significantly predicted youth pain interference. When controlling for covariates (GMFCS level, youth age, youth sex, and caregiver age), both caregiver anxiety and caregiver depression significantly predicted youth pain interference. The remainder of caregiver variables did not predict youth pain intensity nor pain interference. Conclusions: This study is the first of its kind to examine the influence of key parenting elements (e.g., parenting style, mental health, pain-specific protectiveness) on the pain outcomes of youth with CP. Results demonstrate that higher levels of authoritarian parenting style, caregiver depressive symptoms, and caregiver anxiety symptoms is significantly associated with higher levels of youth pain interference. The findings of this study provide valuable insights into the role that parenting has on the pain experience of youth with CP and can be used to inform psychoeducational targets for family-based interventions to continue supporting and promoting healthy functioning and wellbeing in this vulnerable population.
  • Thumbnail Image
    ItemOpen Access
    Social factors associated with self-reported changes in mental health symptoms among youth in the COVID-19 pandemic: a cross-sectional survey
    (2024-02-28) Moss, Stephana J.; Stelfox, Maia; McArthur, Eric; Sriskandarajah, Cynthia; Ahmed, Sofia B.; Birnie, Kathryn; Halperin, Donna M.; Halperin, Scott A.; Harley, Micaela; Hu, Jia; Kamstra, Josh N.; Leppan, Laura; Nickel, Angie; Racine, Nicole; Russell, Kristine; Smith, Stacie; Solis, May; Tutelman, Perri R.; Stelfox, Henry T.; Fiest, Kirsten M.; Parsons Leigh, Jeanna
    Abstract Background Children and youth experienced marked impacts on day-to-day life in the COVID-19 pandemic that were associated with poorer familial and friend relationships, and greater mental health challenges. Few studies provide self-report data on mental health symptoms from children and youth themselves. We sought to examine the associations between social factors and child and youth self-reported symptoms of worsened mood, anxiety, and irritability during the COVID-19 pandemic. Methods A nationally representative cross-sectional survey was administered online to collect self-report data across 10 Canadian provinces among children (11–14 years) and youth (15–18 years), April–May 2022. Age-appropriate questions were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. Associations between a priori defined social factors (e.g., relationship quality) and respondent self-reported mental health were evaluated using ordinal logistic regression models adjusted for age, sex, and geographic location. Results We analyzed data from 483 (51.7%) children (11–14 years; 227, 47.0% girls) and 450 (48.3%) youth (15–18 years; 204, 45.3% girls). The parents of most children and youth had resided in Canada for over 20 years (678, 72.7%). Over one-quarter of children and youth self-identified as Black, Indigenous, or a Person of Color (134, 27.7%; 134, 29.8%, respectively). Over one-third of children and youth self-reported symptoms of worsened mood (149, 30.9%; 125, 27.8%, respectively), anxiety (181, 37.5%; 167, 37.1%, respectively), or irritability (160, 33.1%; 160, 35.6%, respectively) during, compared to pre-pandemic. In descending order of odds ratios (OR), for children and youth, worsened familial relationships (during compared to pre-pandemic) was associated with the self-reported symptoms of worsened mood (child: OR 4.22, 95%CI 2.51–6.88; youth: OR 6.65 95%CI 3.98–11.23), anxiety (child: OR 4.24, 95%CI2.69–6.75; youth: OR 5.28, 95%CI 3.17–8.86), and irritability (child: OR 2.83, 95%CI 1.76–4.56; youth: OR 6.46, 95%CI 3.88–10.90). Conclusions Self-reported data from a nationally representative sample of children and youth suggest strong associations between social factors and mental health during the COVID-19 pandemic. Interventions targeting child and youth familial relationships may positively impact child and youth mental health.
  • Thumbnail Image
    ItemOpen Access
    Well-being approaches targeted to improve child and youth health post-COVID-19 pandemic: a scoping review
    (2024-06-21) Moss, Stephana J.; Sriskandarajah, Cynthia; Brundin-Mather, Rebecca; Cherak, Michal S.; Mizen, Sara J.; Stelfox, Maia; Halperin, Donna; Halperin, Scott; Ahmed, Sofia B.; Lorenzetti, Diane L.; Smith, Stacie; Harley, Micaela; Tutelman, Perri R.; Birnie, Kathryn A.; Anglin, Melanie C.; Stelfox, Henry T.; Fiest, Kirsten M.; Racine, Nicole; Parsons Leigh, Jeanna
    Abstract Background Our previous work synthesized published studies on well-being interventions during COVID-19. As we move into a post-COVID-19 pandemic period there is a need to comprehensively review published strategies, approaches, and interventions to improve child and youth well-being beyond deleterious impacts experienced during COVID-19. Methods Seven databases were searched from inception to January 2023. Studies were included if they: (1) presented original data on an approach (i.e., approach applied) or (2) provided recommendations to inform development of a future approach (i.e., approach suggested), (3) targeted to mitigate negative impacts of COVID-19 on child and youth (≤18 year) well-being, and (4) published on or after December 2019. Results 39 studies (n = 4/39, 10.3% randomized controlled trials) from 2021 to 2023 were included. Twenty-two studies applied an approach (n = 22/39, 56.4%) whereas seventeen studies (n = 17/39, 43.6%) suggested an approach; youth aged 13–18 year (n = 27/39, 69.2%) were most frequently studied. Approach applied records most frequently adopted an experimental design (n = 11/22, 50.0%), whereas approach suggested records most frequently adopted a cross-sectional design (n = 13/22, 59.1%). The most frequently reported outcomes related to good health and optimum nutrition (n = 28/39, 71.8%), followed by connectedness (n = 22/39, 56.4%), learning, competence, education, skills, and employability (n = 18/39, 46.1%), and agency and resilience (n = 16/39, 41.0%). Conclusions The rapid onset and unpredictability of COVID-19 precluded meaningful engagement of children and youth in strategy development despite widespread recognition that early engagement can enhance usefulness and acceptability of interventions. Published or recommended strategies were most frequently targeted to improve connectedness, belonging, and socialization among children and youth.