George J. Youssef

BACKGROUND Theoretically informed by the Dynamic Model of Relapse, GamblingLess: In-The-Moment is a smartphone app-based Just-In-Time Adaptive Intervention (JITAI) that delivers tailored interventions in moments of cognitive vulnerability to people who want to quit or reduce their gambling. Specifically, it aims to reduce gambling symptom severity (primary distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or positive outcome expectancies (secondary proximal outcomes). OBJECTIVE The primary aim was to explore whether the delivery of a tailored intervention via GamblingLess: In-The-Moment, compared with no intervention, reduces the probability of a subsequent gambling episode (primary proximal outcome) and improves subsequent craving intensity, self-efficacy, and positive outcome expectancies (secondary proximal outcomes). Secondary aims included identifying the most beneficial intervention option, conditions under which the intervention is most effective, and how its effects change over the treatment period. METHODS A fully automated and blinded 28-day micro-randomized trial (MRT) was conducted with participants recruited via online convenience sampling. Participants self-reporting high craving intensity, low self-efficacy, and/or high positive outcome expectancies in ecological momentary assessments (EMAs; delivered via push notifications three-times daily) were randomly assigned to either a tailored intervention or a no intervention control condition. The intervention condition comprised three modules (Curbing Cravings; Tackling Triggers; Exploring Expectancies) targeting each of these cognitive processes. The no intervention control condition comprised a brief message of encouragement, but no intervention content. The MRT was supplemented with a within-group six-month follow-up evaluation to investigate longer-term treatment effects. RESULTS The sample comprised 192 participants (66.2% male; median age 35 years) who completed at least one EMA during the trial period. Overall, 5,116 EMAs were completed (compliance rate 31.7%). In the MRT, the tailored intervention was no more effective than no intervention in reducing subsequent gambling episodes (OR=1.05, 95%CI 0.79, 1.38, p=.74) or improving the secondary proximal outcomes. However, post-hoc supplementary analyses indicated improvements in craving intensity and self-efficacy when collapsing all EMAs across each day. Moreover, compared to the no intervention control condition, Tackling Triggers increased subsequent self-efficacy and Exploring Expectancies reduced subsequent positive outcome expectancies. There were also very large improvements in all secondary proximal outcomes across all intervention options immediately after an intervention activity. There were large improvements in gambling symptom severity (primary distal outcome) at the six-month follow-up evaluation (dz=-1.94, p<.001), with 66.5% of participants demonstrating clinically significant recovery or improvement. Finally, there were medium to large improvements in gambling frequency, expenditure, craving severity, self-efficacy, and positive outcome expectancies (secondary distal outcomes). CONCLUSIONS This trial demonstrates promising findings but represents an early stage of gambling mHealth development and evaluation, with further research required to optimise the intervention to improve its effectiveness, efficiency, scalability, and user engagement. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False INTERNATIONAL REGISTERED REPORT RR2-10.2196/38958

Purpose: Maternal perinatal social support is theorised to promote offspring social-emotional development, yet few studies have prospectively examined this relationship. Findings may inform preventative intervention efforts, to support a healthy start to emotional life. Methods: This study examined whether maternal social support perinatally predicts infant social-emotional development at 12 months of age in two longitudinal cohort studies: The Australian Temperament Project (ATP) (n = 1,052 mother-infant dyads [653 mothers, M_{age_at_birth} = 32.03, 88% Australian-born; 1,052 infants, 52% girls]) and The Triple B Pregnancy Cohort Study (Triple B) (n = 1,537 dyads [1,498 mothers, M_{age_at_birth} = 32.53, 56% Australian-born; 1,537 infants, 49% girls]). Social support was assessed at pregnancy (third trimester) and eight-weeks post-birth. Infant social-emotional competencies (ATP: Brief Infant and Toddler Social and Emotional Assessment (BITSEA), Competencies Scale; Triple B: Bayley Scales of Infant and Toddler Development-Social Emotional Scale) and problems (ATP: BITSEA, Problems Scale; Triple B: Ages and Stages Questionnaires: Social-Emotional Scale), were assessed at 12-months of age. Results: In ATP, social support was associated with lower offspring problems (pregnancy: β = -0.15; post-birth: β = -0.12) and greater competencies (pregnancy: β = 0.12; post-birth: β = 0.16) at 12 months. In Triple B, social support also predicted lower offspring problems (pregnancy: β = -0.11; post-birth: β = -0.07) and greater competencies (pregnancy: β = 0.07) at 12 months. Findings did not indicate an association between support at eight-weeks post-birth and subsequent competencies (β = 0.06). Conclusions: Evidence suggests that perinatal social support promotes healthy infant social and emotional development. These results underscore the critical importance of social support for mothers transitioning into parenthood.

Purpose: Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed.Methods: We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress.Results: We included 133 studies representing 118 samples; 99 samples (110,968 mothers) were eligible for meta-analysis. Results showed concurrent associations across a range of timepoints during the first year postpartum, between bonding problems and depression (r= .27 [95% CI 0.20, 0.35] tor= .47 [95% CI 0.41, 0.53]), anxiety (r= .27 [95% CI 0.24, 0.31] tor= .39 [95% CI 0.15, 0.59]), and stress (r= .46 [95% CI 0.40, 0.52]). Associations between antenatal distress and subsequent postpartum bonding problems were mostly weaker and with wider confidence intervals: depression (r= .20 [95% CI 0.14, 0.50] tor= .25 [95% CI 0.64, 0.85]), anxiety (r= .16 [95% CI 0.10, 0.22]), and stress (r= .15 [95% CI − 0.67, 0.80]). Pre-conception depression and anxiety were associated with postpartum bonding problems (r= − 0.17 [95% CI − 0.22, − 0.11]).Conclusion: Maternal psychological distress is associated with postpartum mother-infant bonding problems. Co-occurrence of psychological distress and bonding problems is common, but should not be assumed. There may be benefit in augmenting existing perinatal screening programs with well-validated mother-infant bonding measures.

Most but not all adults become parents, yet it remains unclear which characteristics indicate an orientation toward parenting. The aims of this study were to (a) distinguish profiles of individual and interpersonal resources in young adults that may orient them toward parenthood and (b) investigate whether profiles predicted timing of entering parenthood, postpartum parenting behavior, and parent-infant bonding. Participants were 1,429 young people (53% female) enrolled in an Australian 39-year longitudinal study. Predictor data for latent profile analysis were collected at 23-24 and 27-28 years. Parenthood timing was designated as "early" ≤ 25 years, "on-time" > 25 years, and "not a parent" by age 37 years. Parenting outcomes were assessed at 12 months postpartum in 684 parents of 1,144 children. Four-profile classes were identified: "connected" (n = 463, 32.4%), "constricted empathy" (n = 461, 32.3%), "insecure" (n = 343, 24%), and "disconnected" (n = 162, 11.3%). Connected young adults were characterized by close ties to family of origin and peers and by identity clarity and empathy. Connected participants were more likely than those in insecure and disconnected classes to be parents by 37 years and more likely to enter parenthood "on-time" compared to "early" parenthood in the constricted empathy class. Among those who became parents, the connected class reported the strongest bonds and warmest parenting and was least anxious or hostile in parenting their infants. Findings provide insights into preconception patterns among variables that together predict reproductive timing, postpartum bonding, and quality of parenting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

This study examined whether positive development (PD) in adolescence and young adulthood predicts offspring behavior in two Australasian intergenerational cohorts. The Australian Temperament Project Generation 3 Study assessed PD at age 19–28 (years 2002–2010) and behavior in 1165 infants (12–18 months; 608 girls) of 694 Australian-born parents (age 29–35; 2012–2019; 399 mothers). The Dunedin Multidisciplinary Health and Development Parenting Study assessed PD at age 15–18 (years 1987–1991) and behavior in 695 preschoolers (3–5 years; 349 girls) and their New Zealand born parents (age 21–46; 1994–2018; 363 mothers; 89% European ethnicity). In both cohorts, PD before parenthood predicted more positive offspring behavior (βrange = .11–.16) and fewer behavior problems (βrange = −.09 to −.11). Promoting strengths may secure a healthy start to life.

Aims: Despite the magnitude of alcohol use problems globally, treatment uptake remains low. This study sought to determine the proportion of people presenting to telephone-delivered alcohol treatment who are first-time help-seekers, and explored perceived barriers to help-seeking to understand the barriers this format of treatment may help to address. Methods: Secondary analysis of baseline data from a randomized controlled trial of a telephone-delivered intervention for alcohol use problems. Latent class analysis (LCA) identified participant profiles according to self-reported barriers to alcohol treatment. Results: Participants’ (344) mean age was 39.86 years (SD = 11.36, 18–73 years); 51.45% were male. Despite high alcohol problem severity (Alcohol Use Disorder Identification Test: mean = 21.54, SD = 6.30; 63.37% probable dependence), multiple barriers to accessing treatment were endorsed (mean = 5.64, SD = 2.41), and fewer than one-third (29.36%) had previously accessed treatment. LCA revealed a two-class model: a ‘low problem recognition’ class (43.32%) endorsed readiness-for-change and attitudinal barriers; a ‘complex barriers’ class (56.68%) endorsed stigma, structural, attitudinal and readiness-to-change barriers, with complex barrier class membership predicted by female sex (adjusted OR = 0.45, 95% CI 0.28, 0.72) and higher psychological distress (adjusted OR = 1.13, 95% CI 1.08, 1.18). Conclusion: The majority of people accessing this telephone-delivered intervention were new to treatment, yet had high alcohol problem severity. Two distinct profiles emerged, for which telephone interventions may overcome barriers to care and tailored approaches should be explored (e.g. increasing problem awareness, reducing psychological distress). Public health strategies to address stigma, and raise awareness about the low levels of drinking that constitute problem alcohol use, are needed to increase help-seeking.