Scientific Program | Psychology | Psychiatrist

Telehealth does not increase risk of substance use disorder in ADHD patients

2025-06-12 - 2025-06

Telehealth can make health care easier to access for patients with attention-deficit/hyperactivity disorder (ADHD) who need treatment, but experts worry about an increased risk of substance use disorder for patients being prescribed controlled medications such as stimulants for ADHD during these appointments. Mass General Brigham researchers scrutinized this concern with the first-ever study comparing substance use disorder rates in patients with ADHD who were prescribed stimulant medications during in-person versus virtual appointments. They found that, overall, telehealth was not associated with increased risk of substance use disorder. Still, the researchers noted the importance of comprehensive diagnoses and routine follow-ups. Results are published in the American Journal of Psychiatry.
The researchers examined the electronic health records of 7,944 ADHD patients between March 2020 and August 2023, a time when many physicians pivoted to online care in response to the COVID-19 pandemic. The researchers found that 91% of the patients had at least one in-person visit with the prescriber around the time they received a stimulant prescription, while 9% of the patients had a telehealth-only relationship with their doctor.
The study found that, overall, patients who only had telehealth visits to access their ADHD medication were not more likely to develop a substance use disorder compared to patients who initially met their prescribers in person, after adjusting for other factors like age and income. However, patients who received their initial stimulant prescription through telehealth were at a higher risk of developing a stimulant use disorder after adjusting for other factors. Stimulant use disorder involves drugs such as prescription medications, cocaine or methamphetamine, among other drugs. Patients aged 26 years and above who received an initial stimulant prescription during a telehealth appointment were at a higher risk of developing substance use disorders than younger patients.
The authors note that, given that only 19 patients in the study developed a stimulant use disorder, the finding could be coincidental. Another possibility is that those who opt for telehealth care are at higher risk for stimulant use disorder.
"While we think the findings should be replicated, the vast majority of the data show no increase in substance use disorder developing when patients exclusively use telehealth," said corresponding author Timothy Wilens, MD, chief of the Division of Child and Adolescent Psychiatry and co-director of the Center for Addiction Medicine at MGH. "Our study supports the use of telehealth for ADHD stimulant therapy in clinical settings."

Integration of Psychosomatic and Psychiatric Diagnostic Systems

2025-06-12 - 2025-06

Although psychosomatic medicine is regarded as a branch of psychiatry in many countries, some of its diagnostic concepts are not fully encompassed by mainstream psychiatric diagnostic systems. When these two systems are integrated, the interrelationships among various diagnoses and their associations with psychopathologies remain to be elucidated.
One of the most widely used contemporary psychiatric diagnostic systems is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, DSM-5 does not encompass all the key concepts in the field of psychosomatic medicine.
To address the limitations of the DSM system, a diagnostic framework known as the Diagnostic Criteria for Psychosomatic Research (DCPR) was developed in the 1990s. It includes several classic psychosomatic concepts, such as type A behavior and alexithymia. The Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) is its new version.
In this study published in Psychotherapy and Psychosomatics, researchers from National Taiwan University used a standardized interview to comprehensively examine the relationships between DCPR-R and various DSM-5 diagnostic constructs in 502 individuals. They focused on three core questions: (1) Among DCPR-R and DSM-5 diagnoses, which ones are more closely related? (2) When considering psychopathologies assessed by rating scales, which DCPR-R/DSM-5 diagnoses are more strongly associated with specific psychopathological phenomena? (3) Which DCPR-R/DSM-5 diagnoses have a greater impact on quality of life?
The results showed that DCPR-R/DSM-5 diagnoses could be grouped into three main classes based on latent class analysis: somatic symptoms, demoralization and stress, and insomnia. In addition, somatic symptoms could be further distinguished between constructs related to short-term stress (such as health anxiety) and those representing more chronic and persistent concepts (such as somatic symptom disorder, persistent somatization, hypochondriasis, and disease phobia).
In terms of psychopathological phenomena, the diagnoses most strongly associated with somatic distress were persistent somatization, major depressive disorder, generalized anxiety disorder, adjustment disorder, and panic disorder. The diagnosis most strongly associated with illness-related anxiety was somatic symptom disorder. The diagnoses most strongly associated with depression were major depressive disorder, generalized anxiety disorder, adjustment disorder, and irritable mood.
When focusing on overall quality of life, the DSM-5 diagnoses remained the most impactful, particularly major depressive disorder, generalized anxiety disorder, and adjustment disorder. Among the DCPR-R diagnoses, those with relatively stronger associations with quality of life were irritable mood and demoralization with hopelessness.
The study also yielded several interesting findings. For example, when focusing on quality of life, DSM-5 remains a highly reliable and broadly influential system; thus, clinical decisions based on DSM-5 diagnoses are likely to be highly efficient.
However, incorporating DCPR-R concepts offers opportunities to add more individualized meaning in nuanced areas. In addition, adjustment disorder was among the top diagnoses in terms of associations with both psychopathology and quality of life, suggesting that issues related to short-term stress, even when not meeting the full criteria for major depressive disorder or generalized anxiety disorder, can still involve considerable distress.
In the DCPR-R framework, the constructs within the "demoralization and stress" class-such as demoralization, demoralization with hopelessness, irritable mood, and Type A behavior-were those that most substantially affected quality of life. In contrast, the diagnoses within the "somatic symptoms" class had relatively modest impacts.
"We hope that the results of this study will contribute to the further development of diagnostic systems and help guide the design of more personalized treatment plans," says Prof. Wei-Lieh Huang.

Incorporating physical health considerations into mental health strategies could save millions

2025-06-11 - 2025-06

Reducing the number of physical health issues associated with mental health conditions, such as alcohol use disorders, bipolar disorder, depressive disorders, and schizophrenia, by just 1% could translate to savings of over 190 million purchasing power standard Euros (PPS€) in hospital costs every year in Europe, according to international researchers. The modelling study highlights the importance of integrating mental and physical healthcare to improve overall health outcomes and reduce costs, and they suggest that better access to and quality of care for both mental and physical health can lead to significant economic benefits for healthcare systems in Europe.
The Lancet Psychiatry: Incorporating physical health considerations into mental health strategies could save millions of Euros in annual hospital costs across Europe, modelling study suggests
Reducing the number of physical health issues associated with mental health conditions, such as alcohol use disorders, bipolar disorder, depressive disorders, and schizophrenia, by just 1% could translate to savings of over 190 million purchasing power standard Euros (PPS€)1 in hospital costs every year in Europe, according to a new modelling study published in The Lancet Psychiatry journal. The authors say their study highlights the importance of integrating mental and physical healthcare to improve overall health outcomes and reduce costs, and they suggest that better access to and quality of care for both mental and physical health can lead to significant economic benefits for healthcare systems in Europe.
People with mental health conditions have a higher rate of physical health conditions, such as cardiovascular disease, diabetes, obesity, and infectious diseases, when compared to the general population. These conditions also lead to higher healthcare costs. Understanding the size of these extra costs is important for improving the integration of mental and physical healthcare and reducing related economic costs, but this hadn't been fully studied in Europe before.
This current study is the first to estimate the excess annual hospital costs of non-mental health related physical health issues for those with selected serious mental health conditions in Europe. The study modelled hospital costs for non-mental health services in 32 European countries2, finding that people with serious mental health conditions face significantly higher costs for physical health care compared to the general population in Europe, amounting to approximately 55.3 billion euros annually. The study suggests the costs were 20.3 billion PPS€ euros for alcohol use disorders, 6.7 billion for bipolar disorder, 26.5 billion for depressive disorders, and 1.8 billion for schizophrenia. The authors highlight that people with schizophrenia potentially under-utilise services.
The authors say their study is the first quantification of economic benefits that could be achieved in the European hospital sector by reducing physical health issues related with serious mental health conditions through enhanced preventive, diagnostic and access efforts, and better integrated service pathways.

U.S. Maternal Mental Health Declines Sharply

2025-05-31 - 2025-05

A new study published in JAMA Internal Medicine reveals a concerning decline in self-reported mental health among mothers in the United States between 2016 and 2023. Conducted by researchers at the Columbia University Mailman School of Public Health, the study also found modest but measurable declines in self-reported physical health during the same period.
This large-scale analysis examined data from 198,417 mothers who participated in the National Survey of Children's Health (NSCH), a nationally representative annual survey of households with children aged 0-17. Most participating mothers were over age 30, and over half had a privately insured or a non-Hispanic white child.
"Although high rates of maternal morbidity and mortality have been well documented, national data on the health status of mothers beyond pregnancy and the first year postpartum is lacking," said Jamie Daw, PhD, assistant professor of Health Policy and Management at Columbia Mailman School. The findings show that the percentage of mothers reporting excellent mental health dropped sharply from 38 percent in 2016 to 26 percent in 2023. Similarly, the proportion reporting excellent physical health declined from 28 percent to 24 percent.
Most notably, the percentage of mothers rating their mental health as fair or poor rose by 3.5 percentage points over the 8 year-period, representing a 63.6 percent increase from the baseline prevalence of 5.5 percent in 2016. Declines in maternal mental health originated prior to the COVID-19 pandemic and were observed in nearly every socioeconomic subgroup examined.
Among fathers, the percentage reporting excellent physical health declined as well-from 30 percent to 26.4 percent; the changes in mental health were less pronounced. However, fathers reported substantially better mental and physical health than mothers in all years of the study.
The authors also examined disparities in maternal mental and physical health and found that the prevalence of fair and poor mental and physical health was considerably higher among mothers of lower educational attainment, single mothers, and those whose children have Medicaid or are uninsured.
Daw and colleagues emphasize the intergenerational consequences of poor parental mental health, including increased risks for adverse birth outcomes, developmental delays, and mental health issues in children. "Maternal mood disorders, in particular, can have long-term effects on children, directly by affecting development, and indirectly, by increasing the chance of exposure to co-occurring risks such as parental substance use and lower household resources," Daw explained.
"Our results highlight the rising tide of worsening mental health among parenting women as a key target for efforts to improve maternal and child health in the U.S.," Daw said. "We found consistently worse health outcomes for mothers compared to fathers, suggesting that mothers may need additional consideration and attention in policies aimed at supporting parental health and especially mental health.
In all cases, our study underscores the need for more comprehensive research on the health and well-being of U.S. parents more broadly, and we urge support for more interventions that support prevention, diagnosis and treatment of mental health outcomes."
Co-authors are Colleen L. MacCallum-Bridges, PhD, and Lindsay K. Admon, MD, MSc, University of Michigan.

New Research Offers Insights on Youth Suicide Trends

2025-05-29 - 2025-05

Two recent studies from the American Journal of Psychiatry examine trends in suicidal thoughts and suicides among youth. One study found that one in four high school students experienced suicidal ideation in the past year and that targeted screening based on behavioral risks may be missing many youth. Another study identified Black girls as having especially high rates of suicide.
Screening all students
Researchers, led by Tanner J. Bommersbach, M.D., M.P.H., with the University of Wisconsin, examined data on past-year suicidal thoughts and attempts among 119,000 high school students from the 2007 to 2021 Youth Risk Behavior Survey (Centers for Disease Control and Prevention).
They found significant increases in suicidal plans and attempts from 2017 to 2021. In 2021, nearly 1 in 4 high school students reported suicidal ideation in the past year and 1 in ten reported a suicide attempt. In addition,
The increase in suicidal thoughts was disproportionately high among females, non-Hispanic White and Black students, and students with depressive symptoms.
The increase in suicide attempts rose disproportionately among non-Hispanic White and Black students and high school seniors.
The researchers examined 24 health-risk behaviors/factors across five categories, including: 1. violence related behavior (bullied at school, bullied online, involved in a physical fight, threatened with a weapon, carrying a weapon, etc.); 2. activity/sedentary behavior (e.g., time watching TV/social media; frequency of physical activity; hours sleeping, etc.); 3. weight-related factors (overweight/obese); 4. substance use (alcohol, cannabis, cigarettes, cocaine, etc.); and 5. sexual activity.
Between 2007 and 2021, the students, regardless of behavioral risk, generally reported similar rates of suicidal symptoms. However, there was a disproportionately large increase in suicidal thoughts and attempts among students who used cigarettes or cannabis. The authors conclude that these findings "point to a need to identify adolescents with suicidal symptoms who may not be identified with targeted screening based on behavioral risks."
Black girls at especially high risk
In the second study, researcher Ran Barzilay, M.D., Ph.D., with Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, and colleagues, looked at data on youth suicidal thoughts and suicide attempts.
They analyzed data on youth suicidal ideation and suicide attempts from three sets of data:
The Adolescent Brain Cognitive Development Study (ABCD Study, more than 11,000 youth ages 9-15 years during 2016 and 2022).
The 2021 Youth Risk Behavior Survey (YRBS, more than 16,000 high school students in grades 9 to 12), conducted by the Centers for Disease Control and Prevention.
The Children's Hospital of Philadelphia Emergency Department (CHOP-ED, more than 19,000 youth ages 12 -18 years between 2013 and 2020).
The overall rate of suicidal ideation was 22.5%, and the suicide attempt rate was 8.6%. In all three sets of data, Black girls experienced the higher rates of suicidal ideation and suicide attempt than their white and male peers.
The analysis suggests there are specific factors underpinning the elevated rates among Black girls. And the researchers note that past research has pointed to a "few potential exposures that may disproportionately contribute to suicidal ideation among Black girls, including intimate partner violence, racial discrimination, cyberbullying, and underdiagnosis of depression."
Some specific therapies or approaches may be especially effective for helping Black girls. Other research, the authors note, has identified culturally relevant interventions such as the Adapted-Coping With Stress Course, attachment-based family therapy, and multisystemic therapy that may be effective for Black youths.
The authors expressed the hope that the evidence of elevated suicide ideation and attempts among Black adolescent girls leads to greater clinical awareness of the concern and an increase in suicide prevention efforts created for, and disseminated to, Black girls in particular.
If you or someone you know is struggling or experiencing thoughts of suicide or self-harm, know that your are not alone and help is available.

How your country's culture could affect your mental health recovery journey, study finds

2025-05-28 - 2025-05

Cultural differences can have a big impact on mental health recovery provisions, a new study from the University of Nottingham has shown.
The study, led by Dr. Yasu Kotera at the University of Nottingham, has shown that the effectiveness of Recovery Colleges (RCs)-educational centers supporting people with mental health challenges-is significantly shaped by national cultural values.
This innovative study was also co-led by Professor Mike Slade at the University of Nottingham, and Professor Claire Henderson at King's College London. The researchers looked across 28 countries and revealed how national culture influences the way mental health services-specifically RCs-are run, using cultural indices and data from 169 RCs around the world.
First introduced in England in 2009, RCs now operate in 28 countries across five continents. Rather than focusing solely on clinical treatment, RCs offer educational courses that empower people with mental health difficulties to lead meaningful and fulfilling lives.
These courses-co-produced and co-delivered by people with lived experience and professionals-cover topics such as understanding mental health, developing life skills, and planning for recovery, and are seen as a mental health innovation.
However, most RCs have been developed in Western countries, which share similar cultural characteristics. This has previously raised questions about how well the model fits in other parts of the world, especially where values around independence, group harmony, or emotional expression may differ.
In this current study, published in General Psychiatry, the researchers surveyed 169 RC managers in 28 countries, covering over 55,000 students.
The team assessed how closely RCs follow 12 core operational components such as equality, learning, and community focus. They then analyzed how these scores were linked to cultural characteristics, using Hofstede's widely recognized framework of national culture.
The study found that seven of the twelve core components of RCs are influenced by cultural characteristics. They found that RCs in countries with Individualistic and Indulgent cultures were more likely to emphasize co-production and community connection.
They also explained how RCs in countries with Short-term-oriented cultures scored higher on equality, perhaps because they prioritize immediate, practical outcomes over long-term planning.
Another finding was the strong role of Individualism-it influenced nearly every part of RC operations, from how learning is delivered to how people's strengths are described. In more collectivist societies, the open sharing and self-promotion encouraged by RCs may feel uncomfortable or inappropriate.
"This research shows that culture really matters in mental health recovery. Recovery Colleges are a powerful way to support people, but they cannot be one-size-fits-all. Understanding how cultures shape recovery processes helps us deliver more inclusive and effective care and tools around the world," says Dr. Yasu Kotera, Associate Professor of Cross-Cultural Mental Health at the University of Nottingham and Collaborative Researcher at the University of Osaka.
The study highlights a need to adapt the RC model to local cultures-particularly in countries where services are just starting to emerge.
These findings are especially relevant as RCs continue to expand globally-including into low- and middle-income countries such as Brazil, where planning is already underway.
The research team now plans to use these insights to refine the RECOLLECT Fidelity Measure to better reflect global cultural diversity. They also call for more qualitative research and collaboration with local stakeholders to further understand how to make RCs culturally inclusive.

Study Finds Zuranolone Effective for Anhedonia in Patients With PPD

2025-05-20 - 2025-05

New data presented at the 2025 American Psychiatric Association Annual Meeting demonstrated that zuranolone was relatively safe and effective to addressing anhedonia in adult patients with postpartum depression (PPD). The data was presented as part of the poster session at the meeting, being held May 17-21, 2025, in Los Angeles, California.1
The poster leverage data from the SKYLARK Study (NCT04442503), which looked at the safety and efficacy of 50 mg zuranolone in adults patients with PPD. Investigators conducted a post hoc analysis to assess improvement in anhedonia.2 A core symptom of depression, anhedonia (a loss of interest or pleasure in daily activities) has been linked to worse outcomes and more severe disease states.
Participants included female adults (N=196) aged 18 to 45 years who had a 17-item Hamilton Rating Scale or Depression (HAMD-17) total score of 26. All patients were randomized to receive zuranolone (N=98) or placebo (N=97) once daily for 14 days; there follow-ups evaluations conducted through day 45 to ascertain changes in the Montgomery-Masberg Depression Rating Scale (MADRS) anhedonia subscale score, which examines such symptoms as apparent sadness, reported sadness, concentration difficulty, lassitude, and inability to feel.
At baseline, participants in both the zuranolone and placebo treatment groups had similar MADRS scores, with a mean (SD) MADRS total scores for zuranolone of 35.5 (5.37) and a mean score of 35.0 (4.81). for placebo. As the study progressed, patients in the zuranolone group fared better. At day 15, for example, depressive symptoms measured by MADRS total scores decreased by 19.7 (1.20) points in the zuranolone group while those in the placebo group only realized a 14.6 (1.21) reduction (nominal p=0.003).
Improvements were also seen in anhedonia, which was assessed via LS mean (SE) CFB in MADRS anhedonia subscale scores. By day 8, patients in the zuranolone group experienced an 8.8 (0.78) reduction, while those in the placebo group only experienced a 6.4 (0.78) reduction (nominal p=0.012). The improvements continued through the study, as measured on day 45: patients in the zuranolone group saw a reduction of 12.7 (0.85) points vs a 9.9 (0.85) reduction for participants in the placebo group (nominal p=0.008).
The post hoc analysis likewise found zuranolone to be relatively well tolerated. Most of the treatment adverse events (62/65 [95.38%]) reported were found to be mild or moderate. Somnolence, which also included hypersomnia and sedation) was the most commonly reported event (35/98 [35.71%]). These were categorized as mild or moderate events and resolved either during treatment or shortly (less than 5 days) following the final dose.
Zuranolone, which was approved in 2023 by the US Food and Drug Administration for the treatment of PPD in 2023, became the first oral agent to address PPD. (Zuranolone has also been investigated for the treatment of major depressive disorder, but has not received approval for that indication). It is a positive allosteric modulator of synaptic and extrasynaptic GABAA receptors and neuroactive steroid. In approving the agent, the FDA cautioned that it could impact the patient's ability to drive and perform other potentially hazardous activities. Because it could cause fetal harm, patients should use contraception while taking zuranolone. Dizziness, diarrhea, fatigue, nasopharyngitis, and urinary tract infection were also noted by the FDA as potential adverse effects.
"Postpartum depression is a serious and potentially life-threatening condition in which women experience sadness, guilt, worthlessness-even, in severe cases, thoughts of harming themselves or their child. And, because PPD can disrupt the maternal-infant bond, it can also have consequences for the child's physical and emotional development," Tiffany R. Farchione, MD, then director of the FDA Center for Drug Evaluation and Research Division of Psychiatry, said following its approval.

Mother's childhood trauma linked to emotional and behavioral issues in her children, study finds

2025-05-18 - 2025-05

A new longitudinal study published in the Journal of Child Psychology and Psychiatry provides compelling evidence that a mother's exposure to adversity in childhood can influence the emotional, behavioral, and cognitive development of her own children. The research found that these early experiences are not only linked to a child's outcomes, but also shape the environment in which a child is raised-by affecting socioeconomic status, maternal mental health, relationship conflict, and caregiving behavior.
Researchers undertook this study to better understand how adversity experienced during a mother's early years can ripple forward into the next generation. While previous studies have found that childhood adversity is associated with a range of negative outcomes in adulthood, much less is known about how these effects play out in parenting and early child development. The study aimed to test an intergenerational model of risk by examining both direct and indirect pathways from maternal childhood adversity to child outcomes during the preschool years.
The researchers followed 501 families from the time children were 2 months old until they reached 5 years of age. Participants were recruited in the Toronto area between 2006 and 2008. Mothers reported on their own adverse childhood experiences (including physical and sexual abuse, household substance use, mental illness, parental separation, and exposure to violence), as well as their current socioeconomic conditions, relationship conflict, and symptoms of depression. Fathers contributed information on their own childhood conduct problems, and trained observers assessed parenting behaviors. Children's emotional and behavioral issues were rated by both parents, and cognitive abilities were measured through standardized testing.
The results showed that a mother's history of childhood adversity was linked to her child's emotional and behavioral problems, as well as cognitive performance. However, these associations were not straightforward. Instead, the effects were often indirect, operating through a network of interconnected family and contextual factors.
For example, mothers who had experienced more adversity in childhood were more likely to live in lower socioeconomic conditions as adults. This, in turn, was related to lower maternal sensitivity-how attuned and responsive mothers were to their children during interactions-and also linked to greater marital conflict and maternal depression. These factors shaped children's outcomes in specific ways.
Children's emotional problems, such as anxiety and sadness, were primarily linked to maternal depression. Mothers with more childhood adversity were more likely to experience depression, and this was a key predictor of emotional difficulties in their children. Fathers' histories of conduct problems also contributed indirectly to maternal depression, strengthening this link.
For conduct problems in children-such as aggression and rule-breaking-multiple pathways emerged. One involved fathers' own histories of behavior problems, which were directly associated with children's behavior. Another pathway went through the couple's relationship: maternal childhood adversity predicted more marital conflict, which was in turn linked to conduct issues in children. Lower maternal sensitivity also played a role in this association.
Cognitive outcomes followed a different pathway. Here, maternal sensitivity emerged as a key influence. Mothers with more childhood adversity tended to have lower socioeconomic status, which was associated with less sensitive caregiving. In turn, children in these environments showed poorer performance on measures of vocabulary and early math ability. Interestingly, maternal adversity showed a small direct link to higher child cognitive scores, but this was likely a statistical artifact. Once indirect pathways were considered, the overall effect of adversity on cognition was negative.
These findings support an "interactionist model" of development. In this model, a mother's early adversity can influence her adult socioeconomic status and the characteristics of her romantic partner, which then affect her mental health and caregiving behavior. These, in turn, shape her child's development. The model highlights how early life experiences can create cascades of risk that accumulate over time and generations.
While the study cannot prove causation, its design strengthens confidence in the findings. By including multiple informants (mothers, fathers, and trained observers) and multiple measurement methods (questionnaires, behavioral observations, and standardized tests), the researchers were able to paint a more complete picture than many earlier studies that relied solely on maternal self-reports. The longitudinal design, spanning several years of a child's early development, also allowed the researchers to track how these effects unfolded over time.
One limitation of the study is its focus on mothers. While the researchers did incorporate paternal conduct history, they did not collect data on fathers' own childhood adversity. Future studies could explore whether fathers' early experiences also shape intergenerational risk in similar or distinct ways. Another limitation is that the adversity measures did not include some potentially important forms of early trauma, such as community violence or discrimination. Also, maternal ACEs, mental health, and relationship conflict were all self-reported, which may introduce bias.
Despite these limitations, the study has significant implications for public policy and early intervention. The findings suggest that childhood adversity is not just an individual problem but one that can affect future generations. Policies that aim to reduce childhood trauma or mitigate its effects could have broad, long-lasting benefits. For example, programs that support young families with financial resources, mental health services, and parenting support may help break the cycle of adversity.
Screening tools for adverse childhood experiences are relatively easy to administer and could be incorporated into pediatric and maternal healthcare settings. Identifying families at risk could allow for early, targeted support. Moreover, addressing multiple factors at once-such as economic hardship, caregiver mental health, and parenting quality-may be more effective than focusing on any single issue in isolation.
The study also supports the potential value of broader social policies, such as cash transfer programs, to alleviate economic stress. Preliminary research has found that unconditional financial support to families can lead to improved cognitive and behavioral outcomes in children. High-quality, affordable childcare may also help buffer the effects of family stress on young children's development.
The study, "The long reach of adversity: Intermediary pathways from maternal adverse childhood experiences to child socio-emotional and cognitive outcomes," was authored by Sheri Madigan, Andre Plamondon, and Jennifer M. Jenkins.

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