Background The coronavirus disease 2019 (COVID-19) has severely impacted the lives of children and adolescents. School closure, one of the critical changes during the first COVID-19 wave, caused decreases in social contacts and increases in family time for children and adolescents. This can have both positive and negative influences on suicide, which is one of the robust mental health outcomes. However, the impact of the COVID-19 crisis on children and adolescents in terms of suicide is unknown. Objective This study investigates the acute effect of the first wave of the COVID-19 pandemic on suicide among children and adolescents during school closure in Japan. Data Total number of suicides per month among children and adolescents under 20 years old between January 2018 and May 2020. Methods Poisson regression was used to examine whether suicide increased or decreased during school closure, which spanned from March to May 2020, compared with the same period in 2018 and 2019. Robustness check was conducted using all data from January 2018 to May 2020. Negative binomial regression, a model with overdispersion, was also performed. Results We found no significant change in suicide rates during the school closure (incidence rate ratio (IRR) = 1.15, 95% confidence interval (CI): 0.81 to 1.64). We found the main effect of month, that is, suicides significantly increased suicides in May (IRR: 1.34, 95% CI: 1.01 to 1.78) compared to March, but the interaction terms of month and school closure were not significant (p > 0.1). Conclusions As preliminary findings, this study suggests that the first wave of the COVID-19 pandemic has not significantly affected suicide rates among children and adolescents during the school closure in Japan.
Lack of social support is a known risk factor for postpartum depression (PPD). However, the association between lack of social support from a partner or others and PPD remains unknown. We examined this association among Japanese mothers. We distributed an original questionnaire to mothers participating in a three- or four-month health check-up program over October to November 2012 in Aichi Prefecture, Japan. Of the 9707 eligible mothers, 6590 responded to the questionnaire (response rate: 68%). Social support from a partner or others was assessed based on whether the mother can consult with her partner or others (i.e., parents, relatives, and friends who are close by or far) on childcare. PPD was assessed with the Edinburgh Postnatal Depression Scale. The data were analyzed using multiple logistic regression analysis for four categories: no social support from either a partner/others, social support from a partner only, social support from others only, and social support from both, adjusted for possible covariates. Mothers who have no social support from either a partner/others, have social support from a partner only, and have social support from others only were 7.22 (95% confidence interval [CI], 1.76–29.6), 2.34 (95% CI, 1.37–3.98), and 3.13 (95% CI, 2.11–4.63) times more likely to show PPD, respectively, in comparison with mothers who have social support from both, after adjustment of possible covariates. Mothers with no social support from a partner, but have social support from others, showed significant risk for PPD, which may be invisible. Further prevention effort is needed to detect PPD cases, with a focus on mothers without support from their partner.
The aim of this study is to examine the association between maternal adverse childhood experiences (ACEs) and mental health problems in adolescent offspring. Data were obtained from the population-based Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016, and participants were 10,810 children in the fifth grade (3,144 pairs), eighth grade (3,497 pairs), and eleventh grade (4,169 pairs) living in Kochi Prefecture, Japan. Mothers of participating children were asked about their ACEs, childhood social economic status, current mental and physical health, current social economic status, positive parenting behaviors, child maltreatment, marital status, and child behavior problems using the Strength and Difficulty Questionnaire. Children reported their depressive symptoms using the Depression Self-Rating Scale. Children of mothers with a larger number of ACEs showed higher levels of behavior problems (p for trend <.001) and depressive symptoms (p for trend <.001), adjusting for potential confounders. In particular, maternal psychological distress mediated the association between maternal ACEs and child mental health. The adverse effects of maternal ACEs may have a direct intergenerational impact on behavior problems and depressive symptoms in adolescent offspring. Further studies to elucidate possible mediators are needed.
Background: Intimate partner violence (IPV) during pregnancy can lead to negative consequences for both the mother and offspring. Although IPV is recognized as a worldwide public health issue, its prevalence is considered to be underestimated because cases are likely underreported, suggesting that there might be unmeasured IPV. The aim of this study was to develop an instrument to detect IPV in pregnant women. Methods: A total of 6,590 women in Aichi prefecture, Japan, who took part in a 3 or 4 month infant health checkup program, participated in the study. Questionnaires assessing history of IPV during pregnancy (physical abuse and verbal abuse), maternal characteristics, partner's characteristics, and household characteristics were mailed to women before, or distributed at, the checkup. Women returned the questionnaires to the checkup sites or mailed them back to the health centers. A prediction model for history of IPV was then generated using potential risk factors selected based on the literature. Results: Among 6,530 women who responded to either question on IPV during pregnancy (response rate = 67.3%), the rate of participants who experienced any IPV during pregnancy was 11.1% (physical IPV = 1.2%; verbal IPV = 10.8%). Multiple logistic regression analyses showed that maternal age (<25 years old), multiparity, history of artificial abortion, negative feelings when the pregnancy was confirmed (e.g., confused), having no one to provide support during pregnancy, having relationship problems with their partner, paternal smoking during pregnancy, and difficult financial status were associated with any abuse from the partner. Based on the analysis, the Intimate Partner Violence during Pregnancy Instrument (IPVPI) was developed, comprising of eight questions to detect unmeasured IPV in pregnant women, and showed moderate predictive power (area under receiver operating characteristic curve = 0.719, 95% confidence interval: 0.698 to 0.740) ranging from 0 to 16 with a cut-off point of 2 (sensitivity = 79.5%, specificity = 47.1%). Conclusion: The IPVPI, which allows to ask indirect questions rather that asking directly about experience of IPV, might be helpful to detect unmeasured IPV in pregnant women in fields of primary healthcare and obstetrics. Further research longitudinal studies are needed to improve the sensitivity and specificity of the IPVPI.
This study aimed to investigate the association between the frequency of home cooking and obesity among children in Japan. We used cross-sectional data from the Adachi Child Health Impact of Living Difficulty study, a population-based sample targeting all fourth-grade students aged 9 to 10 in Adachi City, Tokyo, Japan. Frequency of home cooking was assessed by a questionnaire for 4258 caregivers and classified as high (almost every day), medium (4-5 days/week), or low (≤3 days/week). School health checkup data on height and weight were used to calculate body mass index z-scores. Overall, 2.4% and 10.8% of children were exposed to low and medium frequencies of home cooking, respectively. After adjusting for confounding factors, children with a low frequency of home cooking were 2.27 times (95% confidence interval: 1.16-4.45) more likely to be obese, compared with those with a high frequency of home cooking. After adjustment for children's obesity-related eating behaviors (frequency of vegetable and breakfast intake and snacking habits) as potential mediating factors, the relative risk ratio of obesity became statistically non-significant (1.90; 95% confidence interval: 0.95-3.82). A low frequency of home cooking is associated with obesity among children in Japan, and this link may be explained by unhealthy eating behaviors.
Background: The Adachi Child Health Impact of Living Difficulty (A-CHILD) study has been conducted since 2015 to clarify the associations between socioeconomic factors and child health, as well as to accumulate data for political evaluation of the child-poverty agenda. This paper describes the purpose and research design of the A-CHILD study and the baseline profiles of participants, together with the future framework for implementing this cohort study. Methods: We have conducted two types of continuous survey: a complete-sample survey started in 2015 as a first wave study to target first-grade children in all public elementary schools in Adachi City, Tokyo, and a biennial fixed grade observation survey started in 2016 in selected elementary and junior high schools. Questionnaires were answered by caregivers of all targeted children and also by the children themselves for those in the fourth grade and higher. The data of A-CHILD also combined information obtained from school health checkups of all school-grade children, as well as the results from blood test and measurement of blood pressure of eight-grade children since 2016. Results: The valid responses in the first wave were 4,291 (80.1%). The number of households in "living difficulties", such as low household income or material deprivation, stood at 1,047 (24.5%). Conclusions: The A-CHILD study will contribute to the clarification of the impact of poverty on children's health disparities and paves the way to managing this issue in the community.
BackgroundShaking and smothering in response to infant crying are forms of child abuse that often result in death. Unintended pregnancy and young motherhood are risk factors of such child maltreatment that are often comorbid, few studies have examined their synergistic effect on shaking and smothering of infants. We examined the synergistic effects of unintended pregnancy and young motherhood on shaking and smothering among caregivers of infants in Japan.MethodsIn this retrospective cohort study, a questionnaire was administered to caregivers enrolled for a health check for 3- to 4-month-old infants between October 2013 and February 2014 in Nagoya City, Japan. The questionnaire data were linked to those from pregnancy notification forms registered at municipalities and included information on women’s age and feelings about their pregnancy (N = 4,159). Data were analyzed using logistic regression analysis in 2016.ResultsShaking and smothering of 3- to 4-month-old infants occurred at least once in the past month in 2.0 and 1.5% of cases, respectively. Of all participants, 24.8% reported unintended pregnancy while 7.3% were younger than 25 years old. Infants of young mothers (under 25 years old) with unintended pregnancy were 2.77 [95% confidence interval (CI): 1.15–6.68] and 5.61 (95% CI: 2.40–13.1) times more likely to be shaken and smothered, respectively, than those of older mothers with intended pregnancy. In addition, the odds ratio of young mothers with unintended pregnancy regarding smothering was significantly higher than that of older mothers with unintended pregnancy (odds ratio: 2.12; p = 0.02).ConclusionOur findings suggest a synergistic effect of unintended pregnancy and young motherhood on smothering. Infants of young mothers with unintended pregnancy are at greater risk of abuse, especially smothering. Prevention strategies are required for young women with unintended pregnancies.
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