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1.  [No title available] 
PMCID: PMC3766472  PMID: 23584728
2.  Maternal Depressive Symptoms, Maternal Behavior, and Toddler Internalizing Outcomes: A Moderated Mediation Model 
Maternal depression relates to child internalizing outcomes, but one missing aspect of this association is how variation in depressive symptoms, including mild and moderate symptoms, relates to young children’s outcomes. The current study examined a moderated mediation model to investigate how maternal behaviors may mediate this association in the context of child temperament and gender. Mothers and toddlers completed a free-play/clean-up task in the laboratory. Mothers rated their depressive symptoms and their toddlers’ temperament and internalizing behaviors. Results indicated a significant indirect of maternal warmth on the relation between maternal depressive symptoms and toddler internalizing outcomes for boys with low negative emotionality. Toddler gender and temperament moderated the relation between maternal intrusiveness and toddler internalizing outcomes, but mediation was not supported. Results highlight the important interaction between child and maternal variables in predicting child outcomes, and suggest mechanisms by and conditions under which mild maternal depressive symptomatology can be a risk factor for toddler internalizing outcomes.
PMCID: PMC4139471  PMID: 24553739
maternal depression; internalizing behaviors; toddlerhood; parenting; temperament; gender
3.  Prospective Relations between Parental Depression, Negative Expressiveness, Emotional Insecurity, and Children’s Internalizing Symptoms 
Child psychiatry and human development  2013;44(6):10.1007/s10578-013-0362-1.
Building on the conceptual framework of emotional security theory (EST) [1], this study longitudinally examined multiple factors linking parental depressive symptoms and child internalizing symptoms. Participants were 235 children (106 boys, 129 girls) and their cohabiting parents. Assessments included mothers’ and fathers’ depressive symptoms when children were in kindergarten, parents’ negative expressiveness when children were in first grade, children’s emotional insecurity one year later, and children’s internalizing symptoms in kindergarten and second grade. Findings revealed both mothers’ and fathers’ depressive symptoms were related to changes in children’s internalizing symptoms as a function of parents’ negative emotional expressiveness and children’s emotional insecurity. In addition to these similar pathways, distinctive pathways as a function of parental gender were identified. Contributions are considered for understanding relations between parental depressive symptoms and children’s development.
PMCID: PMC3695069  PMID: 23371814
Parental depressive symptoms; emotional security; parental negative emotional expressiveness; children’s internalizing symptoms
4.  Longitudinal Associations Between Preschool Psychopathology and School-Age Peer Functioning 
The current study examined the effects of preschool psychopathology on peer functioning around school entry. Children (N = 211) were assessed at ages 3 and 6. A semi-structured diagnostic interview, the Preschool Age Psychiatric Assessment, was administered to a parent at both time points to assess psychopathology. The peer functioning constructs examined at age 6 included child popularity, socially inappropriate behavior, and conflicted shyness. Simultaneous multiple regressions revealed that age 3 anxiety disorder diagnosis was the only unique diagnostic predictor of age 6 socially inappropriate behavior and conflicted shyness, with age 3 anxiety dimensional scores uniquely predicting all three peer constructs. Age 3 anxiety disorder had direct effects on both socially inappropriate behavior and conflicted shyness, which were not mediated by concurrent anxiety disorder at age 6. Thus, preschool anxiety disorders may have enduring effects on child peer relationships in the early school-age years. Possible explanations and implications are explored.
PMCID: PMC4231779  PMID: 23334266
Preschool psychopathology; Diagnosis; Anxiety; Early childhood; Peer relationships
5.  Parenting Influences on Latino Children’s Social Competence in the First Grade: Parental Depression and Parent Involvement at Home and School 
Although it is widely accepted that parental depression is associated with problems with children’s socioemotional adjustment, the pathways by which parental depression influences children’s adjustment, particularly in low-income Latino children are not fully understood. In our investigation of 1,462 low-income Latino children in the first grade and their Spanish- and English-dominant parents, a factor analysis revealed three main pathways of possible influence of parent involvement in children’s social development: emotional involvement and educational involvement at home and at school. The findings from multigroup structural equation modeling revealed that whereas the first two pathways mediated the effect of parental depression on child social competence for Spanish-dominant parents, only emotional involvement explained parental depression effects for English-dominant parents. Parent educational involvement at school did not mediate parental depression effects for either Spanish- or English-dominant Latino parents. Discussion and implications of findings with respect to research, practice, and policy with Latinos follow.
PMCID: PMC3654068  PMID: 23325021
parental depression; parent involvement; social competence; Latino children; elementary school
6.  Characteristics of DSM-IV Attention Deficit Hyperactivity Disorder Combined and Predominantly Inattentive Subtypes in a Turkish Clinical Sample 
Consecutively referred subjects (N = 537) to an outpatient clinic were evaluated to compare the Attention Deficit Hyperactivity Disorder Combined (ADHD-C) and predominantly inattentive (ADHD-PI) subtypes using parent and teacher ratings and neuropsychological variables. Statistical significance was at P < 0.002 adjusted for multiple comparisons. ADHD-PI subjects were older, more likely to be female, higher socioeconomic status, had lower Child Behavior Checklist and Teacher Report Form Aggression, Delinquency and Social Problems scores, and higher Withdrawal and Competence scores, compared to ADHD-C subjects. Comorbid conduct problems were more common among ADHD-C subjects. There were no differences in terms of anxiety/depression, and neuropsychological measures. The study is unique in that it provides data on a broad range of measures from a middle income developing country with important confirmation of similar pattern of differences and similarities between ADHD-C and ADHD-PI subtypes previously reported in North American and Western European samples.
PMCID: PMC4153434  PMID: 22249362
Attention Deficit Hyperactivity Disorder; Inattentive; Combined
7.  Longitudinal Prediction of Disruptive Behavior Disorders in Adolescent Males from Multiple Risk Domains 
The disruptive behavior disorders are among the most prevalent youth psychiatric disorders, and they predict numerous problematic outcomes in adulthood. This study examined multiple domains of risk during early childhood and early adolescence as longitudinal predictors of disruptive behavior disorder diagnoses among adolescent males. Early adolescent risks in the domains of sociodemographic factors, the caregiving context, and youth attributes were examined as mediators of associations between early childhood risks and disruptive behavior disorder diagnoses. Participants were 309 males from a longitudinal study of low-income mothers and their sons. Caregiving and youth risk during early adolescence each predicted the likelihood of receiving a disruptive behavior disorder diagnosis. Furthermore, sociodemographic and caregiving risk during early childhood were indirectly associated with disruptive behavior disorder diagnoses via their association with early adolescent risk. The findings suggest that preventive interventions targeting risk across domains may reduce the prevalence of disruptive behavior disorders.
PMCID: PMC3625698  PMID: 23239427
Risk factors; disruptive behavior disorders; adolescence; parenting; longitudinal
8.  Anxiety-Promoting Parenting Behaviors: A Comparison of Anxious Parents with and without Social Anxiety Disorder 
While parenting behaviors among anxious parents have been implicated in the familial transmission of anxiety, little is known about whether these parenting behaviors are unique to specific parental anxiety disorders. The current study examined differences in the use of five specific parenting behaviors (i.e., warmth/positive affect, criticism, doubts of child competency, over-control, and granting of autonomy) in anxious parents with (n = 21) and without (n = 45) social anxiety disorder (SAD) during a five-minute task with their non-anxious child (aged 7-12 years, M = 9.14). Parents with SAD demonstrated less warmth/positive affect and more criticism and doubts of child competency than did those without SAD. There were no group differences in over-control or granting of autonomy. Findings help clarify inconsistent results in the literature, inform models of familial transmission, and suggest intervention targets for parents with SAD.
PMCID: PMC3546134  PMID: 23053617
social anxiety disorder; parenting behaviors; etiology
9.  Classes of Psychotic Experiences in Kenyan Children and Adolescents 
Psychotic-like experiences (PLEs) have been observed worldwide in both adults and children outside the context of a clinical disorder. In the current study, we investigate the prevalence and patterns of PLEs among children and adolescents in Kenya. Among 1,971 students from primary and secondary schools around Nairobi (aged 8–19), 22.1 % reported a lifetime history of a psychotic experience, and 16.3 % reported this unrelated to sleep or drugs. Psychotic experiences were more common in males compared to females. LCA resulted in a three-class model comprised of a normative class (83.3 %), a predominately hallucinatory class (Type 1 psychosis: 9.6 %), and a pan-psychotic class (Type 2 psychosis: 7.2 %). These results indicate that PLEs are prevalent in children and adolescents, and the distributions of symptom clusters are similar to that found in adulthood. The relationship of specific PLEs to the future development of psychotic disorder, functional impairment or distress will require further study.
PMCID: PMC3568190  PMID: 23065300
Psychosis; Children; Adolescents; Kenya; Africa; LCA
10.  A Randomized Controlled Trial of the Child Anxiety Multi-Day Program (CAMP) for Separation Anxiety Disorder 
While the efficacy of cognitive behavior therapy for childhood anxiety disorders, including separation anxiety disorder (SAD), has been established, tailoring such treatments to particular interests and needs may enhance uptake of evidence-based interventions. The current investigation evaluates the feasibility and preliminary efficacy of an intensive, cognitive-behavioral intervention for girls with SAD provided within the novel context of a one-week camp-like setting, the Child Anxiety Multi-Day Program (CAMP). Twenty-nine female children aged 7 to 12 with a principal diagnosis of SAD were randomized to immediate CAMP treatment (n = 15) or waitlist (i.e., delayed treatment; n = 14) condition during the course of this randomized controlled trial. Children in the immediate treatment group evidenced significant reductions in SAD severity, functional impairment, and parent report of child anxiety symptoms relative to the waitlist condition. The intervention’s positive therapeutic response suggests one possible delivery model for surmounting difficulties faced in the dissemination of weekly treatments for SAD.
PMCID: PMC3582853  PMID: 23053618
cognitive behavioral therapy; child anxiety; separation anxiety disorder; intensive treatment; summer camp
11.  Symptoms of Anxiety and Associated Risk and Protective Factors in Young Asian American Children 
Anxiety is one of the most prevalent mental health problems in young children but there has been a dearth of studies focusing on Asian American children. This study examines the patterns and the predictors of childhood anxiety and related symptoms in young children in a diverse Asian American (ASA) sample (n = 101). Findings indicate that ASA children are at higher risk for anxiety, somatization, and depressive problems than their peers. Parents’ level of acculturation (i.e., American identity, English competence), parental negative emotion socialization, conflicted parent–child relationship, child emotional knowledge and adaptive skills, as well as teachers’ ethnic background and school class types were all associated with ASA children’s anxiety. A combination of cultural, family, and school factors explained from 17 to 39 % of the variance in anxiety symptoms. Findings inform prevention services for young ASA children.
PMCID: PMC4009686  PMID: 22410755
Asian American; Anxiety; Somatization; Acculturation; Parenting; Risk factor
12.  Maternal Distress Influences Young Children's Family Representations Through Maternal View of Child Behavior and Parent-Child Interactions 
Distress of a parent is a key influence on the quality of the child's experience in the family. We hypothesized that maternal distress would spill over into more negative views of their children's behaviors and less emotional availability in their relationships. Further, we investigated whether these cumulative experiences contributed to children's emerging narratives about mothers and family life.
In this longitudinal study, mothers of young twin children reported their distress on three occasions in relation to: self, the marital relationship, and the family climate. Mothers also reported on their children's externalizing behavior problems. Mother-child interaction was observed focusing on maternal sensitivity and child responsivity. Children responded to story stem beginnings about challenging situations in the family and their narratives were scored for family conflict and cohesion themes. APIM methods of dyadic data analysis accounted for the inclusion of both twins in the analysis.
Results from structural equation models supported the hypothesized cumulative experience of maternal distress on children's family life representations for both family conflict and family cohesion.
A family environment in which children are exposed to persistent maternal distress early in life may have cumulative effects, influencing how mothers interact with and view their children's behavior at later developmental stages. Moreover, exposure to repeated distress for longer periods of time may contribute to an intergenerational continuity of distress for the child that may become rooted in negative affective bias in their own view of family relationships.
PMCID: PMC3992274  PMID: 23568672
maternal distress; behavioral problems; interaction quality; child narratives; Structural Equation Model
13.  The Role of Parental Language Acculturation in the Formation of Social Capital: Differential Effects on High-risk Children 
This person-centered study examines the extent to which parents’ language dominance influences the effects of an after school, multi-family group intervention, FAST, on low-income children’s emotional and behavioral outcomes via parents’ relations with other parents and with school staff. Social capital resides in relationships of trust and shared expectations, which are highly dependent on whether parents share the language of other parents and teachers. This study is based on a community epidemiologically-defined sample of Latino families (N = 3,091) in San Antonio, Texas and Phoenix, Arizona. Latent profile analyses revealed three language profiles of parents across the two cities: English-dominant, Spanish-dominant, and bilingual. Path models revealed that FAST did not have a direct or indirect effect on children’s emotional and behavior functioning, although FAST increased parent-parent and parent-school social capital among Spanish-dominant parents in Arizona and these parent-parent relations were associated with better child outcomes. Implications for interventions are discussed.
PMCID: PMC3530652  PMID: 22903786
acculturation; language; social capital; behavior problems; FAST
14.  Relationship of Ferritin to Symptom Ratings Children with Attention Deficit Hyperactivity Disorder: Effect of Comorbidity 
Child psychiatry and human development  2007;39(3):10.1007/s10578-007-0095-0.
Our aim was to investigate the relation between behavioral symptoms and hematological variables which are related with iron deficiency and anemia, ferritin, hemoglobin, mean corpuscular volume (MCV), and reticulosite distribution width (RDW) in children and adolescents with pure Attention Deficit Hyperactivity Disorder (ADHD) or ADHD comorbid with other psychiatric disorders. The sample consisted of 151 subjects with ADHD, 45 of these subjects had other comorbid conditions. Conners Parent (CPRS) and Teacher Rating Scales (CTRS) were obtained. Comorbid ADHD subjects had lower mean hemoglogin and MCV. In the ADHD group in general, CPRS and CTRS Total scores were significantly negatively correlated with ferritin level. When only pure ADHD subjects were taken into account, the correlations did not reach statistical signifance. Overall, these results suggested that lower ferritin level was associated with higher behavioral problems reported by both parents and teachers. Presence of comorbid conditions might increase the effect of lower iron stores on behavioral measures.
PMCID: PMC3884682  PMID: 18165896
Attention Deficit Hyperactivity Disorder; Ferritin; Comorbidity
15.  Psychopathic Traits and Reactive-Proactive Aggression in a Large Community Sample of Polish Adolescents 
This paper presents results of the only large-scale study carried-out in Poland to date on the prevalence of psychopathic traits and their relationship with aggressive behaviour in mainstream adolescents. The sample consists of 9,415 students (4,808 boys, 4,607 girls) in the first to third grades at 142 public secondary schools. Psychopathic traits were measured by teacher-report ratings with the antisocial process screening device (APSD), while aggressive behaviours were assessed using the Reactive-Proactive Aggression Questionnaire. Analysis of results revealed that boys scored much higher than girls in total APSD scale measuring psychopathic traits. Only 2.68 % of assessed adolescents scored above the cut-off of 25 points. Results also showed significant correlations between psychopathic traits and both proactive and reactive aggression. The authors concluded that screening a large sample to identify children and youths with psychopathic traits has some important advantages but, on the other hand, it is a sensitive undertaking because of the label ‘psychopath’ can have negative consequences for the subjects.
PMCID: PMC4065651  PMID: 24374497
Adolescents; Psychopathic traits; Reactive-proactive aggression; Assessment
16.  Perceived Child Behavior Problems, Parenting Stress, and Maternal Depressive Symptoms Among Prenatal Methamphetamine Users 
The present study was designed to examine parenting stress, maternal depressive symptoms, and perceived child behavior problems among mothers who used methamphetamine (MA) during pregnancy. Participants were a subsample (n = 212; 75 exposed, 137 comparison) of biological mothers who had continuous custody of their child from birth to 36 months. The subsample was drawn from a larger, ongoing longitudinal study on the effects of prenatal methamphetamine exposure (n = 412; 204 exposed, 208 comparison) (Arria et al in Matern Child Health J 10:293–302 2006). Mothers who used MA during pregnancy reported more parenting stress and more depressive symptoms than a matched comparison group. There were no differences between groups on perceived child behavior problems. In a hierarchical linear model, depressive symptoms, and perceived child behavior problems, but not MA exposure, were statistically significant predictors of parenting stress. Screening for potential parenting problems among mothers with a history of substance abuse is warranted. Parenting interventions targeting depressive symptoms, parenting stress, and child behavior problems are needed for this population.
PMCID: PMC3717339  PMID: 22552952
Parenting stress; Prenatal drug exposure; Methamphetamine; Child behavior problems; Maternal depression
17.  Preventive Intervention for Anxious Preschoolers and Their Parents: Strengthening Early Emotional Development 
The high prevalence and early onset of anxiety disorders have inspired innovative prevention efforts targeting young at-risk children. With parent–child prevention models showing success for older children and adolescents, the goal of this study was to evaluate a parent–child indicated preventive intervention for preschoolers with mild to moderate anxiety symptoms. Sixteen children (ages 3–5) and at least one of their parents participated in Strengthening Early Emotional Development (SEED), a new 10-week intervention with concurrent groups for parents and children. Outcome measures included clinician-rated and parent-rated assessments of anxiety symptoms, as well as measures of emotion knowledge, parent anxiety, and parental attitudes about children’s anxiety. Participation in SEED was associated with reduced child anxiety symptoms and improved emotion understanding skills. Parents reported decreases in their own anxiety, along with attitudes reflecting enhanced confidence in their children’s ability to cope with anxiety. Reductions in child and parent anxiety were maintained at 3-month follow-up. Findings suggest that a parent–child cognitive-behavioral preventive intervention may hold promise for young children with mild to moderate anxiety. Improvements in parent anxiety and parental attitudes may support the utility of intervening with parents. Fostering increased willingness to encourage their children to engage in new and anxiety-provoking situations may help promote continued mastery of new skills and successful coping with anxiety.
PMCID: PMC3759969  PMID: 22331442
Child anxiety; Parent anxiety; Indicated prevention
18.  Factor Structure of Measures of Anxiety and Depression Symptoms in African American Youth 
Previous research has suggested that the factor structure of anxiety measures is different in African American samples compared to majority population samples. However, these findings may be due to misuse of analytic methods rather than meaningful differences in the underlying presentation of anxiety. To address this, we examined the factor structure of two measures of child anxiety: the Revised Children’s Anxiety and Depression Scale (RCADS) and the Multidimensional Anxiety Scale for Children (MASC) in a sample of 229 African American youth. Contrary to previous research, confirmatory factor analyses yielded good fit for the original factor structures of both measures. These results suggest that the underlying factor structure of these measures may not be significantly different for African American and majority population youth as previously thought. The effect of data analytic procedures on subsequent conclusions and theory is discussed and recommendations are made.
PMCID: PMC3737595  PMID: 23224837
child anxiety; child depression; factor analysis; African American children; assessment
19.  Temperamental Profiles of Dysregulated Children 
It is crucial to characterize self-regulation in children. We compared the temperamental profiles of children with the Child Behavior Checklist (CBCL) Dysregulation Profile (CBCL-DP) to profiles associated with other CBCL-derived syndromes. 382 children (204 boys; aged 5–18) from a large family study were examined. Temperamental profiles were based on the Juvenile Temperament and Character Inventory (JTCI). . Children with the CBCL-DP had a temperamental profile characterized by high Novelty Seeking (NS), high Harm Avoidance (HA), low Reward Dependence (RD) and low Persistence (P). Linear mixed models and regression-based models demonstrated that the CBCL-DP was associated with a “disengaged” temperamental profile. This profile is similar to the profile seen in adult disorders of self-regulation, including cluster B personality disorders. These results support the hypothesis that the CBCL-DP measures poor self-regulation.
PMCID: PMC3374895  PMID: 22271225
juvenile bipolar disorder; ADHD; CBCL; temperament; JTCI
20.  Modifying Adolescent Interpretation Biases Through Cognitive Training: Effects on Negative Affect and Stress Appraisals 
Adolescent anxiety is common, impairing and costly. Given the scale of adolescent anxiety and its impact, fresh innovations for therapy are in demand. Cognitive Bias Modification of Interpretations (CBM-I) studies of adults show that by training individuals to endorse benign interpretations of ambiguous situations can improve anxious mood-states particularly in response towards stress. While, these investigations have been partially extended to adolescents with success, inconsistent training effects on anxious mood-states have been found. The present study investigated whether positive versus negative CBM-I training influenced appraisals of stress, in forty-nine adolescents, aged 15–18. Data supported the plasticity of interpretational styles, with positively-trained adolescents selecting more benign resolutions of new ambiguous situations, than negatively-trained adolescents. Positively-trained adolescents also rated recent stressors as having less impact on their lives than negatively-trained adolescents. Thus, while negative styles may increase negative responses towards stress, positive styles may boost resilience.
PMCID: PMC3764320  PMID: 23722473
Cognitive bias modification; Interpretational style; Adolescence; Anxiety; Stress reactivity
21.  Identifying Patterns of Early Risk for Mental Health and Academic Problems in Adolescence: A Longitudinal Study of Urban Youth 
This investigation examined profiles of individual, academic, and social risks in elementary school, and their association with mental health and academic difficulties in adolescence. Latent profile analyses of data from 574 urban youth revealed three risk classes. Children with the “well-adjusted” class had assets in the academic and social domains, low aggressive behavior, and low depressive symptoms in elementary school, and low rates of academic and mental health problems in adolescence. Children in the “behavior-academic-peer risk” class, characterized by high aggressive behavior, low academic achievement, and low peer acceptance, had conduct problems, academic difficulties, and increased mental health service use in adolescence. Children with the “academic-peer risk” class also had academic and peer problems but they were less aggressive and had higher depressive symptoms than the “behavior-academic-peer risk” class in the first grade; the “academic-peer risk” class had depression, conduct problems, academic difficulties, and increased mental health service use during adolescence. No differences were found between the risk classes with respect to adolescent outcomes.
PMCID: PMC3651024  PMID: 21538121
childhood risk; adolescent adjustment; person-centered approach
22.  [No title available] 
PMCID: PMC3637687  PMID: 22080366
23.  Understanding the Relation of Low Income to HPA-Axis Functioning in Preschool Children: Cumulative Family Risk and Parenting As Pathways to Disruptions in Cortisol 
This study examined the relation of low income and poverty to cortisol levels, and tested potential pathways from low income to disruptions in cortisol through cumulative family risk and parenting. The sample of 306 mothers and their preschool children included 29 % families at or near poverty, 27 % families below the median income, and the remaining families at middle and upper income. Lower income was related to lower morning cortisol levels, and cumulative risk predicted a flatter diurnal slope, with a significant indirect effect through maternal negativity, suggesting that parenting practices might mediate an allostatic effect on stress physiology.
PMCID: PMC3621874  PMID: 22528032
Low income; Cumulative risk; Parenting practices; Cortisol; Children
24.  Children with Generalized Anxiety Disorder Do Not Have Peer Problems, Just Fewer Friends 
A common assumption is that all youth with anxiety disorders (AD) experience impaired peer relationships relative to healthy control children. Social impairments have been identified among youth with certain AD (e.g., social anxiety disorder; SAD), but less is known about the peer relationships of children with generalized anxiety disorder (GAD). We therefore compared the interpersonal functioning of youth with GAD, SAD, and controls (6 to 13 years). Despite having relatively fewer friends overall, children with GAD did not differ from controls in terms of the likelihood of having a best friend, participation in groups/clubs, and parent ratings of social competence. In comparison, youth with SAD were less socially competent, had fewer friends and difficulty making new friends compared to controls. Findings suggest that peer difficulties are not a universal feature of all childhood AD and highlight a need to better understand the social experiences and functioning of children with GAD.
PMCID: PMC3213291  PMID: 21739298
generalized anxiety disorder; peer relations; social competence; social anxiety disorder
25.  Emotional and Behavioral Functioning of Offspring of African American Mothers with Depression 
Extensive research demonstrates the negative impact of maternal depression on their offspring. Unfortunately, few studies have been explored in African American families. This study examined emotional and behavioral functioning among children of African American mothers with depression. African American mothers (n = 63), with a past year diagnosis of a depressive disorder, and one of their children (ages 7–14) completed behavioral rating scales in a cross-sectional design. Results showed that 6.5% and 15% scored within the clinical range for depression and anxiety symptoms, respectively. Approximately a third of the offspring reported suicidal ideation. Based on mothers’ report, 25.4% and 20.6% of the offspring exhibited internalizing and externalizing symptoms in the clinical range, respectively. Offspring whose mothers were in treatment exhibited higher levels of self-reported anxiety symptoms Offspring of African American mothers with depression were exhibiting socioemotional problems in ways that are similar to offspring of European American mothers with depression.
PMCID: PMC3177021  PMID: 21671005
Depression; Anxiety; Mothers; Offspring; African American

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