Psychological interventions have demonstrated effectiveness in treating perinatal depression (PND), but understanding for whom, how and under what conditions they improve symptoms in low- and middle-income countries (LMICs) is largely unknown. This review aims to synthesise current knowledge about predictors, moderators and mediators of psychological therapies to treat PND in LMICs. Five databases were searched for studies quantitatively examining the effects of at least one mediator, moderator or predictor of therapies for PND in LMICs. The review sampled seven publications evaluating findings from randomised trials conducted in Asia and sub-Saharan Africa. The small number of included studies limited generalisability of findings. Analyses of trials with acceptable quality suggest that patient activation in Pakistan and social support in both India and Pakistan may mediate psychotherapy effectiveness, higher baseline depression severity may moderate treatment response in South Africa, and shorter depression duration at baseline may moderate intervention response in India. This review highlights current gaps in evidence quality and the need for future trials exploring PND psychotherapy effectiveness in LMICs to follow reporting guidelines to facilitate appropriate predictor, moderator and mediator analyses.

Maternal experiences of childhood adversity can increase the risk of emotional and behavioural problems in their children. This systematic review and meta-analysis provide the first narrative and quantitative synthesis of the mediators and moderators involved in the link between maternal childhood adversity and children's emotional and behavioural development. We searched EMBASE, PsycINFO, Medline, Cochrane Library, grey literature and reference lists. Studies published up to February 2021 were included if they explored mediators or moderators between maternal childhood adversity and their children's emotional and behavioural development. Data were synthesised narratively and quantitatively by meta-analytic approaches. The search yielded 781 articles, with 74 full-text articles reviewed, and 41 studies meeting inclusion criteria. Maternal mental health was a significant individual-level mediator, while child traumatic experiences and insecure maternal–child attachment were consistent family-level mediators. However, the evidence for community-level mediators was limited. A meta-analysis of nine single-mediating analyses from five studies indicated three mediating pathways: maternal depression, negative parenting practices and maternal insecure attachment, with pooled indirect standardised effects of 0.10 [95% CI (0.03–0.17)), 0.01 (95% CI (−0.02 to 0.04)] and 0.07 [95% CI (0.01–0.12)], respectively. Research studies on moderators were few and identified some individual-level factors, such as child sex (e.g. the mediating role of parenting practices being only significant in girls), biological factors (e.g. maternal cortisol level) and genetic factors (e.g. child's serotonin-transporter genotype). In conclusion, maternal depression and maternal insecure attachment are two established mediating pathways that can explain the link between maternal childhood adversity and their children's emotional and behavioural development and offer opportunities for intervention.

Objectives: Although individuals with traumatic brain injury (TBI) often report higher levels of social isolation, little is known about the factors influencing their self-perception of loneliness. The aim of the current study was to investigate the relationship between loneliness, social network size, and personality variables (neuroticism and extraversion) after TBI, and in particular whether specific personality variables mediate the relationship between social network size and perception of loneliness. Methods: Here, we assessed self-reported loneliness, personality variables, and social network size of 24 individuals with moderate-to-severe TBI and 41 healthy comparison participants. We then carried out a mediation analysis to examine whether personality variables mediated the relationship between loneliness and social network size. Results: Our results indicate that individuals with TBI reported higher levels of loneliness and neuroticism, but there was no group difference in social network size or extraversion. The mediation analysis revealed that the association between social network size and loneliness was mediated by neuroticism, but not by extraversion. Conclusions: Our findings show that neuroticism is an intervening variable in the relationship between social network size and self-perception of loneliness in individuals with moderate-to-severe TBI, and presents a new possible target for clinicians and rehabilitators seeking to address reports of loneliness and social isolation in TBI. (JINS 2019, 25, 266–274)

This paper considers Dietrich Bonhoeffer's understanding of the theological dimension of the concept of Christian community and in particular his conviction that believers must avoid the confusion that follows when ‘community romanticism’ (Gemeinschaftsromantik) is equated with the community of saints (Gemeinschaft der Heiligen). Bonhoeffer insisted that the task of building Christian community was one of crafting a space in which Jesus stands between believers, protecting them from the ‘damage of sheerly human immediacy’.1 Without Jesus' mediating presence he believed, everything could go badly wrong.

Hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) is becoming increasingly established in Asian hospitals. The primary aim of this study was to decompose the risk factors for HA-MRSA based on conceptual clinical pathways. The secondary aim was to show the amount of effect attributable to antibiotic exposure and total length of stay before outcome (LBO) so that institutions can manage at-risk patients accordingly. A case-control study consisting of 1200 inpatients was conducted in a large tertiary hospital in Singapore between January and December 2006. Results from the generalized structural equation model (GSEM) show that LBO [adjusted odds ratio (aOR) 14·9, 95% confidence interval (CI) 8·7–25·5], prior hospitalization (aOR 6·2, 95% CI 3·3–11·5), and cumulative antibiotic exposure (aOR 3·5, 95% CI 2·3–5·3), directly affected HA-MRSA acquisition. LBO accounted for the majority of the effects due to age (100%), immunosuppression (67%), and surgery (96%), and to a lesser extent for male gender (22%). Our model enabled us to account and quantify effects of intermediaries. LBO was found to be an important mediator of age, immunosuppression and surgery on MRSA infection. Traditional regression approaches will not only give different conclusions but also underestimate the effects. Hospitals should minimize the hospital stay when possible to reduce the risk of MRSA.

Contemporary theology exhibits a lively interest in using the traditional doctrine of the munus triplex (the threefold mediatorial office of Christ as prophet, priest and king) to unify our understanding of the person and work of Jesus Christ and ground it in the Old Testament witness. This article explores Karl Barth's contribution to this trend and draws from it a set of reflections for the church today. Scholarly consensus suggests that Barth offers an exceptionally robust development of the munus triplex in shaping the formal structure and material content of his doctrine of reconciliation. In this article I contend that his use of this concept is actually quite superficial in nature. As scholars are wont to point out, Barth incorporates the munus triplex into eye-catching summary statements throughout CD IV – but these statements are more ambiguous than they might at first seem. A closer examination of the details of his account of the work of Christ, and particularly his hamartiology, demonstrates that the munus triplex does not substantially inform his treatment of these subjects, and that his own unique christological concerns provide the determining influence. While Barth was eager to align his position with that of Reformed orthodoxy, focusing on the munus triplex ultimately distracts the reader from his primary concerns. Much the same is true for the church today – when used as a sufficient interpretative device for offering an account of the person and work of Jesus Christ, the munus triplex suffers the fate of many an artificial schema for biblical interpretation, distracting us from the breadth and depth of the biblical witness by offering an overly tidy, artificially organised account of the material. Nevertheless, when modestly employed, it remains a significant though limited conceptual device for understanding Christ's person and work, which the church should employ in several ways so as to integrate the Old and New Testaments in its proclamation of the Gospel.