Explaining differences in birthweight between ethnic populations. The Generation R Study

OBJECTIVE

To examine whether differences in birthweight of various ethnic groups residing in The Netherlands can be explained by determinants of birthweight.

DESIGN

Population-based birth cohort study.

SETTING

Data of pregnant women and their partners in Rotterdam, The Netherlands.

POPULATION

We examined data of 6044 pregnant women with a Dutch, Moroccan, Turkish, Capeverdean, Antillean, Surinamese-Creole, Surinamese-Hindustani and Surinamese-other ethnic background.

METHODS

Regression analyses were used to assess the impact of biomedical, socio-demographic and lifestyle-related determinants on birthweight differences.

MAIN OUTCOME MEASURE

Birthweight was established immediately after delivery in grams.

RESULTS

Compared with mean birthweight of offspring of Dutch women (3485 g, SD 555), the mean birthweight was lower in all non-Dutch populations, except in Moroccans. Differences ranged from an 88-g lower birthweight in offspring of the Turkish women to a 424-g lower birthweight in offspring of Surinamese-Hindustani women. Differences in gestational age, maternal and paternal height largely explained the lower birthweight in the Turkish, Antillean, Surinamese-Creole and Surinamese-other populations. Differences in birthweight between the Dutch and the Capeverdean and Surinamese-Hindustani populations could only partly be explained by the studied determinants.

CONCLUSIONS

These results confirm significant differences in birthweight between ethnic populations that can only partly be understood from established determinants of birthweight. The part that is understood points to the importance of determinants that cannot easily be modified, such as parental height. Further study is necessary to obtain a fuller understanding.

Higher cortisol awakening response in young adolescents with persistent anxiety problems

OBJECTIVE

The aims of the present study were to test the association between current anxiety problems and basal cortisol levels in a large population sample of young preadolescents, and to test if HPA-axis activity differs between individuals with no, only current, or persistent anxiety problems.

METHOD

Cortisol levels of 10- to 12-year olds (n = 1,768) from the general population were measured on three time points during the day. A self-report questionnaire (RCADS) was used to assess current anxiety, a parent-report questionnaire (TPBQ) to assess anxiety problems at age 4.

RESULTS

Associations between cortisol levels and current anxiety problems were not found. However, individuals with persistent anxiety problems had higher morning cortisol levels and a higher cortisol awakening response.

CONCLUSION

Apparently, only persistent, and not current, anxiety problems are associated with higher HPA-axis activity. Alterations in HPA-axis activity might underlie persistent anxiety problems, or result from the stress accompanied by persistent anxiety problems.

Genetic and environmental influences on self-reported and parent-reported behavior problems in young adult adoptees

The aim of the present study was to estimate the genetic, shared and nonshared environmental contributions to self-reported and parent-reported internalizing and externalizing problems in a follow-up study of intercountry adopted young adults. Young Adult Self-Report ratings were obtained from 1475 adoptees aged 22-32 years and Young Adult Behavior Checklist ratings from 1115 adoptive parents. For the genetic analyses, a subset of 143 adopted biologically related and 295 unrelated siblings was used. The data were subjected to model fitting decomposing three sources of variance: genetic factors (A) shared environment (C) and nonshared environment (E). Genetic factors were of more importance in both self-reported (A(2)= 54%, C(2)= 0, and E(2)= 46%) and parent-reported (A(2)= 76%, C(2)= 15% and E(2)= 9%) internalizing problems. Environmental factors were of more importance in both self-reported (A(2)= 33%, C(2)= 17% and E(2)= 50%) and parent-reported (A(2)= 28%, C(2)= 27% and E(2)= 45%) externalizing problems. This was in contrast with findings from the first and second assessments in the same sample during adolescence when genetic factors were more important in explaining externalizing problems compared with internalizing problems. Our results suggest a developmental reversal in genetic and environmental influences on behavior problems from early adolescence into adulthood, which could be related to different underlying developmental trajectories.

Perceived parental rearing of bipolar offspring

OBJECTIVE

To explore the impact of growing up with a parent with a bipolar disorder. First, we compared parental rearing behavior perceived by young adult offspring of bipolar parents with parental rearing behavior perceived by same aged young adults from the general population. Secondly, we examined the associations between perceived parental rearing behavior and parental psychopathology and psychopathology in offspring.

METHOD

Subjects were 129 offspring of 80 bipolar parents and their spouses and 1122 young adults from the general population. In offspring the Structured Clinical Interview for DSM-IV was used to assess DSM-IV diagnoses and the EMBU was used to assess perceived parental rearing in both groups.

RESULTS

In general, offspring growing up in a family with a bipolar parent perceived their mothers as less rejecting, more emotionally warm and less overprotecting and their fathers as less emotionally warm and less overprotecting compared with young adults from the general population. Perceived rejection was related to psychopathology in offspring.

CONCLUSION

Overall, parental rearing in families with a parent with a bipolar disorder is not more dysfunctional, as perceived by their offspring, than in families from the general population. Offspring with a bipolar disorder perceive their parents as more rejecting.

Parent-teacher disagreement regarding psychopathology in children: a risk factor for adverse outcome?

OBJECTIVE

To investigate if parent-teacher discrepancies in reports of behavioral/emotional problems in children predict poor outcome.

METHOD

A total of 1154 4- to 12-year-old children from the general population were followed up. At the first assessment, parent and teacher ratings were obtained with the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF). Fourteen years later, DSM-IV diagnoses were assessed, and ratings of self-reported and parent-rated behavioral and emotional problems were obtained.

RESULTS

CBCL and TRF scores predicted most of the outcomes, but in general, discrepancies between CBCL and TRF scores did not. There were some exceptions. For instance, higher parental vs. teacher ratings of aggressive behaviors increased the risk of suicide attempts/self-mutilation.

CONCLUSION

Risk factors for self-mutilating behaviors may be supplemented with parent-reported aggressive behaviors that are not observed by the teachers. In general, whereas CBCL and TRF scale scores were useful predictors of outcome, parent-teacher discrepancies were not.

[Child and adolescent psychiatry: a profession and its identity II]

BACKGROUND

Up till the 1970s child and adolescent psychiatry had no distinctive diagnostic system of its own. From the 1980s onwards qualitative information-gathering (e.g. via discussion or play-situations) was no longer regarded as adequate and the standardised gathering of (quantitative) information became the cornerstone of the diagnostic process. This development fundamentally changed the child psychiatrist's profession and its identity.

AIM

To investigate the specific features that are required in current child and adolescent psychiatry.

METHOD

In this article we will clarify the change in the child psychiatrist's profession and identity by outlining how child an adolescent psychiatry evolved as from the early 1980s. We will do this by concentrating on the diagnostic process. The treatment aspect will be discussed only briefly.

RESULTS

Over the last 25 years the role of the child psychiatrist has undoubtedly changed. From being mainly a diagnostician and/or being personally responsible for treating the child or adolescent the child psychiatrist has become increasingly the person who controls the diagnostic process and plans treatment.

CONCLUSION

Over the last two decades the diagnostic technique of the child psychiatrist has developed in a new direction. The child psychiatrist has chosen instead to elucidate a patient's referral and to discuss the reasons for a request for assistance and/or care. The psychiatrist uses many types of information and a multitude of informants and methods. This development has led to a fundamental change in the child psychiatrist's profession and its identity.

Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years

BACKGROUND

Children born very preterm (VP; <32 weeks' gestation) or with very low birth weight (VLBW, <1500 g; hereafter called VP/VLBW) are at risk for behavioural and emotional problems during school age and adolescence. At school entrance these problems may hamper academic functioning, but evidence on their occurrence at this age in VP/VLBW children is lacking.

AIM

To provide information on academic functioning of VP/VLBW children and to examine the association of behavioural and emotional problems with other developmental problems assessed by paediatricians.

DESIGN, SETTING AND PARTICIPANTS

A cohort of 431 VP/VLBW children aged 5 years (response rate 76.1%) was compared with two large national samples of children of the same age (n = 6007, response rate 86.9%).

OUTCOME MEASURES

Behavioural and emotional problems measured by the Child Behavior Checklist (CBCL), and paediatrician assessment of other developmental domains among VP/VLBW children.

RESULTS

The prevalence rate of a CBCL total problems score in the clinical range was higher among VP/VLBW children than among children of the same age from the general population (13.2% v 8.7%, odds ratio 1.60 (95% confidence interval 1.18 to 2.17)). Mean differences were largest for social and attention problems. Moreover, they were larger in children with paediatrician-diagnosed developmental problems at 5 years, and somewhat larger in children with severe perinatal problems.

CONCLUSION

At school entrance, VP/VLBW children are more likely to have behavioural and emotional problems that are detrimental for academic functioning. Targeted and timely help is needed to support them and their parents in overcoming these problems and in enabling them to be socially successful.

Health-related Quality of Life in Children and Adolescents after Invasive Treatment for Congenital Heart Disease

Since the 1980s treatment techniques for congenital heart disease (ConHD) have gradually evolved. Therefore, actual information on the outcomes, including quality of life is required. Health-related quality of life was assessed long-term in four diagnostic groups of children, who underwent invasive treatment for ConHD between 1990 and 1995. The scores on the TNO-AZL Child Quality of Life Questionnaire (TACQOL) of both children with ConHD and their parents were compared with those of a same-aged reference group. The total sample of ConHD children (n = 113, 8-15 years old) obtained significantly lower mean scores on motor functioning, cognitive functioning, and positive emotional functioning than reference peers, reflecting an experience of poorer functioning. ConHD children, aged 8-11 years, obtained lower mean scores on 5 of the 7 TACQOL scales than reference peers. They also had a lower score on positive emotional functioning than 12- to 15-year-old ConHD children. The total sample of ConHD children obtained lower outcomes compared to their parents on 4 of the 7 TACQOL scales. No significant differences were found in health-related quality of life between ConHD boys and girls, neither between different diagnostic groups. Overall, this sample of recently treated ConHD children showed a worse health-related quality of life compared to reference groups. These findings deserve further attention.

Prediction of change in level of problem behavior among children of bipolar parents

OBJECTIVE

To determine the effects of familial loading, birth weight, and family problems on change in parent-reported problems across a 14-month period among children of bipolar parents.

METHOD

Emotional and behavioral problems in a sample of 140 offspring of bipolar parents and familial loading in first- and second-degree relatives were assessed at two measurements. Parents reported the birth weight of their offspring and completed a questionnaire on family problems. Multiple linear regression analyses were performed to assess associations of the three predictors with change in problem scores at follow-up.

RESULTS

Familial loading of unipolar disorder was a unique predictor for an increase in problem scores from the first to the second measurement with beta-coefficients ranging from 0.17 to 0.25. Birth weight and family problems were not associated with change in problem scores across the two measurements.

CONCLUSION

Familial loading of unipolar disorder predicted an increase in behavioral and emotional problems across the 14-month follow-up.

Internalizing and externalizing problems in adolescence: general and dimension-specific effects of familial loadings and preadolescent temperament traits

BACKGROUND

We investigated the links between familial loading, preadolescent temperament, and internalizing and externalizing problems in adolescence, hereby distinguishing effects on maladjustment in general versus dimension-specific effects on either internalizing or externalizing problems.

METHOD

In a population-based sample of 2230 preadolescents (10-11 years) familial loading (parental lifetime psychopathology) and offspring temperament were assessed at baseline by parent report, and offspring psychopathology at 2.5-years follow-up by self-report, teacher report and parent report. We used purified measures of temperament and psychopathology and partialled out shared variance between internalizing and externalizing problems.

RESULTS

Familial loading of internalizing psychopathology predicted offspring internalizing but not externalizing problems, whereas familial loading of externalizing psychopathology predicted offspring externalizing but not internalizing problems. Both familial loadings were associated with Frustration, low Effortful Control, and Fear. Frustration acted as a general risk factor predicting severity of maladjustment; low Effortful Control and Fear acted as dimension-specific risk factors that predicted a particular type of psychopathology; whereas Shyness, High-Intensity Pleasure, and Affiliation acted as direction markers that steered the conditional probability of internalizing versus externalizing problems, in the event of maladjustment. Temperament traits mediated one-third of the association between familial loading and psychopathology. Findings were robust across different composite measures of psychopathology, and applied to girls as well as boys.

CONCLUSIONS

With regard to familial loading and temperament, it is important to distinguish general risk factors (Frustration) from dimension-specific risk factors (familial loadings, Effortful Control, Fear), and direction markers that act as pathoplastic factors (Shyness, High-Intensity Pleasure, Affiliation) from both types of risk factors. About one-third of familial loading effects on psychopathology in early adolescence are mediated by temperament.

Ethnic differences in prenatal growth and the association with maternal and fetal characteristics

OBJECTIVES

The objectives of this study were to determine ethnic differences in prenatal growth and to examine their association with differences in maternal and fetal characteristics such as maternal height, weight, age, parity and fetal gender.

METHODS

A total of 1494 women from Rotterdam, The Netherlands, with a low-risk pregnancy who participated in a population-based cohort study, the Generation R Study, were offered three ultrasound examinations during pregnancy. Multilevel modeling was applied to determine ethnic differences in (estimated) fetal weight (including birth weight) and in the separate biometric variables that were used to calculate the estimated fetal weight (abdominal circumference, head circumference and femur length). Additionally the association of ethnic differences with maternal and fetal characteristics (i.e. maternal weight, height, age, parity and fetal gender) was studied.

RESULTS

Turkish, Cape Verdian, Surinamese-Creole and Surinamese-Hindustani women had on average smaller fetuses than the native Dutch women. The differences became more pronounced towards term. In the Turkish group the differences were no longer statistically significant when adjusted for maternal weight, height, age, parity and fetal gender. In the Cape Verdian, Surinamese-Creole and Surinamese-Hindustani groups the differences decreased after adjustment (31%, 16% and 39%, respectively).

CONCLUSIONS

This study shows that there are ethnic differences in fetal growth, which to a large extent may be attributed to differences in maternal weight, height, age and parity. For some ethnic groups, however, additional factors are involved, as differences remain significant after correction for fetal and maternal characteristics.

[Better health care for children and adolescents with attention deficit hyperactivity disorder]

Recently Donker et al. reported a massive rise in the prescription of methylphenidate by general practitioners in the northeast of The Netherlands. On comparing their results with national and international guidelines on the management of attention deficit hyperactivity disorder (ADHD) it would appear that medication is not always being prescribed to the correct group of children i.e. those with the core problems of ADHD. Girls are under-diagnosed, while boys frequently receive medication for oppositional or conduct problems, which are usually better treated by parent management training. Many children are never given the full multidisciplinary assessment recommended by the guidelines and it is unclear whether other evidence-based treatments such as school liaison or parent management training were offered. Overall it seems children with ADHD do not always receive the treatment they require. Improvement might be achieved if the European and Dutch recommendations are followed.

Determinants of salivary cortisol levels in 10-12 year old children; a population-based study of individual differences

The hypothalamic-pituitary-adrenal (HPA)-axis is a central component of the body's neuroendocrine response to stress. Its major end-product cortisol has profound effects on mood and behavior. Although it has often been suggested, it remains unknown whether differences in HPA-axis physiology are part of an individual's vulnerability to psychopathology, and constitute a causal factor in its development. In order to study the contribution of HPA-axis physiology to the development of psychopathology, we measured HPA-axis physiology in a community-cohort of 1768 10-12 year-old children. The aims of the here presented study were twofold: (1) to obtain data on HPA-axis function in a large cohort of pre- and early-adolescent children, both in terms of total hormonal output and in terms of the dynamics of cortisol secretion (by means of the cortisol awakening response); and (2) to study potential confounders of the cortisol-psychopathology relationship in this age group, such as season of sampling, age, gender, pubertal development, perinatal variables and BMI. We found a wide interindividual variability in HPA-axis function. An increase in cortisol in the first 30 min after awakening was present in 70.7% of children, but the increase appears lower in children than in adults. In addition, this study suggests that season of sampling and gender may act as potential confounders in the cortisol-psychopathology relationship. We will follow these children longitudinally for the development of psychopathology in the period from childhood into adulthood. This period covers adolescence, which is a critical time for the appearance and development of psychiatric disorders.

Psychosocial problems among immigrant and non-immigrant children--ethnicity plays a role in their occurrence and identification

BACKGROUND

This study aims to examine a) the prevalence of psychosocial problems and b) the association between parent-reported problems and the identification by doctors and nurses (child health professionals, CHP) working in preventive child health care, among immigrant and non-immigrant children.

METHODS

CHPs examined 4,098 children aged 5 through 15 years (response: 90.1%) and interviewed parents and children during their routine health assessments in 19 Child Healthcare Services across the Netherlands, serving nearly all school-aged children routinely. The Child Behavior Checklist (CBCL) was completed by the parents. We compared five ethnic groups: indigenous Dutch, economic immigrants, immigrants from (former) Dutch colonies, from other non-industrialised, and from other industrialised countries.

RESULTS

The prevalence of parent-reported problems on the CBCL is higher among children from former Dutch colonies and economic immigrant children than among indigenous children, especially regarding internalizing problems (odds ratios (OR); 95% confidence interval: 1.84; 1.03 to 3.29, and 2.52; 1.46 to 4.34). CHPs identified more problems among economic immigrant children (OR: 1.62; 1.01 to 2.60). Regarding associations, rates of CHP-identified problems were higher among indigenous children with clinical compared with normal CBCL Total Problems scores (OR: 6.90; 5.27 to 9.03), but not among economic immigrant children (OR: 0.73; 0.16 to 3.21).

CONCLUSIONS

Psychosocial problems occur more frequently among some immigrant groups. CHP identification of psychosocial problems is poorly associated with parent report regarding economic immigrant children. This needs to be improved in order to provide better care.

Medical predictors for psychopathology in adults with operated congenital heart disease

AIMS

To test the predictive value of medical variables, covering the complete medical course from birth until the present, for long-term behavioural and emotional problems in adulthood, in patients operated for congenital heart disease in childhood.

METHODS AND RESULTS

This study concerns the second psychological and medical follow-up of a cohort of patients operated for congenital heart disease (n=362; age 20-46 years). Behavioural and emotional problems were assessed with the Young Adult Self-Report and the Young Adult Behavior Checklist. Medical prediction variables were derived from medical examination and file search. Being female, having low exercise capacity and restrictions imposed by physicians are significant predictors for behavioural and emotional problems as reported by patients themselves. Regarding the scar, personal experiences of patients form a better predictor for later problems than judgement of aesthetical aspects by physicians. Early hospitalisations with reoperations are predictive for behavioural and emotional problems as reported by other informants. The cardiac diagnoses of ventricular septal defect and transposition of the great arteries are associated with higher levels of behavioural and emotional problems.

CONCLUSION

Recent experiences concerning the scar, physical condition and imposed restrictions are the strongest predictors for behavioural and emotional problems as reported by patients themselves.

The Genetic Basis of Problem Behavior in 5-Year-Old Dutch Twin Pairs

Different instruments can be used in the assessment of psychopathology in young children. In the present study the psychometric properties of a subset of items of the Devereux Child Behavior (DCB) rating scale were evaluated and the contribution of genetic and environmental influences to the variance of derived problem behavior scales was estimated. Maternal and paternal ratings were obtained in about 7600 5-year-old Dutch twin pairs. Six problem scales were derived from exploratory and confirmatory factor analysis and designated as emotional lability, aggressive behavior, attention problems, anxiety problems, physical coordination problems, and dependency. Univariate genetic analyses of the problem scales yielded large additive genetic effects. Heritability estimates ranged from 40% for aggressive behavior to 81% for attention problems. Shared environmental influences were found for aggressive behavior, anxiety problems, dependency, and emotional lability. Rater contrast and/or sibling interaction effects were found for attention problems and physical coordination.

Measuring quality of life in children referred for psychiatric problems: Psychometric properties of the PedsQLTM4.0 generic core scales

OBJECTIVE

The aim of this study was to assess the psychometric properties of the Dutch translation of the Pediatric Quality of Life Inventory (PedsQL 4.0) generic core scales and assess its usefulness in measuring quality of life (QoL) in a child psychiatric population.

METHODS

Reliability and validity of the PedsQL were assessed in 310 referred children (ages 6-18 years) and a comparison group consisting of 74 non-referred children (ages 7-18 years), and the parents in both groups.

RESULTS

Confirmatory factor analysis resulted in a four-factor solution. Internal consistency reliability for the PedsQL Total Scale Score (alpha = 0.84 child self-report, alpha = 0.87 parent proxy-report), Psychosocial Health Score (alpha = 0.70 child self-report, alpha = 0.81 parent proxy-report), and most subscale scores were acceptable for group comparisons. Correlations between scores of fathers and mothers were large. Criterion-related validity was demonstrated by significantly lower PedsQL scores for referred vs. non-referred children. Significant correlations between PedsQL scales and measures of psychopathology showed convergent validity. Small correlations between PedsQL scales and intelligence of the child evidenced discriminant validity.

CONCLUSION

The PedsQL seems a valid instrument in measuring QoL in children referred for psychiatric problems.

Determinants of self-reported emotional and behavioral problems in Turkish immigrant adolescents aged 11-18

OBJECTIVE

The aim of this study was to determine how adolescent, parent, family and stress factors and parental psychopathology are associated with self-reported emotional and behavioral problems in Turkish immigrant adolescents.

METHODS

Multiple logistic models were fitted to determine the associations between problems, assessed by the Youth Self-Report (n = 363), and determinants, derived from the Turkish Immigrant Assessment Questionnaire and the General Health Questionnaire-28 filled in by parents.

RESULTS

Repeating a grade,not living with both parents, remarriage and death or serious health problems in the family were associated with higher YSR scores. Support from the mother's family was of major importance. The strongest predictive power was found for family-related factors in boys and for parent-related factors in girls.

CONCLUSIONS

Cultural aspects and post-immigration issues play an important underlying role in explaining problem behavior in Turkish immigrant adolescents. Future research should include additional immigrant-specific factors, e. g., acculturation-related issues, preferably in a longitudinal study design to gain more insight into the complex relationship between immigrant status and psychopathology.

Using shared and unique parental views to study the etiology of 7-year-old twins' internalizing and externalizing problems

In a sample of 1,940 Dutch 7-year-old twin pairs we studied the etiology of individual differences in Internalizing and Externalizing behavioral problems. For the majority of twins in the sample, both maternal and paternal ratings of behavioral problems were obtained from the Child Behavior Checklist. This made it possible to take into account processes underlying agreement and disagreement between maternal and paternal ratings. For both problem behaviors, a Psychometric model fitted the data better than a Rater Bias model, implying that parents, in addition to the behaviors they similarly observed, also assessed unique aspects of their children's behaviors. Relatively large genetic influences were found for Externalizing problems, explaining over 50% of the variance in both boys and girls. For internalizing problems, the heritability was over 30% in both sexes. Shared environmental factors were nearly as important as genetic influences in explaining the variation in behavioral problems. For both Externalizing and Internalizing problems, around 30% of the variance was accounted for by the shared environmental factors.

Detecting psychosocial problems among 5-6-year-old children in Preventive Child Health Care: The validity of a short questionnaire used in an assessment procedure for detecting psychosocial problems among children

BACKGROUND

An extended re-assessment of the psychometric properties of the LSPPK, an instrument aimed at identifying children with emotional and behavioural problems.

METHODS

Data came from a national sample in The Netherlands of parents of 1248 children (aged 5-6 years) interviewed by child health professionals (CHP). Data were obtained regarding psychosocial problems, treatment status and scores on the LSPPK (Parent and CHP Index), and on the Child Behavior Checklist (CBCL). The scale structure, reliability, criterion and content validity and added value of the LSPPK were assessed using the CBCL and treatment status as criteria.

RESULTS

The scale structure corresponded with that found originally; the LSPPK improved the prediction of problems according to the CBCL, compared to predictions using readily available risk indicators alone. Reliability varied between 0.55 and 0.69. For the LSPPK Parent Index, sensitivity varied between 0.42 and 0.50. For the CHP Index sensitivity varied between 0.60 and 0.96, but specificity varied between 0.76 and 0.79. Both indices were very sensitive for attention and social problems, but less so for other problems.

CONCLUSION

The LSPPK Parent Index cannot distinguish sufficiently between children with or without serious problems. Either too many children with problems remain unnoticed or too many children without problems are labelled as a case. The LSPPK CHP Index, reflecting the CHP's interpretation of the Parent Index after interviewing the parents does not compensate adequately for the weaknesses of the Parent Index. Better assessment procedures and strategies need to be developed.

Neighbourhood socioeconomic disadvantage and behavioural problems from late childhood into early adolescence

STUDY OBJECTIVE

This study investigates whether neighbourhood socioeconomic disadvantage may contribute to child behavioural and emotional problems, beyond the effects of parental socioeconomic status. It also examines the influence of neighbourhood disadvantage on changes in the frequency of behavioural problems from late childhood into early adolescence.

DESIGN AND SETTING

The study was conducted in a large community sample in Rotterdam, the Netherlands. An index of neighbourhood socioeconomic disadvantage was calculated for each of the city's 74 neighbourhoods. Multilevel regression analysis estimated effects of neighbourhood disadvantage and individual variables (parental socioeconomic status, child's gender, and age) on behavioural problems reported by children (Youth Self-Report) and parents (Child Behavior Checklist) and on changes in these scores over a two year follow up.

PARTICIPANTS

A cohort of all children born in 1978 and living in Rotterdam. Of those eligible, 73% (n=2587) participated in the first measurement (T1), at 10-12 years; 71% of the T1 respondents participated again two years later (T2), at 12-14 years.

MAIN RESULTS

Neighbourhood disadvantage was associated with higher Total, Internalising, and Externalising Problems, as assessed with both the Child Behavior Checklist and the Youth Self-Report, even after controlling for parental socioeconomic status. Neighbourhood disadvantage also seemed to contribute to increases in Total Problems over the follow up.

CONCLUSIONS

Living in a disadvantaged neighbourhood is associated with greater behavioural problems and may lead to an exacerbation of problems as children move from childhood into adolescence. Public health interventions to improve child mental health must take the neighbourhood environment into account.

Early detection of psychosocial problems in adolescents: how useful is the Dutch short indicative questionnaire (KIVPA)?

BACKGROUND

Psychosocial problems, such as behavioural, emotional, and educational problems, are highly prevalent among children and adolescents. Early treatment may reduce these problems, if accurately identified. Validated questionnaires may support identification. The aim of this study is to assess the psychometric qualities of such a questionnaire, the Short Indicative Questionnaire for Psychosocial problems among Adolescents (KIVPA,) and to determine whether it is suitable for and adds to the early detection of psychosocial problems among adolescents.

METHODS

Data came from a national sample of 1,440 Dutch adolescents, using the KIVPA, the Child Behavior Checklist (CBCL), and the Youth Self-Report (YSR). Of these, 1,248 provided data on all questionnaires (77.8%). The scale structure of the KIVPA was assessed; its sensitivity and specificity using CBCL, YSR and referral for psychosocial problems as criteria; and its contribution to detecting CBCL and YSR problems.

RESULTS

The KIVPA is mostly uni-dimensional but the variance explained by its main factor is relatively low. The total KIVPA score discriminates between adolescents with and without problems on the three criteria. Using a clinical YSR total problem score as criterion, sensitivity and specificity are 0.82 and 0.85, respectively, at the proposed cut-off (area under the ROC curve: 0.92; 95% confidence interval (CI) 0.90-0.95). The odds ratio of a clinical YSR score for an elevated KIVPA score is 29.1 (95% CI: 14.4-59.1), although the KIVPA mainly covers internalizing problems.

CONCLUSION

The KIVPA has added value in the early detection of internalizing psychosocial problems, but is not sufficiently efficient.

[Violent behavior in men due to genetic predisposition and childhood abuse: an hypothesis]

Caspi et al. recently reported that the likelihood of an abused child becoming violent as an adult hinges on a gene regulating the expression of monoamine oxidase A. This enzyme metabolises neurotransmitters. The scientists followed 442 boys from birth to their mid twenties and found an interaction between childhood abuse and a genetic polymorphism. Major strengths of the study are the longitudinal design and the excellent follow-up rate. Moreover, childhood abuse and antisocial behaviour are operationalised in various manners. The different forms of childhood abuse and neglect are, however, summarised and individual results are only presented for the different outcomes. In this way the consistency of the results is shown, but significance is only reached for one outcome: 'antisocial personality disorder symptoms'. It is especially important to replicate the study that investigated an association but no causal mechanism. Thus, conclusions about susceptibility to childhood abuse or medical treatment options for neglected children are premature.

Psychosocial functioning of the adult with congenital heart disease: a 20-33 years follow-up

AIMS

Since knowledge about the psychosocial function of adult patients with congenital heart disease is limited, we compared biographical characteristics, and emotional and social functioning of these patients with that of the reference groups.

METHODS AND RESULTS

Patients with congenital heart disease (N=362, aged 20-46 years), belonging to five diagnostic groups, were subjected to extensive medical and psychological examination, 20-33 years after their first open heart surgery. All the patients were seen by the same psychologist, who examined their psychosocial functioning using a structured interview and questionnaires. The majority (78%)was living independently and showed favourable outcome regarding the marital status. Among married/cohabitant patients, 25-39-year-olds showed normal offspring rates. None of the 20-24-year-old patients had any children. The offspring rate dropped after the age of 40. The proportion of adult patients with a history of special education was high (27%). Accordingly, patients showed lower educational and occupational levels compared to reference groups. As regard to the emotional and social functioning (leisure-time activities), the sample showed favourable results.

CONCLUSIONS

Overall, this sample of patients with congenital heart disease seemed capable of leading normal lives and seemed motivated to make good use of their abilities.

Family factors and life events as risk factors for behavioural and emotional problems in children

The aim of this study was to identify groups of children at increased risk of behavioural or emotional problems on the basis of socio-demographic characteristics, family characteristics, and recent life events with a focus on unemployment and divorce or separation. We obtained data on the Child Behavior Checklist (CBCL) from a community-based national sample of 4480 parents of school-aged children and interviewed them about their demographic and family characteristics and about the child's recent life events. Results showed that family characteristics and recent life events were more strongly associated with children's risks of behavioural and emotional problems as measured by the CBCL than other demographic characteristics. Risks were somewhat higher for children who had experienced parental unemployment and divorce or separation recently, as compared to those who had experienced these events in the more distant past. We conclude that children with recent experience of parental unemployment or parental divorce or separation are at a relatively high risk of behavioural and emotional problems as reported by parents. Although relatively high, the risks that were found do not justify restriction of screening for behavioural and emotional problems to these children.