Predicting service use for mental health problems among young children

OBJECTIVE

To identify sociodemographic, child, parent, and day care provider factors at age 4 that predict Norwegian children's service use for mental health problems at age 7.

METHOD

Two birth cohorts of 4-year-old children and their parents living in the city of Trondheim, Norway, were invited (82% consented). We successfully interviewed 995 parents among 1250 drawn to participate using the Preschool Age Psychiatric Assessment to set diagnoses and record parental burden and service use. Information concerning sociodemographics, child impairment, parental social support, and child need for mental health services according to parents, day care teacher, and health nurse were obtained.

RESULTS

Rate of service use among those with a behavioral or emotional disorder was 10.7% at age 4 and 25.2% at age 7. Behavioral disorders (odds ratio [OR] 2.6, confidence interval [CI] 1.3-5.3), but not emotional disorders, predicted service use. When adjusted for incapacity (OR 1.3, CI 1.2-1.6), disorders were no longer predictive. Incapacity, in turn, was not predictive once parental burden (OR 1.1, CI 1.0-1.1) and parents' (OR 2.7, CI 1.0-7.9) and day care teachers' (OR 2.1, CI 1.4-3.2) judgment of child need of help were included. Lower socioeconomic status predicted more service use over and beyond these factors (OR 3.0, CI 1.5-6.1).

CONCLUSIONS

Behavioral disorders may instigate service use if they result in impairment, and such impairment may operate via increased parental burden and parent and caregiver problem recognition. Service use may be increased through effective screening programs and efforts to increase day care teachers' recognition of emotional problems.

What do parents know about their children's comprehension of emotions? accuracy of parental estimates in a community sample of pre-schoolers

BACKGROUND

Parents' ability to correctly perceive their child's skills has implications for how the child develops. In some studies, parents have shown to overestimate their child's abilities in areas such as IQ, memory and language. Emotion Comprehension (EC) is a skill central to children's emotion regulation, initially learned from their parents. In this cross-sectional study we first tested children's EC and then asked parents to estimate the child's performance. Thus, a measure of accuracy between child performance and parents' estimates was obtained. Subsequently, we obtained information on child and parent factors that might predict parents' accuracy in estimating their child's EC.

METHODS

Child EC and parental accuracy of estimation was tested by studying a community sample of 882 4-year-olds who completed the Test of Emotion Comprehension (TEC). The parents were instructed to guess their children's responses on the TEC. Predictors of parental accuracy of estimation were child actual performance on the TEC, child language comprehension, observed parent-child interaction, the education level of the parent, and child mental health.

RESULTS

Ninety-one per cent of the parents overestimated their children's EC. On average, parents estimated that their 4-year-old children would display the level of EC corresponding to a 7-year-old. Accuracy of parental estimation was predicted by child high performance on the TEC, child advanced language comprehension, and more optimal parent-child interaction.

CONCLUSION

Parents' ability to estimate the level of their child's EC was characterized by a substantial overestimation. The more competent the child, and the more sensitive and structuring the parent was interacting with the child, the more accurate the parent was in the estimation of their child's EC.

Treatment of obesity in children: Parent's perceived emotional barriers as predictor of change in body fat

SUMMARY

AIM

Research supports the use of family-based interventions in the treatment of obesity in children, but there is a lack of knowledge about what factors affect parents' ability to carry out the lifestyle changes necessary to reduce their child's obesity. The aim of the present study was to examine whether parents' self-efficacy, perceived emotional barriers, subjective norms, and attitudes could predict change in their children's body fat at 6 month and 2 year follow-ups after a family-based treatment of obesity.

METHODS

Body Mass Index Standard Deviation Scores (BMI SDS) were calculated and body fat (dual-energy X-ray absorptiometry) were measured in 99 treatment-seeking children with obesity (ages 7-12; 48 girls, 51 boys; mean BMI SDS = 2.99) at baseline, after 6 month and after 2 year follow-up. Parental cognitions regarding diet and physical activity were examined by parent-completed questionnaires. Structural equation modeling (SEM) was used to test whether the selected health cognitions could predict treatment outcome.

RESULTS

Parental perceived emotional barriers was a significant predictor of change in body fat at 6 month (β = -.32, p = .001) and 2 year (β = -.38, p = .002) follow-up when the initial body fat values were controlled. Self-efficacy, subjective norms and attitudes did not improve the amount of variance explained.

CONCLUSION

Parents' perceived emotional barriers significantly predict change in total body fat in children treated for obesity. In order to increase treatment-efficacy, perceived emotional barriers should be addressed.

Preschool predictors of childhood anxiety disorders: a prospective community study

BACKGROUND

Anxiety disorders are often present at preschool age. Research on older children and studies contrasting preschoolers with high versus low behavioral inhibition (BI) highlight several risk factors, but these have not been investigated in community samples of young children. Child, parent, and peer factors at age 4 were therefore examined as potential predictors of anxiety disorders at age 6.

METHODS

Two birth cohorts of 4-year olds living in the city of Trondheim, Norway, were screened for emotional and behavioral problems. A subsample oversampled for emotional and behavioral problems were drawn to take part in the study; 82.1% consented. Parents of 1000 children were interviewed with the Preschool Age Psychiatric Assessment and provided ratings of children's BI, victimization by peers and their own anxiety symptoms. Assessments of attachment and parent-child interaction were based on observation. Preschool teachers rated children's social competence. Children were reassessed after 2 years (N = 797).

RESULTS

High scores on BI, attention-deficient/hyperactivity disorder, parental anxiety, and peer victimization, along with low scores on social skills at age 4 collectively predicted anxiety disorders at age 6 after controlling for initial anxiety and other disorders. The effect of parental anxiety did only apply to children with high levels of BI. No effects of age-4 anxiety, gender, parenting, parental SES, divorce, peer acceptance, or attachment emerged.

CONCLUSIONS

Behavioral inhibition, parental anxiety, and peer victimization function as risk factors whereas high social competence may protect against anxiety disorders in young children.

Detecting psychiatric disorders in preschoolers: screening with the strengths and difficulties questionnaire

OBJECTIVE

To examine screening efficiency for preschool psychopathology by comparing the Strengths and Difficulties Questionnaire findings against diagnostic information, and to determine the added value of impact scores and teacher information.

METHOD

Using a 2-phase sampling design, a population-based sample of 845 children 4 years of age was recruited from community health check-ups in Trondheim, Norway, screen score stratified and oversampled for high screening scores. Blinded to screen ratings, DSM-IV diagnoses were assigned using the Preschool Age Psychiatric Assessment interview, against which the Strengths and Difficulties Questionnaire scores were compared through receiver operating characteristic analysis.

RESULTS

Emotional and behavioral disorders were identified through parent ratings with a specificity of 88.8% (range, 87.0%-90.6%) and a sensitivity of 65.1% (range, 51.6-78.6%). The negative predictive value was 97.9% (range, 96.8%-98.9%), whereas the positive predictive value was 24.2% (range, 18.0%-30.3%) at a prevalence of 5.2%. Parental ratings identified more behavioral disorders (79.3%) than emotional disorders (59.2%). Screening for any disorder was somewhat less efficient: specificity, 88.9% (range, 87.0%-90.7%); sensitivity, 54.2% (range, 41.8%-66.6%); negative predictive value, 96.4% (range, 95.0%-97.8%); and positive predictive value, 25.9% (range, 19.6%-32.2%) at a prevalence of 6.7%. The area under the curve (AUC) value was 0.83 (range, 0.76-0.90) for emotional and behavioral disorders and 0.76 (range, 0.68-0.83) for any disorder. The prediction accuracy was not improved by impact scores or teacher information.

CONCLUSIONS

The results indicate that preschoolers' emotional and behavioral disorders can be screened with the same efficiency as those of older children and adults. Other disorders were identified to a lesser extent. Further research should explore the potential of preschool screening to improve early detection and subsequent intervention.

Smoking during pregnancy and psychiatric disorders in preschoolers

The overall objective of this study was to determine whether smoking during pregnancy is related to psychiatric disorders in 4-year-olds while controlling for a wide range of potential confounding variables (i.e. parental anxiety, depression, personality disorders, drug abuse, and socio-economic characteristics). Parents of a community sample of 4-year-olds (N = 995) residing in the city of Trondheim, Norway were interviewed using the Preschool Age Psychiatric Assessment, which includes information on prenatal smoking. After adjusting for potential confounding variables using the propensity score, smoking during pregnancy was found to increase the odds for attention-deficit/hyperactivity disorder (ADHD) OR = 2.59 (CI 1.5-4.34, p < 0.001), oppositional defiant disorder (ODD) OR = 2.69 (CI 1.84-3.91, p = 0.02) and comorbid OR = 2.55 (CI 1.24-5.23, p < 0.001). Prenatal smoking during pregnancy is associated with an increased risk for symptoms of ADHD and ODD independently of each other, in 4-year-olds.

Competence and emotional/behavioural problems in 7-16-year-old Norwegian school children as reported by parents

BACKGROUND

Previous studies from Nordic countries suggest that parent ratings of children's emotional and behavioural problems using the Child Behavior Checklist (CBCL) are among the lowest in the world. However, there has been no Norwegian population study with acceptable response rates to provide valid Norwegian reference data.

AIMS

Firstly, to compare CBCL Internalizing, Externalizing, Total Problems and Competence scores of Norwegian children and adolescents with those from 1) previous Norwegian studies, 2) other Nordic countries, and 3) international data. Secondly, to present Norwegian reference data in order to perform these comparisons. Thirdly, to investigate the effects of age, gender, socio-economic and urban/rural status on the CBCL.

METHODS

A stratified cluster sample of 2582 school children (1302 girls and 1280 boys) was identified from the general Norwegian population and their parents were asked to complete the CBCL.

RESULTS

The response rate was 65.5%. The mean Total Problems score for the whole sample was 14.2 (standard deviation, s = 14.1). Girls were rated as having greater Competence and fewer Total Problems than boys. Younger children had more Total Problems than adolescents. Parents with low education reported more child Total Problems and lower Competence than those with high education. All effect sizes were small, except for the effect of parental education on child Competence, which was moderate.

CONCLUSIONS

Total Problems scores were lower than in other societies. The data from this study obtained from one county in central Norway provide an important reference for clinical practice and treatment outcome research.

Predictors of growth and decline in leisure time physical activity from adolescence to adulthood

OBJECTIVE

To study the predictors of change in leisure time physical activity (LTPA) from adolescence to young adulthood.

METHOD

A nationally representative sample of 3,251 Norwegian students between 12 and 19 years of age were initially surveyed, and follow-up surveys were conducted three times over a 13-year period. The initial response rate was 97%, and retention rates for the three follow-up sessions were 92%, 84%, and 82%, respectively. Four groups of predictors were assessed: sociodemographics, such as gender, age, parental socioeconomic status, pubertal status, and grades; previous LTPA, such as the amount of LTPA and sports club membership; athletic self-concept and depressive symptoms; and other health behaviors, such as smoking, dieting, and body mass. Autoregressive cross-lagged analyses were supplemented with latent growth-curve analyses.

RESULTS

Membership in a sports club and a positive athletic self-concept in adolescence predicted a high level of LTPA in adulthood, whereas smoking tobacco, high BMI, and depressive symptoms in adolescence predicted low levels of LTPA.

CONCLUSIONS

Engaging adolescents in organized sports and enhancing adolescents' athletic self-concept may increase the number of adults who are physically active. Preventive efforts to reduce tobacco consumption, obesity, and depression in adolescence may also contribute to an increase in adult LTPA.

Prevalence of psychiatric disorders in preschoolers

BACKGROUND

  Many disorders in childhood and adolescence were already present in the preschool years. However, there is little empirical research on the prevalence of psychiatric disorders in young children. A true community study using structured diagnostic tools has yet to be published.

METHODS

  All children born in 2003 or 2004 in the city of Trondheim, Norway, who attended the regular community health check-up for 4-year-olds (97.2% of eligible children) whose parents consented to take part in the study (N = 2,475, 82.0%) were screened for behavioral and emotional problems with the Strengths and Difficulties Questionnaire (SDQ). A screen-stratified subsample of 1,250 children took part in a furthermore comprehensive study including a structured diagnostic interview (the Preschool Age Psychiatric Assessment, PAPA), which 995 parents (79.6%) completed.

RESULTS

  The estimated population rate for any psychiatric disorder (excluding encopresis - 6.4%) was 7.1%. The most common disorders were attention deficit hyperactivity disorder (1.9%), oppositional defiant disorder (1.8%), conduct disorder (0.7%), anxiety disorders (1.5%), and depressive disorders (2.0%). Comorbidity among disorders was common. More emotional and behavioral disorders were seen in children whose parents did not live together and in those of low socioeconomic status. Boys more often had attention-deficit/hyperactivity disorder (ADHD) and depressive disorders than girls.

CONCLUSIONS

  The prevalence of disorders among preschoolers was lower than in previous studies from the USA. Comorbidity was frequent and there was a male preponderance in ADHD and depression at this early age. These results underscore the fact that the most common disorders of childhood can already be diagnosed in preschoolers. However, rates of disorder in Norway may be lower than in the USA.

Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females

BACKGROUND

There is limited information about psychological predictors of cosmetic surgery and how cosmetic surgery influences subsequent changes in mental health and overall appearance satisfaction. To date, there is a lack of studies examining this issue, whereby representative population samples are assessed at an age before cosmetic surgery is typically conducted and followed up after such surgery has commonly been performed.

METHOD

We obtained data from a survey study following 1597 adolescent females from a representative Norwegian sample over a 13-year period. Participants provided information on cosmetic surgery, appearance satisfaction, mental health, risky sexual behavior, drug use and conduct problems at two time-points (overall response rate 67%).

RESULTS

Of all participants, 78 (4.9%) reported having undergone cosmetic surgery, of whom 71 were operated on during the course of the study and seven before the first data collection. Symptoms of depression and anxiety [odds ratio (OR) 1.66, 95% confidence interval (CI) 1.07-2.57] and a history of deliberate self-harm (OR 2.88, 95% CI 1.46-5.68), parasuicide (OR 3.29, 95% CI 1.53-7.08) and illicit drug use (OR 2.46, 95% CI 1.07-5.82) predicted prospective cosmetic surgery. Moreover, those who underwent surgery during the course of the study experienced a greater increase than other females in symptoms of depression and anxiety (t=2.07, p=0.04) and eating problems (t=2.71, p<0.01). Patients' use of alcohol also increased more than among non-patients (t=2.47, p=0.01).

CONCLUSIONS

A series of mental health symptoms predict cosmetic surgery. Cosmetic surgery does not in turn seem to alleviate such mental health problems.

Change in body fat during a family-based treatment of obesity in children: the relative importance of energy intake and physical activity

OBJECTIVE

The aim of the current study was to examine to what extent changes in reported energy intake and physical activity predict changes in body fat during a family-based outpatient treatment of obesity in children.

METHODS

Total body fat (DXA), reported energy intake (4-day diet record), and physical activity (accelerometer) was measured in 99 children (age 7-12 years, mean BMI SDS = 2.99) at baseline as well as after 6 months 2 years of treatment. Repeated measures (GLM), growth modeling, and structural equation modeling (SEM) were applied in the data analyses.

RESULTS

There was significant decrease in body fat, reported energy intake, and physical activity at both follow-ups (p < 0.001) compared to baseline. Changes in reported energy intake from baseline to 6 months predicted a decrease in body fat from baseline to 6 months (β = 0.68, p < 0.001). In addition, changes in reported energy intake had a strong indirect effect on body fat at 2-year follow-up, mediated by changes in body fat from baseline to 6 months (indirect β = 0.50, p < 0.001). Changes in physical activity did not predict changes in body fat during treatment.

CONCLUSIONS

Changes in reported energy intake significantly affected body fat at 6 months and indirectly predicted the amount of body fat at 2-year follow-up. The indirect effect was mediated by a decrease in body fat obtained during the first phase of treatment.

The Three Dimensions of the Student–Teacher Relationship Scale

The validity of the Student–Teacher Relationship Scale (STRS) was examined in a preschool community sample ( N = 925) using confirmatory factor analysis (CFA). Factorial invariance across genders was also investigated as was concurrent and discriminant validity. Indicators of validity were teacher-rated social competence, problem behavior, and mental health, as well as the children’s score on the Peabody Picture Vocabulary Test. Results showed that the original three-dimensional model of the STRS was not satisfactorily confirmed. However, a slightly modified 25 items, 3-factor version of the STRS showed an acceptable fit. Model fit was acceptable for both boys and girls. The modified three-factor model evidenced good concurrent validity. The discriminant validity of the dependency versus the conflict subscale was somewhat unsatisfactory, mainly due to imperfections in the dependency subscale.

Prevalence and characteristics of depressive disorders in early adolescents in central Norway

BACKGROUND

Prevalence of depressive disorders among adolescents has varied across studies. The present study aims to assess current and lifetime prevalence and characteristics of adolescent Major Depressive Disorder (MDD), Dysthymia and Depression NOS among adolescents in Central Norway in addition to socio-demographics and use of mental health care.

METHOD

In the Youth and Mental Health Study a representative sample of 2432 junior high school students (mean age 14.9 years, SD = 0.6) from two counties in Central Norway were screened with the Mood and Feelings Questionnaire (MFQ). A subset of 345 of these adolescents (72.5% girls), 220 high scorers (MFQ = > 26), 74 middle scorers (MFQ 7-25), and 50 low scorers (MFQ < 7), 1 unknown score, were drawn and interviewed with the Kiddie SADS-PL (Present-Life Version). In all, 79% had parental interviews as well. All estimates of prevalence rates and population shares were weighted back using a sandwich estimator to yield true population estimates.

RESULTS

Almost one in four subjects (23%) had life-time depression. Prevalences of current Major Depressive Disorder (MDD), Dysthymia and "Double depression" were 2.6%, 1.0% and 0.6%, respectively, and for Depression NOS 6.3%.All depressive disorders were characterized by long duration of episodes with large variations, and for any depressive disorder onset before 12 years of age. In multivariate analyses MDD and Dysthymia were most strongly associated with gender and not living with both biological parents. There was no gender difference for Depression NOS. Although a considerable number of depressed subjects had received mental health care, the reason for contact with services was seldom due to affective symptoms. Less than 20% had been in contact with specialist mental health services.

CONCLUSION

High rates of Depression NOS, early onset of depressive episodes, long duration, and low use of specialized services point to the need for improved diagnostic assessment and treatment for young individuals.

Quality of Life as reported by children and parents: a comparison between students and child psychiatric outpatients

BACKGROUND

During the recent decade, a number of studies have begun to address Quality of Life (QoL) in children and adolescents with mental health problems in general population and clinical samples. Only about half of the studies utilized both self and parent proxy report of child QoL. Generally children with mental health problems have reported lower QoL compared to healthy children. The question whether QoL assessment by both self and parent proxy report can identify psychiatric health services needs not detected by an established instrument for assessing mental health problems, i.e. the Child Behavior Checklist (CBCL), has never been examined and was the purpose of the present study.

METHODS

No study exists that compares child QoL as rated by both child and parent, in a sample of referred child psychiatric outpatients with a representative sample of students attending public school in the same catchment area while controlling for mental health problems in the child. In the current study patients and students, aged 8-15.5 years, were matched with respect to age, gender and levels of the CBCL Total Problems scores. QoL was assessed by the self- and parent proxy-reports on the Inventory of Life Quality in Children and Adolescents (ILC). QoL scores were analyzed by non-parametric tests, using Wilcoxon paired rank comparisons.

RESULTS

Both outpatients and their parents reported significantly lower child QoL on the ILC than did students and their parents, when children were matched on sex and age. Given equal levels of emotional and behavioural problems, as reported by the parents on the CBCL, in the two contrasting samples, the outpatients and their parents still reported lower QoL levels than did the students and their parents.

CONCLUSIONS

Child QoL reported both by child and parent was reduced in outpatients compared to students with equal levels of mental health problems as reported by their parents on the CBCL. This suggests that it should be helpful to add assessment of QoL to achieve a fuller picture of children presenting to mental health services.

Receipt of help after deliberate self-harm among adolescents: changes over an eight-year period

OBJECTIVE

This study assessed whether there were any changes in receiving help after deliberate self-harm among adolescents over an eight-year period as a result of significant changes in service provision and media attention and, if so, whether individual predictors of receiving help may aid in explaining these changes.

METHODS

School surveys among Norwegian adolescents in 1994 (N=7,446) and 2002 (N=11,678) asked identical questions about whether the students had experienced deliberate self-harm and, if so, whether they had received treatment or help from various health services, from informal sources, or from no one.

RESULTS

Among the 1,401 students with valid responses who reported deliberate self-harm, 23% had received treatment or help from health services and 48% had received help from family or friends. These proportions increased significantly from 1994 to 2002, when individual predictors were controlled for. The number of sources from which help had been received also increased significantly over the period, whereas the proportion reporting no receipt of help or treatment from anyone decreased from 49% to 40%. A history of a suicide attempt increased the likelihood of receiving help, both from health services and from family or friends. Male gender and poorer parental attachment increased the likelihood of not having received any help or treatment after deliberate self-harm.

CONCLUSIONS

Only about one in four adolescents seems to be reached by health services after deliberate self-harm. Yet the increase in the proportion receiving help from professional and informal sources over this period suggests that changes in societal factors may have reduced barriers for these vulnerable young people to seek help.

Prevalences and correlates of sleep problems among adolescents in specialty mental health services and in the community: what differs?

AIMS

Knowledge of sleep problems and their relationships among adolescent psychiatric patients is limited. This study investigated whether adolescents in specialty mental health care differ in rate and correlates of sleep problems from adolescents in a community sample; 2465 adolescents from a community sample were compared with a representative clinical sample of 129 adolescent patients.

METHODS

Comparisons were made on frequent sleep problems according to scores on the Youth Self-Report, the Mood and Feelings Questionnaire, and instruments assessing coping styles, stresses and family functioning.

RESULTS

Sleep problems were more frequent in the clinical sample than the community sample (31.3% vs. 5%). Sleeping little and being overtired were the most common sleep problems. Sleep problems were multivariately associated with internalizing problems in both samples. Poor family functioning and distractive coping were multivariately associated with sleep problems among adolescent patients, whereas depressive symptoms were multivariately associated in community adolescents.

CONCLUSIONS

Prevalences of sleep problems were high among adolescent patients. However, sleep problems may be in danger of being unnoticed in clinical practice. Clinicians should ask about such problems and be aware of possible connections with family functioning, depression and suicidality. Therapeutic interventions directed towards sleep problems should be considered.

Impaired parent-reported quality of life in treatment-seeking children with obesity is mediated by high levels of psychopathology

PURPOSE

The purpose of the current study was to explore psychopathology as a mediator of quality of life (QOL) in children and adolescents with obesity. The notion that psychopathology and QOL are two distinct constructs was also tested.

METHODS

A sample of treatment-seeking children and adolescents with obesity (n = 185, average age = 11.5, mean BMI SDS = 3.03) was matched to a community sample of children (n = 799, average age = 11.5). Both self- and parent-reported measures of QOL (KINDL-R) and psychopathology (CBCL/YSR) was completed.

RESULTS

Parent-reported QOL was impaired, and both self-reported and parent-reported psychopathology was elevated in children and adolescents with obesity. Psychopathology accounted for all the variance of the effect of obesity on parent-reported QOL. The distinction between QOL and psychopathology was supported through confirmatory factor analysis.

CONCLUSION

Impaired parent-reported QOL in children and adolescents with obesity was attributable to their elevated levels of psychopathology.

Ung i Norge

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Alcohol intoxication and school dropout

The aim of the study was to investigate if alcohol intoxications predict dropout from senior high school over and beyond the effect of alcohol consumption and to seek out potential confounding or mediating mechanisms in the form of a longitudinal cohort-sequential survey. The participants were a nationally representative sample of Norwegian junior and senior high school students (n=5308). Measures used were of alcohol consumption, number of intoxications, school dropout, conduct problems, drug use, friends' problem behaviour, truancy, attitude to school, educational aspirations, grades, homework, youth centrism, leisure time activities, religiosity, depression, academic self-concept, attachment to parents. Intoxications did override the effect of alcohol consumption and predicted dropout. This effect was confounded by parental attachment, whereas truancy and associating with peers high in problem behaviour mediated the effect of intoxications. Frequent alcohol intoxications increase the risk for school dropout by means of increased truancy and differential association with counternormative peers.

Changes in quality of life among Norwegian school children: a six-month follow-up study

BACKGROUND

A considerable gap exists in regard to longitudinal research on quality of life (QoL) in community populations of children and adolescents. Changes and stability of QoL have been poorly examined, despite the fact that children and adolescents undergo profound developmental changes. The aims of the study were to investigate short-term changes in student QoL with regard to sex and age in a school-based sample.

METHODS

A representative Norwegian sample of 1,821 school children, aged 8-16 years and their parents were tested at baseline and 6 months later, using the Inventory of Life Quality for Children and Adolescents (ILC) and the Kinder Lebensqualität Fragebogen (KINDL). Student response rate at baseline was 71.2% and attrition over the follow-up period was 4.6%, and 1,336 parents (70%) completed the follow-up. Change scores between baseline and follow-up evaluations were analysed by means of ANCOVA in regard to sex and age effects.

RESULTS

Students in the 8th grade reported a decrease in QoL over the six-month follow-up period as compared to those in the 6th grade with regard to Family and School domains and total QoL on the KINDL. For emotional well-being a significant linear decrease in QoL across grades 6th to 10th was observed. However, student ratings on the Friends and Self-esteem domains did not change significantly by age. Girls reported a higher decrease in their QoL across all grades over the follow-up period than did boys in respect of Self-esteem on the KINDL, and an age-related decrease in total QoL between 6th and 8th grade on the ILC. Parent reports of changes in child QoL were nonsignificant on most of the domains.

CONCLUSION

The observed age and sex-related changes in school children's QoL across the six-month follow-up period should be considered in epidemiological as well as clinical research.

Does sports participation during adolescence prevent later alcohol, tobacco and cannabis use?

AIMS

To study whether participation in organized sports during adolescence predicts increased smoking of tobacco, alcohol intoxication and cannabis use from late adolescence to adulthood when controlling for potential confounders. Moreover, to study whether such increased drug use varies according to type of sport (team versus individual), main skills needed (endurance, strength or technical) and level of competition.

DESIGN, SETTING AND PARTICIPANTS

Survey of national sample of Norwegian high school students (aged 13-19 years) in 1992 (T1) followed-up in 1994 (T2), 1999 (T3) and 2006 (T4) (n = 3251).

MEASUREMENTS

Outcome measures included smoking of tobacco and 12-month prevalences of alcohol intoxication and cannabis use, respectively. Confounders included pubertal timing, friends' drug use, perceived social acceptance, grades and parental socio-economic status.

FINDINGS

Latent growth curve analyses showed that initial level of participation in organized sports predicted growth in alcohol intoxication. Those involved initially in team sports had greater growth in alcohol intoxication, but lower growth in tobacco use and cannabis use, during the adolescent and early adult years compared to those involved in technical or strength sports. Practising endurance sports, as opposed to technical or strength sports, predicted reduced growth in alcohol intoxication and tobacco use.

CONCLUSIONS

Sports participation in adolescence, and participation in team sports in particular, may increase the growth in alcohol intoxication during late adolescent and early adult years, whereas participation in team sports and endurance sports may reduce later increase in tobacco and cannabis use.

Quality of Life as reported by school children and their parents: a cross-sectional survey

BACKGROUND

Comprehensive evidence exists regarding the discrepancy between children's reports and parents' by proxy reports on emotional and behavioural problems. However, little is yet known about factors influencing the extent to which child self- and parent by proxy reports differ in respect of child Quality of Life (QoL). The aim of the study was to investigate the degree of discrepancy between child and parent by proxy reports as measured by two different QoL instruments.

METHODS

A representative Norwegian sample of 1997 school children aged 8-16 years, and their parents were studied using the Inventory of Life Quality (ILC) and the 'Kinder Lebensqualität Fragebogen' (KINDL). Child and parent reports were compared by t-test, and correlations were calculated by Pearson product moment coefficient. Psychometric aspects were examined in regard to both translated QoL instruments (internal consistency by Cronbach's alpha and test-retest reliability by intraclass correlation coefficients).

RESULTS

Parents evaluated the QoL of their children significantly more positively than did the children. Correlations between mother-child and father-child reports were significant (p < 0.01) and similar but low to moderate (r = 0.32; and r = 0.30, respectively, for the KINDL, and r = 0.30 and r = 0.26, respectively, for the ILC). Mother and father reports correlated moderately highly (r = 0.54 and r = 0.61 for the KINDL and ILC, respectively). No significant differences between correlations of mother-daughter/son and father-daughter/son pairs in regard to reported child QoL were observed on either of the two instruments.

CONCLUSION

In the present general population sample, parents reported higher child QoL than did their children. Concordance between child and parent by proxy report was low to moderate. The level of agreement between mothers and fathers in regard to their child's QoL was moderate. No significant impact of parent and child gender in regard to agreement in ratings of child QoL was found. Both the child and parent versions of the Norwegian translations of the KINDL and ILC can be used in surveys of community populations, but in regard to the self-report of 9-10 years old children, only the KINDL total QoL scale or the ILC are recommended.

The impact of becoming a mother on eating problems

OBJECTIVE

This study examines the relationship between becoming a mother and changes in eating problems.

METHOD

A sample of 1,206 initially childless Norwegian women was followed over a six-year period and growth curve analyses were conducted.

RESULTS

Participants who became mothers over the course of the study showed a greater reduction in eating problems compared to still childless women. This relationship could be explained by a corresponding decrease in alcohol usage and impulsiveness in mothers compared to childless women. At the same time, appearance satisfaction increased comparatively less in mothers, resulting in turn in a reduction of the effect of motherhood on changes in eating problems.

CONCLUSION

The results of this study indicate that motherhood has on the whole a positive effect on eating problems.