1
|
Pines A, Tozzi L, Bertrand C, Keller AS, Zhang X, Whitfield-Gabrieli S, Hastie T, Larsen B, Leikauf J, Williams LM. Psychiatric Symptoms, Cognition, and Symptom Severity in Children. JAMA Psychiatry 2024:2822689. [PMID: 39196567 PMCID: PMC11359114 DOI: 10.1001/jamapsychiatry.2024.2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/07/2024] [Indexed: 08/29/2024]
Abstract
Importance Mental illnesses are a leading cause of disability globally, and functional disability is often in part caused by cognitive impairments across psychiatric disorders. However, studies have consistently reported seemingly opposite findings regarding the association between cognition and psychiatric symptoms. Objective To determine if the association between general cognition and mental health symptoms diverges at different symptom severities in children. Design, Setting, and Participants A total of 5175 children with complete data at 2 time points assessed 2 years apart (aged 9 to 11 years at the first assessment) from the ongoing Adolescent Brain and Cognitive Development (ABCD) study were evaluated for a general cognition factor and mental health symptoms from September 2016 to August 2020 at 21 sites across the US. Polynomial and generalized additive models afforded derivation of continuous associations between cognition and psychiatric symptoms across different ranges of symptom severity. Data were analyzed from December 2022 to April 2024. Main Outcomes and Measures Aggregate cognitive test scores (general cognition) were primarily evaluated in relation to total and subscale-specific symptoms reported from the Child Behavioral Checklist. Results The sample included 5175 children (2713 male [52.4%] and 2462 female [47.6%]; mean [SD] age, 10.9 [1.18] years). Previously reported mixed findings regarding the association between general cognition and symptoms may consist of several underlying, opposed associations that depend on the class and severity of symptoms. Linear models recovered differing associations between general cognition and mental health symptoms, depending on the range of symptom severities queried. Nonlinear models confirm that internalizing symptoms were significantly positively associated with cognition at low symptom burdens higher cognition = more symptoms) and significantly negatively associated with cognition at high symptom burdens. Conclusions and Relevance The association between mental health symptoms and general cognition in this study was nonlinear. Internalizing symptoms were both positively and negatively associated with general cognition at a significant level, depending on the range of symptom severities queried in the analysis sample. These results appear to reconcile mixed findings in prior studies, which implicitly assume that symptom severity tracks linearly with cognitive ability across the entire spectrum of mental health. As the association between cognition and symptoms may be opposite in low vs high symptom severity samples, these results reveal the necessity of clinical enrichment in studies of cognitive impairment.
Collapse
Affiliation(s)
- Adam Pines
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Leonardo Tozzi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Claire Bertrand
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Arielle S. Keller
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Xue Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | | | - Trevor Hastie
- Department of Statistics, Stanford University, Stanford, California
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Bart Larsen
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - John Leikauf
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
- Sierra-Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| |
Collapse
|
2
|
Kiani B, Hadianfard H, Weiss MD, Dehbozorgi S. Receiver operating characteristic curve analysis of the Weiss Functional Impairment Rating Scale-Parent Report for screening children with ADHD: Looking beyond symptoms in ADHD diagnosis. Early Interv Psychiatry 2023. [PMID: 38030566 DOI: 10.1111/eip.13484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/15/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
AIM The current study aimed at examining the ability of the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) to discriminate between children with ADHD and controls in functional impairment and identifying optimal cutoff scores for the WFIRS-P subscales and total scale. METHODS Parents of 51 children with ADHD (90.2% male; grades 1-6) and 51 gender/grade matched controls (90.2% male; grades 1-6) completed the WFIRS-P. Receiver operating characteristic (ROC) curve analysis was used to examine the ability of the WFIRS-P to differentiate children with ADHD from controls and to determine optimal cutoff scores of the WFIRS-P. RESULTS Area under the curve (AUC) was 0.98 for the WFIRS-P total scale, indicating excellent ability to differentiate children with ADHD from controls. The score of 0.45 with 0.88 for sensitivity and 0.96 for specificity was determined as the optimal cutoff score for the total scale of the WFIRS-P. AUC was 0.73 to 0.97 for the WFIRS-P subscales, suggesting good to excellent ability for discriminating between children with ADHD and controls. Among the subscales, the family subscale score of 0.42 with 0.92 for sensitivity and 0.96 for specificity showed the highest discriminating power. The self-concept and life skills subscales had low sensitivity, suggesting Iranian mothers do not identify problems with self-concept or difficulty with life skills as particularly problematic in ADHD. CONCLUSIONS The WFIRS-P is a sensitive and specific measure of the functional impairment associated with ADHD in Iranian children. Our sample was predominantly male, limiting the generalizability of results to females.
Collapse
Affiliation(s)
- Behnaz Kiani
- Department of Clinical Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Habib Hadianfard
- Department of Clinical Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Margaret D Weiss
- Cambridge Health Alliance, Harvard University, Cambridge, Massachusetts, USA
| | - Sara Dehbozorgi
- Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
3
|
Hysaj M, Crone MR, Kiefte-de Jong JC, Vermeiren RRJM. Do parental attachment and prosocial behavior moderate the impairment from depression symptoms in adolescents who seek mental health care? Child Adolesc Psychiatry Ment Health 2023; 17:133. [PMID: 38017555 PMCID: PMC10685577 DOI: 10.1186/s13034-023-00680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
We investigated parental attachment and prosocial behavior as social protective indicators in adolescents (age 11-17) with symptoms of depression in a clinical setting. Specifically, we tested the moderating effect of these factors on the relation between symptoms of depression and their impairment on daily life. The Development and Well-Being Assessment, as completed by children, mothers, and fathers, was used, and hierarchical multiple regression analyses were conducted for these three perspectives. From the adolescents' reports we only found a significant effect of symptoms on impairment indicating that a higher number of symptoms were related to higher impairment. For the mothers and fathers, a higher score on the adolescents' prosocial behavior was related to a lower impairment from depression symptoms on the daily life of the adolescent and the family. Only for the mothers did a higher score on prosocial behavior buffered the effect of symptoms on impairment, while a higher parental attachment score was associated with a lower impairment. Further, when examining maternal and paternal attachment separately, we found that, only the mothers, reported less impairment from the symptoms when they perceived that the adolescent was attached to the father, and paternal attachment even buffered the effect of symptoms on impairment. To conclude, our results indicate that social protective factors, from the parent's perspective, are likely to have a beneficial effect in clinical practice and should be taken into account when examining impairment scores. Future studies should investigate whether additional protective indicators from the adolescents' perspective, such as quality of parental attachment or family climate, may have a positive impact on their daily functioning.
Collapse
Affiliation(s)
- Marsida Hysaj
- Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - Mathilde R Crone
- Department of Public Health and Primary Care / LUMC-Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care / LUMC-Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
4
|
Tang Y, Algurén B, Pelletier C, Naylor PJ, Faulkner G. Physical Literacy for Communities (PL4C): physical literacy, physical activity and associations with wellbeing. BMC Public Health 2023; 23:1266. [PMID: 37386373 PMCID: PMC10311742 DOI: 10.1186/s12889-023-16050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Physical literacy (PL) is considered an important determinant of children's physical activity through which health benefits may be derived. The purpose of this study is to describe a sample of Canadian children's baseline levels of PL and movement behaviors, and explore whether the associations between PL and their mental wellbeing, if any, are mediated by moderate-to-vigorous physical activity (MVPA). METHODS All grade two children in 14 elementary schools in the West Vancouver School District, Canada were invited to participate in a two-year longitudinal project. PL was assessed through PLAYfun and PLAYself tools. Physical activity was measured by wrist-worn accelerometers (GT3X + BT) for seven days. Children's mental well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). A score of total difficulties was aggregated for internalizing and externalizing problems. RESULTS A total of 355 children aged 7-9 (183 boys, 166 girls, 6 non-binary) participated with 258 children providing valid accelerometer data. Children exhibited an average of 111.1 min of MVPA per day, with 97.3% meeting the physical activity guidelines. Approximately 43% (108/250) of participants were meeting the Canadian 24-h movement guidelines. Children were at an 'emerging' level of overall physical competence (45.8 ± 5.6) and reported a mean score of 68.9 (SD = 12.3) for self-perceived PL, with no significant differences between boys and girls. PL was significantly associated with MVPA (r = .27) and all SDQ variables (rs = -.26-.13) except for externalizing problems. Mediation analyses showed PL was negatively associated with internalizing problems and total difficulties when the association with MVPA was considered. However, the mediating role of MVPA was found only between PL and internalizing problems, β = -.06, 95%CI [-.12, -.01]. CONCLUSIONS Although most of our sample was physically active and showed higher adherence to 24-H movement guidelines than comparable population data, the motor competence and self-perceived PL of our sample were similar to those of previous studies. PL has an independent association with children's internalizing problems and total difficulties. Ongoing assessment will investigate the relationships between PL and children's mental health from a longitudinal perspective.
Collapse
Affiliation(s)
- Yiling Tang
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Beatrix Algurén
- Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Göteborg, Sweden
| | - Chelsea Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Guy Faulkner
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
5
|
Kobus S, Buehne AM, Kathemann S, Buescher AK, Lainka E. Parents' Perceptions of the Effectiveness of Music Therapy on Their Chronically Ill Children. Behav Sci (Basel) 2023; 13:409. [PMID: 37232646 PMCID: PMC10215122 DOI: 10.3390/bs13050409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
Chronic disease in a child, with the associated hospital stays, places considerable demands on the child and their family. The aim of this study was to investigate the parents' perceptions of the music therapy used with their child during a hospital stay and to determine whether they felt that it reduced the child's anxiety and stress generated by hospital admission. We hypothesized that the use of live music therapy from a music therapist would positively support these patients in everyday clinical practice, promote their wellbeing, and have positive impacts on their vital signs and blood pressure. Children with chronic gastroenterological and nephrological diseases included in this prospective study received live music therapy with a median duration of 41 min (range from 12 to 70 min) two to four times per week until discharged from the hospital. At the time of discharge, the parents were asked to complete a Likert-style questionnaire to evaluate the music therapy. Seven items were related to general questions about the patients and sessions, and eleven items evaluated the personal perceptions of the parents. Music therapy was conducted in 83 children, with a median age of 3 years (range from 1 month to 18 years). All parents (100%) completed the questionnaire at the time of discharge. Seventy-nine percent of the parents stated that their children were able to enjoy the music therapy sessions without being stressed. In addition, 98% of the respondents said that they were grateful for the music therapy their children received (97% fully agreed and 1% rather agreed). All parents considered music therapy to be beneficial for their child. The parents' responses reflected the view that music therapy is beneficial to patients. According to the parents, music therapy can be integrated effectively in the inpatient clinical setting and can support children with chronic illnesses during their hospital stay.
Collapse
Affiliation(s)
- Susann Kobus
- Center of Artistic Therapy, University Medicine Essen, 45147 Essen, Germany
- Clinic for Pediatrics I, University Children’s Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Alexandra M. Buehne
- Clinic for Pediatrics II, University Children’s Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Simone Kathemann
- Clinic for Pediatrics II, University Children’s Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Anja K. Buescher
- Clinic for Pediatrics II, University Children’s Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Elke Lainka
- Clinic for Pediatrics II, University Children’s Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| |
Collapse
|
6
|
Andrews JL, Schweizer S. The Need for Functional Assessments in School-Based Mental Health Intervention Research. JAMA Psychiatry 2023; 80:103-104. [PMID: 36542370 DOI: 10.1001/jamapsychiatry.2022.4316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This Viewpoint discusses the need to study functional impairment in addition to symptoms in school-based mental health intervention research.
Collapse
Affiliation(s)
- Jack L Andrews
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Susanne Schweizer
- School of Psychology, University of New South Wales, Sydney, Australia.,Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
7
|
Tatlı C, Ergin DA. Multigroup analysis of the relationship loneliness, fear of missing out, problematic internet usage and peer perception in gifted and normally developing adolescents. CURRENT PSYCHOLOGY 2023; 42:2325-2334. [PMID: 35915775 PMCID: PMC9330965 DOI: 10.1007/s12144-022-03384-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Abstract
The current study examined the effects of Internet usage characteristics and peer perception on loneliness. The mediating role of Internet usage characteristics was examined in the relationship between loneliness and peer perception. The sample included 661 Turkish adolescents (Ngirls =379, 57.34%; Ngifted= 211, 31.92%) aged 11-18 years. Structural equation model analyzes were conducted to test the hypothesis model across the group. Moreover, multigroup structural model was conducted to test the differences of the relationships across gifted and normally developing adolescents. The results of the structural model showed that Internet use characteristics did not have a mediating role in the relationship between adolescents' peer perception and loneliness. On the other hand, problematic Internet use had a full mediator role in the relationship between fear of missing out and loneliness. The results of the multigroup structural model emphasized the similar effects between the research variables in gifted and normally developing adolescents. The results were discussed with the effects of Internet use characteristics and peer perception on loneliness. We also pointed out that gifted and normally developing adolescents have similar social and technological outcomes and that these outcomes influence mental health.
Collapse
Affiliation(s)
- Cemre Tatlı
- grid.440437.00000 0004 0399 3159Department of Psychological Counseling and Guidance, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Derya Atalan Ergin
- grid.465997.00000 0004 9333 5423Department of Psychology, Cappadocia University, Nevşehir, Turkey
| |
Collapse
|
8
|
Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study. BMC PRIMARY CARE 2022; 23:211. [PMID: 35996092 PMCID: PMC9396915 DOI: 10.1186/s12875-022-01780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022]
Abstract
Background In Germany, 19.1% of boys and 14.5% of girls are affected by mental health problems (MHP). Paediatricians are usually the first in line to be contacted but they often do not feel adequately trained to diagnose and treat MHP in primary care. A major statutory health insurance fund introduced a health coaching (HC) programme to strengthen primary care consultation for MHP. The HC includes a training concept for paediatricians, standardised guidelines for actions and additional payments. The aim of this study was to investigate the potential effects of the HC programme on the change of MHP in children and adolescents. Methods A prospective cohort study was conducted in Bavaria, Germany, in 2018 and 2019. Data were collected at 2 points 1 year apart using an online questionnaire. Parents of patients with developmental disorder of speech and language, head/abdominal pain, conduct disorder or non-organic enuresis were approached by their health insurance. Families treated according to the HC programme form the intervention group while all others serve as controls. MHP was assessed using the Strengths and Difficulties Questionnaire (SDQ) as a child self-assessment (SDQ-S)/or external assessment by parents (SDQ-P). Determinants of SDQ total score were analysed using linear mixed effects models. Results Cross-sectional (n = 1090) and longitudinal analyses (n = 599) were performed. At baseline, a total of 23.5% had an SDQ total score “at risk” (SDQ-S > 15/SDQ-P > 13). There were no significant differences between intervention and controls. After full adjustment for all potential confounders, higher SDQ scores indicating more problems were significantly associated with male sex (2.000, p < 0.001) whereas a high parental education level was significantly associated with decreased SDQ scores (-2.127, p =0.034). There was a significant improvement in the control group over time (-0.814, p = 0.001) while the SDQ scores in the intervention group remained stable (-0.012, p = 0.020). Conclusion This evaluation of the HC programme could not prove a clinically relevant intervention’s effect on the MHP developmental course. Nevertheless, (HC) paediatricians have crucial potential to improve the care of MHP patients. Targeting families with less access to support measures might help reduce the burden of MHP and be a step towards continuous improvement of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01780-1.
Collapse
|
9
|
Gustafsson BM, Steinwall S, Korhonen L. Multi-professional and multi-agency model PLUSS to facilitate early detection and support of pre-school children with neurodevelopmental difficulties - a model description. BMC Health Serv Res 2022; 22:419. [PMID: 35354442 PMCID: PMC8966250 DOI: 10.1186/s12913-022-07815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Neurodevelopmental difficulties, such as problems in social inter-relatedness, communication, motor coordination, and attention, are frequent in preschoolers and constitute a risk for later negative consequences. This article describes the development of a multi-professional and multi-agency model, PLUSS, to facilitate care and interventions for preschoolers with neurodevelopmental difficulties. Methods The PLUSS model was developed for children aged 1.5–5 years with a need for a further assessment of neurodevelopmental symptoms. The model is evaluated using a quasi-experimental study design along with qualitative interviews that study preschool teacher, and parent experiences of PLUSS. Outcomes of interest are a) implementation, b) effectiveness related to processes and multi-agency collaboration, c) capacity building among professionals, d) child-related outcomes with a longitudinal follow-up as well as d) parental wellbeing and satisfaction. Results The model was launched in 2019 and so far, approximately 130 children have been assessed. Results from a pilot study with 62 children (27–72 months; boys: girls 2.65:1) show that the total mean SDQ score in parental rating was 15 ± 6 and in preschool teacher ratings 14 ± 7, exceeding the Swedish cut-off of 12. 54 parents have participated in parental training and rate high levels of satisfaction (mean score 4.5, max 5.0). In addition, 74 pre-school professionals have been trained in early signs of neurodevelopmental difficulties to facilitate early detection. Feedback from participants indicates high satisfaction with educational activities (mean score 4.2, max 5.0 = very satisfied). Conclusions The pilot study shows that the screening procedure can detect children with clinically significant problems. In addition, participant satisfaction is high in parent- and preschool teacher training. The longitudinal study approach enables both child follow-up and evaluation of interventions provided by the working model. Trial registration Clinical Trials 2021, PLUSS identifier, NCT04815889. First registration 25/03/2021.
Collapse
Affiliation(s)
- Berit M Gustafsson
- Department of Psychiatry and Rehabilitation, Psychiatric Clinic, Högland Hospital, Region Jönköping County, Jönköping, Sweden. .,Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Samina Steinwall
- Department of Child and Adolescent Psychiatry, Division of Psychiatry and Rehabilitation, Region Jönköping County, Jönköping, Sweden
| | - Laura Korhonen
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
10
|
Hagmann D, Allgaier K, Wolf J, Chiumento O, Bürkle L, Conzelmann A, Renner TJ. [Evolution of Emergency Department Characteristics in Child and Adolescent Psychiatry: A Retrospective Review over Two Decades]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 50:286-297. [PMID: 35225683 DOI: 10.1024/1422-4917/a000859] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Evolution of Emergency Department Characteristics in Child and Adolescent Psychiatry: A Retrospective Review over Two Decades Abstract. Objective: Emergency inpatient admissions to child and adolescent psychiatric hospitals because of a mental health crisis represent a substantial proportion of all inpatient admissions and have increased substantially over time. This study examines changes in the characteristics of this patient group at a university care clinic over two decades. Method: We evaluated the emergency admissions from 1996, 2002, 2008, and 2014 of the Child and Adolescent Psychiatry Clinic in Tübingen retrospectively using sociodemographic data, psychosocial circumstances, and diagnoses. Results: We evaluated a total of N = 403 emergency admissions. The emergency admissions in the periods mentioned increased by 405 %. Especially patients from families with separated parents and with multiple diagnoses increased over time. Conclusions: From 1996 to 2014, there was a significant increase in emergency admissions. The results also indicate that more complex disease situations and less favorable psychosocial conditions are occurring. The findings underscore the need to improve the clinical care of children and adolescents during acute mental health crises and work toward their prevention. There is also a need to focus broad societal discussion on improving overall mental health during childhood development. There is an urgent need for prospective studies to identify the factors leading to the increase in emergency admissions among children and adolescents.
Collapse
Affiliation(s)
- Daniela Hagmann
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinikum für Psychiatrie und Psychotherapie Tübingen, Zentrum für Psychische Gesundheit, Tübingen
| | - Katharina Allgaier
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinikum für Psychiatrie und Psychotherapie Tübingen, Zentrum für Psychische Gesundheit, Tübingen.,LEAD Graduate School and Research Network, Universität Tübingen
| | - Jonathan Wolf
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinikum für Psychiatrie und Psychotherapie Tübingen, Zentrum für Psychische Gesundheit, Tübingen.,Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Klinikum Stuttgart
| | - Ornella Chiumento
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinikum für Psychiatrie und Psychotherapie Tübingen, Zentrum für Psychische Gesundheit, Tübingen
| | - Laura Bürkle
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinikum für Psychiatrie und Psychotherapie Tübingen, Zentrum für Psychische Gesundheit, Tübingen
| | - Annette Conzelmann
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinikum für Psychiatrie und Psychotherapie Tübingen, Zentrum für Psychische Gesundheit, Tübingen.,LEAD Graduate School and Research Network, Universität Tübingen
| | - Tobias J Renner
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinikum für Psychiatrie und Psychotherapie Tübingen, Zentrum für Psychische Gesundheit, Tübingen.,LEAD Graduate School and Research Network, Universität Tübingen
| |
Collapse
|
11
|
Janschewski J, Käppler C, Berens P. Schulische Prädiktoren für psychische Auffälligkeiten bei Kindern und Jugendlichen anhand einer Befragung von Schülerinnen und Schülern an Klinik- und Regelschulen. ZEITSCHRIFT FUR PADAGOGISCHE PSYCHOLOGIE 2022. [DOI: 10.1024/1010-0652/a000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Ungefähr ein Fünftel aller Kinder und Jugendlichen zeigt psychische Auffälligkeiten, doch nur ein geringer Teil der Betroffenen erhält professionelle Hilfe. Häufig gehen mit psychischen Beeinträchtigungen auch gravierende schulische Probleme einher. In dieser Studie untersuchten wir, ob es schulische Merkmale von Schülerinnen und Schülern gibt, die Hinweise auf eine psychische Auffälligkeit liefern können. Dazu wurden 185 Klinikschülerinnen und -schüler und 387 Schülerinnen und Schüler an Regelschulen zu ihrer schulischen Situation befragt. Außerdem wurde der Strengths and Difficulties Questionnaire (SDQ) genutzt, um eine Vergleichsgruppe mit ausschließlich psychisch unauffälligen Schülerinnen und Schülern bilden zu können. Wir verwendeten ein logistisches Regressionsmodell, um herauszufinden, welche Antwortitems eine gute Vorhersage auf psychische Auffälligkeiten ermöglichten. Der Klassifikator war in der Lage, psychisch auffällige und unauffällige Schülerinnen und Schüler mit hoher Genauigkeit zu unterscheiden (Genauigkeit .83, Sensitivität: .76; Spezifität: .87). Die Klassifikation basierte dabei – anders als vermutet werden könnte – nicht primär auf Aussagen zum Lern- und Leistungsverhalten der Schülerinnen und Schüler, sondern auf Aussagen zu schulvermeidendem Verhalten und ihrer sozialen Integration. Diese schulischen Prädiktoren waren auch unter Kontrolle von Alter und Geschlecht sehr stabil. Die Ergebnisse deuten darauf hin, dass Lehrkräfte eine bedeutsame Rolle bei der Früherkennung von psychischen Auffälligkeiten einnehmen können.
Collapse
Affiliation(s)
- Judith Janschewski
- Rudolf-Leski-Schule, Tübingen, Deutschland
- Lehrstuhl Soziale und Emotionale Entwicklung, Fakultät Rehabilitationswissenschaften, TU Dortmund, Deutschland
| | - Christoph Käppler
- Lehrstuhl Soziale und Emotionale Entwicklung, Fakultät Rehabilitationswissenschaften, TU Dortmund, Deutschland
| | - Philipp Berens
- Forschungsinstitut für Augenheilkunde, Universität Tübingen, Deutschland
| |
Collapse
|
12
|
Moussavi Y, Wergeland GJ, Bøe T, Haugland BSM, Larsen M, Lehmann S. Internalizing Symptoms Among Youth in Foster Care: Prevalence and Associations with Exposure to Maltreatment. Child Psychiatry Hum Dev 2022; 53:375-388. [PMID: 33575864 PMCID: PMC8924138 DOI: 10.1007/s10578-020-01118-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2020] [Indexed: 02/07/2023]
Abstract
Among youth in foster care (N = 303, aged 11-17 years), we investigated prevalence of internalizing symptoms; associations between symptom level and maltreatment types and numbers; and the interaction between gender and maltreatment, on internalizing symptoms. Youth completed Spence Children Anxiety Scale, Short Mood Feelings Questionnaire, and Child and Adolescent Trauma Screen. Compared to community samples, symptom levels above clinical cut-off was more frequent, with social- and generalized anxiety (ES = 0.78-0.88) being most prevalent among youth in foster care. Girls reported more internalizing symptoms (ES = 0.59-0.93). Sexual abuse and neglect were associated with a broader range of internalizing symptoms (ES = 0.35-0.64). Increased incidence of maltreatment was associated with increased levels of symptoms (ES = 0.21-0.22). Associations between maltreatment and symptom level were stronger for girls. This study stresses the importance of broad screening of maltreatment and internalizing symptoms to meet the needs of youth in foster care.
Collapse
Affiliation(s)
- Yasmin Moussavi
- Regional Centre for Child and Youth Mental Health and Child Welfare - West, NORCE Norwegian Research Centre, P.O.B 22 Nygårdstangen, 5838, Bergen, Norway. .,Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare - West, NORCE Norwegian Research Centre, P.O.B 22 Nygårdstangen, 5838 Bergen, Norway ,Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | - Marit Larsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - West, NORCE Norwegian Research Centre, P.O.B 22 Nygårdstangen, 5838 Bergen, Norway ,Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare - West, NORCE Norwegian Research Centre, P.O.B 22 Nygårdstangen, 5838 Bergen, Norway ,Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
13
|
Haavet OR, Šaltytė Benth J, Gjelstad S, Hanssen-Bauer K, Dahli MP, Kates N, Ruud T. Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office. BMJ Open 2021; 11:e050036. [PMID: 34952870 PMCID: PMC8712985 DOI: 10.1136/bmjopen-2021-050036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Young people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions. AIM To investigate whether shared care with mental health professionals in GP offices increases the detection of youth's mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician. DESIGN AND SETTING This was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3-8 GP offices. One GP office was randomised to the intervention group and the other to the control group. METHOD We used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth. RESULTS Over a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients' regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm. CONCLUSION Shared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient's regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group. TRIAL REGISTRATION NUMBER NCT03624829; Results.
Collapse
Affiliation(s)
- Ole Rikard Haavet
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ketil Hanssen-Bauer
- Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway
| | - Mina Piiksi Dahli
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nick Kates
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine McMaster University, Hamilton, Ontario, Canada
| | - Torleif Ruud
- Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway
| |
Collapse
|
14
|
Gustafsson BM, Korhonen L. The PLUSS model: a study protocol for evaluation of a multi-professional and intersectoral working model to detect and support preschool children with neurodevelopmental difficulties (Preprint). JMIR Res Protoc 2021; 11:e34969. [PMID: 35704376 PMCID: PMC9244646 DOI: 10.2196/34969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Berit M Gustafsson
- Linköping University, Department of Child and Adolescent Psychiatry, Department of Biomedical and Clinical Sciences, Linkoping, Sweden
| | - Laura Korhonen
- Linköping University, Department of Child and Adolescent Psychiatry, Department of Biomedical and Clinical Sciences, Linkoping, Sweden
| |
Collapse
|
15
|
Boege I, Corpus N, Weichard M, Schepker R, Young P, Fegert JM. Long-term outcome of intensive home treatment for children and adolescents with mental health problems - 4 years after a randomized controlled clinical trial. Child Adolesc Ment Health 2021; 26:310-319. [PMID: 34477291 DOI: 10.1111/camh.12500] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Admission rates to child and adolescent mental health inpatient units in Germany are substantial (58.831 admissions in 2019). Historically, different treatment pathways have not been available. The evidence suggests that home treatment could be an alternative. The objective of this study was to assess the long-term stability of treatment gains among children and adolescents treated for serious mental health problems with home treatment (HT) as compared with inpatient treatment-as-usual (TAU). METHODS Hundred patients were enrolled and randomized into an intervention (HT n = 54) and control group (TAU n = 46). Follow-up data were available after 8.4 months (n = 78) (T3) and after 4.3 years (n = 51) (T4). The primary outcome measured was overall level of functioning, for which the Children's Global Assessment Scale (CGAS) was used. Secondary outcomes included severity of patient impairment and parental competency in dealing with their child's symptoms, measured using the Health of the Nation Outcome Scales (HoNOSCA). A qualitative interview with parents was performed at T3 and T4. RESULTS Treatment effects remained stable for both groups at T3 and T4 (p < .001). After 4.3 years 70% of the parents in the intervention group stated satisfaction with the treatment received, while only 36.8% of the parents within the control group rated themselves as satisfied. 43.7% of parents in the home treatment group reported that the most helpful aspect of this pathway was the prompt and intensive professional help and advice they received as primary caregivers at home. CONCLUSIONS Home treatment may be considered a viable alternative to inpatient care.
Collapse
Affiliation(s)
- Isabel Boege
- CAP, ZfP Suedwuerttemberg, Ravensburg, Germany.,CAP, Universitaet Ulm, Ulm, Germany
| | | | | | | | | | | |
Collapse
|
16
|
Witt S, Dingemann J, Dellenmark-Blom M, Quitmann J. Parent-Child Assessment of Strengths and Difficulties of German Children and Adolescents Born With Esophageal Atresia. Front Pediatr 2021. [PMID: 34604141 DOI: 10.3389/fped.2021.723410/pdf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Introduction/Aim: Children and adolescents with a chronic somatic disease have a higher risk of developing psychological disorders than healthy peers. Therefore, we aim to investigate internalizing and behavioral problems in pediatric patients with esophageal atresia (EA) and compare this sample with German reference values using both childrens' self-reports and parents' proxy reports. Methods: The present cross-sectional study is part of the German-Swedish EA-QOL study developing a condition-specific instrument to assess Health-related Quality of Life in children and adolescents born with EA from both self and proxy perspectives. The current analyses use data from the German sample collected within the field test phase. Participants were enrolled from the Medical School Hannover and "Auf der Bult" Children's Hospital, Hannover. The cooperating clinicians provided the medical records while socio-demographic information was collected through the parent-report within the questionnaires. We used the Strengths and Difficulties Questionnaire (SDQ) to measure internalizing and behavioral problems of children and adolescents born with EA ranging from 2 to 18 years. Results: A total of 51 families participated in the field test phase. Eighty-eight parent reports and 22 child reports were included in the analyses. While the parents' perspective from the SDQ leads to a higher percentage of abnormal or borderline behavior, there is no difference to the reference group from the children's perspective. Conclusion: Incorporating routine psychological assessment into pediatric health care can help improve understanding of the burden of illness, examine treatment outcomes, assess the quality of care, and tailor interventions to meet patient and parent needs. Involving the whole family can help develop appropriate and functional coping strategies. From our point of view, it is necessary to address parental needs and concerns as well in order to provide the best possible holistic development in the family system. The family is the basis for the children's successful development, especially for children with special health care needs.
Collapse
Affiliation(s)
- Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Dingemann
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - Michaela Dellenmark-Blom
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg, Sweden
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Julia Quitmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
17
|
Witt S, Dingemann J, Dellenmark-Blom M, Quitmann J. Parent-Child Assessment of Strengths and Difficulties of German Children and Adolescents Born With Esophageal Atresia. Front Pediatr 2021; 9:723410. [PMID: 34604141 PMCID: PMC8485724 DOI: 10.3389/fped.2021.723410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction/Aim: Children and adolescents with a chronic somatic disease have a higher risk of developing psychological disorders than healthy peers. Therefore, we aim to investigate internalizing and behavioral problems in pediatric patients with esophageal atresia (EA) and compare this sample with German reference values using both childrens' self-reports and parents' proxy reports. Methods: The present cross-sectional study is part of the German-Swedish EA-QOL study developing a condition-specific instrument to assess Health-related Quality of Life in children and adolescents born with EA from both self and proxy perspectives. The current analyses use data from the German sample collected within the field test phase. Participants were enrolled from the Medical School Hannover and "Auf der Bult" Children's Hospital, Hannover. The cooperating clinicians provided the medical records while socio-demographic information was collected through the parent-report within the questionnaires. We used the Strengths and Difficulties Questionnaire (SDQ) to measure internalizing and behavioral problems of children and adolescents born with EA ranging from 2 to 18 years. Results: A total of 51 families participated in the field test phase. Eighty-eight parent reports and 22 child reports were included in the analyses. While the parents' perspective from the SDQ leads to a higher percentage of abnormal or borderline behavior, there is no difference to the reference group from the children's perspective. Conclusion: Incorporating routine psychological assessment into pediatric health care can help improve understanding of the burden of illness, examine treatment outcomes, assess the quality of care, and tailor interventions to meet patient and parent needs. Involving the whole family can help develop appropriate and functional coping strategies. From our point of view, it is necessary to address parental needs and concerns as well in order to provide the best possible holistic development in the family system. The family is the basis for the children's successful development, especially for children with special health care needs.
Collapse
Affiliation(s)
- Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Dingemann
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - Michaela Dellenmark-Blom
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Julia Quitmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
18
|
Decke S, Deckert K, Lang M, Laub O, Loidl V, Schwettmann L, Grill E. "We're in good hands there." - Acceptance, barriers and facilitators of a primary care-based health coaching programme for children and adolescents with mental health problems: a qualitative study (PrimA-QuO). BMC FAMILY PRACTICE 2020; 21:273. [PMID: 33341115 PMCID: PMC7749989 DOI: 10.1186/s12875-020-01344-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
Background 11.5 % of girls and 17.8 % of boys are affected by a mental health problem (MHP). The most prevalent problem areas are behavioural problems (girls/boys in %: 11.9/17.9), emotional problems (9.7/8.6) and hyperactivity problems (4.8/10.8). Primary care paediatricians are the first in line to be contacted. Nevertheless, even for less severely affected patients, referral rates to specialised care are constantly high. Therefore, a major statutory health insurance fund introduced a Health Coaching (HC) programme, including a training concept for paediatricians, standardised guidelines for actions and additional payments to strengthen primary care consultation for MHP and to decrease referrals to specialised care. The aim of this study was to examine how the HC is perceived and implemented in daily practice to indicate potential strengths and challenges. Methods During a one-year period starting in November 2017, a series of guideline-based interviews were conducted by phone with HC-developers, HC-qualified paediatricians, parents and patients (≥14 years) treated according to the HC programme. Paediatricians were selected from a Bavarian practice network with a total of 577 HC qualified paediatricians. Parents of patients with the four most common MHP diagnoses were approached by their health insurance: [World Health Organization, 2013] developmental disorder of speech and language [Wille N, et al., 2008] head/abdominal pain (somatoform) [Holling H, et al., 2003-2006 and 2009-2012] conduct disorder [Plass-Christl A, et al., 2018] non-organic enuresis. 23 paediatricians, 314 parents and 10 adolescents consented to be interviewed. Potential participants were selected based on purposeful sampling, according to principles of maximum variance. All interviews were recorded and transcribed verbatim. Two researchers analysed the transcripts independently of each other. Structuring content analysis derived from Mayring was used for analysis. Results 11 paediatricians, 3 co-developers, 22 parents and 4 adolescents were included. Families were generally satisfied with paediatric care received in the programme’s context. The HC supported paediatricians’ essential role as consultants and improved their diagnostic skills. Lack of time, financial restrictions and patients’ challenging family structures were reported as major barriers to success. Conclusion The HC programme is perceived as a facilitator for more patient-centred care. However, structural barriers remain. Starting points for improvement are further options to strengthen families’ resources and expanded interdisciplinary networking. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01344-1.
Collapse
Affiliation(s)
- Siona Decke
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany. .,Pettenkofer School of Public Health, Munich, Germany.
| | | | - Martin Lang
- Berufsverband der Kinder- und Jugendärzte (BVKJ) e.V., Cologne, Germany.,PaedNetz Bayern e.V., Munich, Germany
| | - Otto Laub
- PaedNetz Bayern e.V., Munich, Germany
| | - Verena Loidl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management (IGM), Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany. .,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.
| |
Collapse
|
19
|
Boege I, Schepker R, Grupp D, Fegert JM. Kinder- und jugendpsychiatrische stationsäquivalente Behandlung (StäB): Therapieoption – für alle oder für wenige? ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:348-357. [DOI: 10.1024/1422-4917/a000711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Fragestellung: Aufsuchende stationsäquivalente Behandlung (StäB) ist seit dem 01.01.2017 in Deutschland möglich und seit dem 01.01.2018 abrechenbar. Dennoch wird StäB unter Infragestellung der Machbarkeit der Rahmenbedingungen derzeit nur an wenigen Standorten der Kinder- und Jugendpsychiatrie und Psychotherapie in Deutschland regelhaft angeboten. Ziel war es, anhand der ersten 58 stationsäquivalent behandelten Kinder und Jugendlichen am ZfP Südwürttemberg (2018–2019) die Machbarkeit und Kosten von StäB zu evaluieren. Methodik: Es wurden alle seit dem 01.01.2018 konsekutiv stationsäquivalent behandelten Fälle eingeschlossen und anhand von rein deskriptiven Analysen in SPSS.25 evaluiert. Ergebnisse: Die durchschnittliche Behandlungsdauer betrug 37.95 Tage (SD 15.35), 86.2 % aller Familien beendeten die Behandlung regelgerecht, es kam nur bei drei Patientinnen und Patienten zu einem einvernehmlichen Behandlungsabbruch, fünf mussten in eine stationäre Behandlung verlegt werden. Es wurden primär internalisierende Störungen indiziert (70.7 %), während externalisierende Störungen nur ein Viertel der Behandlungsfälle ausmachten (27.8 %). Kosten einer StäB beliefen sich im Durchschnitt auf 8779,25 €. Schlussfolgerungen: StäB stellt eine neue Behandlungsform im familiären Umfeld dar, welche täglich stattfindet. Multiprofessionalität der Behandlung ist Voraussetzung. Eine Umsetzung in den gegebenen Rahmenbedingungen ist möglich. Eine Akzeptanz von den Familien ist gegeben, die durchschnittliche Behandlungsdauer liegt leicht über dem stationären Bundesdurchschnitt.
Collapse
Affiliation(s)
- Isabel Boege
- ZfP Südwürttemberg, Akademisches Lehrkrankenhaus der Universität Ulm, Ravensburg, Deutschland
- KJPP Universität Ulm, Ulm, Deutschland
| | - Renate Schepker
- ZfP Südwürttemberg, Akademisches Lehrkrankenhaus der Universität Ulm, Ravensburg, Deutschland
| | - Dieter Grupp
- ZfP Südwürttemberg, Akademisches Lehrkrankenhaus der Universität Ulm, Ravensburg, Deutschland
| | | |
Collapse
|
20
|
Erickson SJ, Hile S, Kubinec N, Annett RD. Self-reported and parent proxy reported functional impairment among pediatric cancer survivors and controls. Health Qual Life Outcomes 2020; 18:142. [PMID: 32423481 PMCID: PMC7236514 DOI: 10.1186/s12955-020-01387-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 04/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background A unique and limiting component in the research on functional impairment among children has been the exclusive use of parent proxy reports about child functioning; and there is limited information regarding the impact of pediatric cancer treatment on children’s day-to-day functioning and how this is related to neurocognitive functioning. The objective of the current study was to examine a novel measure of self-reported functional impairment, and explore the relationship between self-reported and parent-reported child functional impairment in pediatric cancer survivors compared to controls. Methods A cross-sectional cohort of survivors (n = 26) and controls (n = 53) were recruited. Survivors were off treatment an average of 6.35 years (SD = 5.38; range 1–15 years) and demonstrated an average “medium” Central Nervous System treatment intensity score. Participants completed measures of functional impairment (FI), intellectual assessment (RIST) and executive functions (NIH Examiner), while parents reported on children’s functional impairment. Results Survivors were similar to controls in functional impairment. Regardless of group membership, self-reported FI was higher than parent-reported FI, although they were correlated and parent report of FI significantly predicted self-reported FI. Across groups, increased impairment was associated with four of seven Examiner scores. Conclusions Research regarding self-reported functional impairment of cancer survivors and its association with parent-reported functional impairment and neurocognitive deficits has been limited. Our results suggest that self-reported FI appears to be a reasonable and viable outcome measure that corresponds with and adds incremental validity to parent reported FI. While low treatment intensity may confer relative sparing of functional impairment among survivors, children report higher FI levels than parents, suggesting that FI can be of clinical utility. In conclusion, pediatric cancer survivors should be screened for self-reported functional difficulties.
Collapse
Affiliation(s)
- Sarah J Erickson
- Department of Psychology, Logan Hall, University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA.
| | | | - Nicole Kubinec
- Department of Psychology, Logan Hall, University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA
| | - Robert D Annett
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
21
|
Profitieren Kinder und Jugendliche mit unterschiedlichen Aufnahmegründen gleichermaßen von einer Heimunterbringung? Prax Kinderpsychol Kinderpsychiatr 2020; 69:218-235. [DOI: 10.13109/prkk.2020.69.3.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
22
|
The Perspective Matters: A Multi-informant Study on the Relationship Between Social-Emotional Competence and Preschoolers' Externalizing and Internalizing Symptoms. Child Psychiatry Hum Dev 2019; 50:1021-1036. [PMID: 31172334 DOI: 10.1007/s10578-019-00902-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recent research demands a multi-informant and multi-factorial assessment of preschool-age psychopathology. Based on a tripartite model, we tested the relationship between emotional and social competence and their contribution to externalizing and internalizing symptoms in a preschool-age community sample (N = 117, M = 4.67 years, SD = 2.75 months). We assessed teachers' (N = 109) and parents' (N = 77) perspective using the Strengths-and-Difficulties-Questionnaire and children's perspective using the Berkeley-Puppet-Interview and a standardized emotional-competence-test (MeKKi). We found externalizing symptoms being negatively related to prosocial behavior in teachers' and parents' reports and positively related to social initiative in teachers' reports. In teachers' reports only, a mediation effect of emotional competence via social competence on externalizing symptoms was shown. Children, but not caregivers, reported internalizing symptoms being positively related to prosocial behavior. These results highlight the importance of multiple informants and especially of children's self-perception in preschool-age psychopathology.
Collapse
|
23
|
Böge I, Schepker R, Fegert JM. [Intensive psychiatric care of children and adolescents in their natural environment : Alternatives to inpatient treatment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:195-204. [PMID: 30627734 DOI: 10.1007/s00103-018-2874-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mental health disorders are one of the main diseases in children and adolescents, the persistence rate into adulthood being around 50%. Early intervention is therefore essential. However, present treatment options reach only 50% of children and adolescents with mental health problems.The objective of this article is to depict why legal deficits complicated the establishment of outreach treatment in the past and to illustrate recent legal changes that now allow innovative outreach treatment programs that meet the need of children and adolescents with mental health issues.This review is based on pertinent publications that were retrieved by a selective literature search in PubMed and Cochrane Library concerning types of home treatment in child and adolescent psychiatry, with due reference to the authors' own experience with intensive home treatment.The literature shows that outreach work has been effective in many other countries. In Germany however, clear separation in finances between outpatient and inpatient treatment did not allow the establishment of outreach teams in the past. On 01.01.2017 a new law, the PsychVVG, entered into force, and now provides a sound legal basis for outreach work. Home treatment in the form of, for example, intensive outreach work that equals the intensity and frequency of inpatient treatment (StäB) or continuum of care school (CCSchool), a project that joins school-based diagnostic elements with school-based treatment, can now be installed and evaluated.Intensive outreach work, especially in child and adolescent psychiatry, will now be a good alternative to inpatient treatment that integrates parents into the treatment approach.
Collapse
Affiliation(s)
- Isabel Böge
- KJPP, Universität Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland. .,KJPP, ZfP Südwürttemberg, Weingartshoferstraße 2, 88214, Ravensburg, Deutschland.
| | - Renate Schepker
- KJPP, Universität Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland.,KJPP, ZfP Südwürttemberg, Weingartshoferstraße 2, 88214, Ravensburg, Deutschland
| | - Jörg M Fegert
- KJPP, Universität Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland
| |
Collapse
|
24
|
Stülb K, Messerli-Bürgy N, Kakebeeke TH, Arhab A, Zysset AE, Leeger-Aschmann CS, Schmutz EA, Meyer AH, Kriemler S, Jenni OG, Puder JJ, Munsch S. Prevalence and Predictors of Behavioral Problems in Healthy Swiss Preschool Children Over a One Year Period. Child Psychiatry Hum Dev 2019; 50:439-448. [PMID: 30368619 DOI: 10.1007/s10578-018-0849-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Behavioral problems impair children's health but prevalence rates are scarce and persistence rates vary due to divergence in age ranges, assessment methods and varying environmental factors. The aim of this study was to assess prevalence rates of behavioral problems, their persistence over a 1-year period, and the impact of child- and parent-related factors on behavioral problems. 555 2-6-year-old healthy preschool children were assessed at baseline and 382 of the initial sample at 1-year follow-up. Assessment included questionnaires concerning behavioral problems and their potential predictors (e.g. socio-economic status or parenting style). Altogether, nearly 7% of these children showed clinically relevant behavioral problems, and 3% showed persistent symptoms. Low SES, inconsistent parenting and corporal punishment were positively associated with behavioral problems. The prevalence rates of behavioral problems in Swiss preschoolers are similar to other European countries, but persistence is still rather low within preschool age. These findings need further confirmation in longitudinal studies.
Collapse
Affiliation(s)
- Kerstin Stülb
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.A. de Faucigny 2, 1700, Fribourg, Switzerland
| | - Nadine Messerli-Bürgy
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.A. de Faucigny 2, 1700, Fribourg, Switzerland.,Department of Psychology-Clinical Child Psychology and Biological Psychology, University of Fribourg, Rue P.A. de Faucigny 2, 1700, Fribourg, Switzerland.,Obstetric Service, Lausanne University Hospital, Ave de Sallaz 82, 1011, Lausanne, Switzerland
| | - Tanja H Kakebeeke
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Amar Arhab
- Obstetric Service, Lausanne University Hospital, Ave de Sallaz 82, 1011, Lausanne, Switzerland
| | - Annina E Zysset
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Claudia S Leeger-Aschmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Einat A Schmutz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Andrea H Meyer
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.A. de Faucigny 2, 1700, Fribourg, Switzerland.,Department for Psychology, University of Basel, Missionsstrasse 62A, 4055, Basel, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oskar G Jenni
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jardena J Puder
- Obstetric Service, Lausanne University Hospital, Ave de Sallaz 82, 1011, Lausanne, Switzerland
| | - Simone Munsch
- Department of Clinical Psychology and Psychotherapy, University of Fribourg, Rue P.A. de Faucigny 2, 1700, Fribourg, Switzerland.
| |
Collapse
|
25
|
Araz Altay M, Bozatlı L, Demirci Şipka B, Görker I. Current Pattern of Psychiatric Comorbidity and Psychotropic Drug Prescription in Child and Adolescent Patients. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E159. [PMID: 31108992 PMCID: PMC6572123 DOI: 10.3390/medicina55050159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/15/2019] [Accepted: 05/15/2019] [Indexed: 11/30/2022]
Abstract
Background: In recent years, patterns of the use of psychotropic drugs vary with increasing rates of psychiatric presentation and diagnosis in children and adolescents. Purpose: In this study, we aimed to investigate distributions of current psychiatric symptoms and diagnosis, patterns of the use of psychotropic drugs, and differences according to age and gender in patients presented to a child and adolescent outpatient clinic. Methods: All patients aged between 0 and 18 years presenting to a child and adolescent psychiatry outpatient clinic between November 1, 2017 and November 1, 2018 were included in the study. Files of all patients were examined in detail, and patients' demographic characteristics, symptoms, psychiatric diagnoses established according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), psychotropic drugs initiated, and side effect profiles were recorded. Psychiatric symptoms and diagnostic features of the patients were determined, and the differences were investigated according to gender. Clinical characteristics were compared between diagnosed and undiagnosed patients, and between patients with and without drug initiation. Results: Of the 2066 patients, 1298 (62.8%) were male and the mean age was 10.14 ± 4.42 years. The most common symptoms were hyperactivity (23.8%) and inattention (21.6%) in males, inattention (15.1%) and irritability (14.2%) in females, and 79% of the patients received one or more psychiatric diagnoses. The most common psychiatric diagnoses in both genders were attention-deficit hyperactivity disorder (ADHD), specific learning disorder (SLD), and conduct disorder, respectively. Of the patients who received a psychiatric diagnosis, 61.8% were using psychotropic drugs, with the majority of them (71.3%) receiving monotherapy. The most frequently initiated drugs included psychostimulants, antipsychotics, and antidepressants, with 28.7% of the drug user patients receiving multiple drug therapy. Conclusion: Our study indicates that rate of presentation to child and adolescent psychiatry outpatient clinics is increasing, and rates of diagnosis and initiation of psychiatry drugs are high among the presented children. The prevalence of ADHD shows an increase in males and females in our country, and psychiatric polypharmacy has reached significant rates.
Collapse
Affiliation(s)
- Mengühan Araz Altay
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine, 22030 Edirne, Turkey.
| | - Leyla Bozatlı
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine, 22030 Edirne, Turkey.
| | - Begüm Demirci Şipka
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine, 22030 Edirne, Turkey.
| | - Işık Görker
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine, 22030 Edirne, Turkey.
| |
Collapse
|
26
|
Huber L, Plötner M, Schmitz J. Social competence and psychopathology in early childhood: a systematic review. Eur Child Adolesc Psychiatry 2019; 28:443-459. [PMID: 29637284 DOI: 10.1007/s00787-018-1152-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/02/2018] [Indexed: 11/25/2022]
Abstract
The acquisition of social competence, such as showing prosocial behaviour (fulfilling others' needs) and social initiative (fulfilling own needs), constitutes one major developmental task in childhood and adolescence. Previous research suggests that in middle childhood, impaired social competences are related to childhood psychopathology, such as externalizing and internalizing disorders. As the period of preschool age is a particularly important time for both the development of social competence and early psychopathological symptoms, we conducted a systematic review to investigate the role of social competence in relation to early childhood psychopathology. Twenty-one clinical as well as subclinical studies published prior to September 2016 were included in a qualitative analysis of the relation between prosocial behaviour, social initiative, and early externalizing and internalizing symptoms in preschool age children (age 3-6). Effect sizes for each study were calculated if required information was available. Our review suggests that from early on in childhood development, externalizing symptoms are accompanied by prosocial behaviour deficits such as lower levels of helping or cooperating, whereas internalizing symptoms may be accompanied by either deficient or excessive levels of prosocial behaviour. Exhibiting social initiative such as initiating contact with others or communicating one's own needs seems to be impaired in children with internalizing symptoms. Implications for current theory and future research are discussed.
Collapse
Affiliation(s)
- Laura Huber
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, University of Leipzig, Neumarkt 9-19, 04109, Leipzig, Germany.
- Leipzig Research Centre for Early Childhood Development, University of Leipzig, Jahnallee 59, 04109, Leipzig, Germany.
| | - Maria Plötner
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, University of Leipzig, Neumarkt 9-19, 04109, Leipzig, Germany
- Leipzig Research Centre for Early Childhood Development, University of Leipzig, Jahnallee 59, 04109, Leipzig, Germany
| | - Julian Schmitz
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, University of Leipzig, Neumarkt 9-19, 04109, Leipzig, Germany
- Leipzig Research Centre for Early Childhood Development, University of Leipzig, Jahnallee 59, 04109, Leipzig, Germany
| |
Collapse
|
27
|
Eppelmann L, Parzer P, Lenzen C, Bürger A, Haffner J, Resch F, Kaess M. [Cluster-randomized, controlled evaluation of stress management training for high school students]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:497-504. [PMID: 29658822 DOI: 10.1024/1422-4917/a000577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cluster-randomized, controlled evaluation of stress management training for high school students Abstract. OBJECTIVE One fifth of German adolescents show elevated levels of mental health problems. The development of mental health problems is often closely related to experiences of stress. Hence, fostering competences in coping with stress offers an approach for counteracting the development of psychological problems. The aim of the present study is to test a stress management training of 3 x 90 minutes in a German high school, 11th grade. METHOD A cluster-randomized, controlled design was used. The primary outcome was stress. Secondary outcome criteria were knowledge about stress, coping behaviour, emotional and behavioural problems as well as health-related quality of life. Students from twenty-one courses from four schools participated in the study. RESULTS The sample comprised 286 students (58.25 % girls; mean age 16.58 ± 0.65). Changes in stress levels from pre- to post-evaluation did not differ significantly between intervention and control group. With regard to secondary criteria, apart from a significant increase in knowledge no further effects were observed. An exploratory moderation analysis hints at a positive association between baseline levels of stress and effectiveness of the training. CONCLUSIONS The results question whether the universal application of a brief cognitive behavioural intervention is appropriate to prevent stress in this population. Future research should, inter alia, investigate the potential of indicated prevention regarding stress.
Collapse
Affiliation(s)
- Lena Eppelmann
- 1 Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg
| | - Peter Parzer
- 1 Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg
| | - Christoph Lenzen
- 1 Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg
| | - Arne Bürger
- 2 Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg
| | - Johann Haffner
- 1 Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg
| | - Franz Resch
- 1 Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg
| | - Michael Kaess
- 1 Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg.,3 Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern
| |
Collapse
|
28
|
Posserud M, Hysing M, Helland W, Gillberg C, Lundervold AJ. Autism traits: The importance of "co-morbid" problems for impairment and contact with services. Data from the Bergen Child Study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:275-283. [PMID: 26826893 DOI: 10.1016/j.ridd.2016.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/08/2015] [Accepted: 01/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Co-occurring problems are common in individuals with clinical autism spectrum disorder (ASD) but their relevance for impairment and contact with health services in ASD is largely unexplored. AIMS We investigated the extent of co-occurring problems in children with high ASD traits from a total population sample. We explored the contribution of co-occurring problems to impairment and service contact, and whether there were children without co-occurring problems in this group; as proxy for "ASD only". METHODS AND PROCEDURES Children screening positive on the Autism Spectrum Screening Questionnaire (ASSQ) were used as proxy for ASD. Attention Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) were operationalised using symptom counts. A parent or teacher report above the 95th percentile counted as "problem" present for other symptom domains. OUTCOMES AND RESULTS 92% of ASSQ high-scorers had a minimum of two other problems. Emotional problems, ADHD symptoms and learning problems were the most commonly reported problems, also predicting impairment and contact with services. CONCLUSIONS AND IMPLICATIONS Co-occurring problems were common in ASD screen positive children and contributed strongly to both impairment and to contact with services. Gender differences indicated that female symptoms were perceived as less impairing by parents and teachers.
Collapse
Affiliation(s)
- M Posserud
- Department of Child and Adolescent Mental Health, Division of Psychiatry, Haukeland University Hospital, Norway.
| | - M Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Norway
| | - W Helland
- Section of Research and Innovation Helse Fonna HF, Haugesund, Norway; Department of Speech and Language Disorders, Statped Vest, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Norway
| | - C Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
| | - A J Lundervold
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Norway; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Norway
| |
Collapse
|
29
|
Aitken M, Martinussen R, Tannock R. Incremental Validity of Teacher and Parent Symptom and Impairment Ratings when Screening for Mental Health Difficulties. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:827-837. [PMID: 27448434 DOI: 10.1007/s10802-016-0188-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although universal screening for mental health difficulties is increasingly recognized as a way to identify children who are at risk and provide early intervention, little research exists to inform decisions about screening, such as the choice of informants and the type of information collected. The present study examined the incremental validity of teacher- and parent-rated (primarily mothers) symptoms and impairment in a non-referred sample of early elementary school children (n = 320, 49 % boys, ages 6 to 9) in terms of predicting impairment as rated by a different teacher 1 year later. Teacher-rated symptoms and impairment and parent-rated impairment were each unique predictors of later impairment; however, parent-rated symptoms did not contribute to the prediction of later impairment above and beyond these other indicators. The results indicate that, when screening for mental health difficulties in the school system, impairment ratings collected across settings add useful information, but it may not be necessary to use parent symptom ratings when teacher symptom ratings are available.
Collapse
Affiliation(s)
- Madison Aitken
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, 9th floor, Toronto, ON, M5S 1V6, Canada.
| | - Rhonda Martinussen
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, 9th floor, Toronto, ON, M5S 1V6, Canada
| | - Rosemary Tannock
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, 9th floor, Toronto, ON, M5S 1V6, Canada.,Neurosciences and Mental Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| |
Collapse
|
30
|
Kachi Y, Abe A, Ando E, Kawada T. Socioeconomic disparities in psychological distress in a nationally representative sample of Japanese adolescents: A time trend study. Aust N Z J Psychiatry 2017; 51:278-286. [PMID: 27553359 DOI: 10.1177/0004867416664142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Socioeconomic status as a determinant of mental health problems has received scant attention in Japan, which has long been considered an egalitarian society. This study examined the association between socioeconomic status and psychological distress and its trends over 6 years among Japanese adolescents. METHODS We used data from a nationally representative sample of 9491 adolescents aged 12-18 years who participated in three repeated cross-sectional surveys between 2007 and 2013. The K6 scale was used to assess psychological distress. Socioeconomic status indicators included household income, parental education, parental working status and household structure. RESULTS Psychological distress prevalence decreased significantly from 2007 (10.7%) to 2013 (7.6%). However, the socioeconomic status patterns of psychological distress were consistent through the study period. Adolescents living in both lower (odds ratio = 1.61; 95% confidence interval = [1.27, 2.05]) and higher income households (odds ratio = 1.30; 95% confidence interval = [1.03, 1.62]) were more likely to report psychological distress than their middle-income counterparts. Adolescents with low household income were more likely to feel stress from interpersonal relationships and less likely to have help-seeking behaviors, while those with high household income were more likely to feel stress about school achievement. Psychological distress was also associated with parental poor education and single parenthood. CONCLUSIONS Socioeconomic status disparities in adolescent psychological distress were evident and consistent during the 6-year period. There is a unique U-shaped relationship between household income and psychological distress among adolescents in Japan, unlike those from other countries. However, the underlying mechanisms may differ by income status. Future prevention efforts should consider socioeconomic status as a determinant of adolescent mental health problems.
Collapse
Affiliation(s)
- Yuko Kachi
- 1 Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Aya Abe
- 2 School of Humanities and Social Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Emiko Ando
- 3 Department of Mental Health, The University of Tokyo, Tokyo, Japan
| | - Tomoyuki Kawada
- 1 Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
31
|
Schell A, Albers L, von Kries R, Hillenbrand C, Hennemann T. Preventing Behavioral Disorders via Supporting Social and Emotional Competence at Preschool Age. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:647-54. [PMID: 26479484 DOI: 10.3238/arztebl.2015.0647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND 13-18% of all preschool children have severe behavioral problems at least transiently, sometimes with long-term adverse consequences. In this study, the social training program "Lubo aus dem All! - Vorschulalter" (Lubo from Outer Space, Preschool Version) was evaluated in a kindergarten setting. METHODS 15 kindergartens were randomly assigned to either an intervention group or a control group, in a 2:1 ratio. The intervention was designed to strengthen emotional knowledge and regulation, the ability to take another person's point of view, communication skills, and social problem solving. The control group continued with conventional kindergarten activities. The primary endpoint was improvement in social-cognitive problem solving strategies, as assessed with the Wally Social Skills and Problem Solving Game (Wally). Secondary endpoints were improvement in prosocial behavior and reduction in problematic behavior, as assessed with the Preschool Social Behavior Questionnaire (PSBQ) and the Caregiver-Teacher Report Form (C-TRF). Data were collected before and after the intervention and also 5 months later. Mixed models were calculated with random effects to take account of the cluster design and for adjustment for confounding variables. RESULTS 221 children in kindergarten, aged 5-6 years, were included in the study. Randomization was unsuccessful: the children in the intervention group performed markedly worse on the tests carried out before the intervention. Five months after the end of the intervention, the social-cognitive problem solving strategies of the children in the intervention group had improved more than those of the children in the control group: the intergroup difference in improvement was 0.79 standard deviations of the Wally test (95% confidence interval [CI] 0.13-1.46). This effect was just as marked 5 months later (0.63, 95% CI 0.03-1.23). Prosocial behavior, as measured by the PSBQ, also improved more in the intervention group, with an intergroup difference of 0.37 standard deviations (95% CI 0.05-0.71). CONCLUSION An age-appropriate program to prevent behavioral disorders among kindergarten children improved both the children's knowledge of prosocial problem solving strategies and their prosocial behavior.
Collapse
Affiliation(s)
- Annika Schell
- Department of Special Needs Education and Rehabilitation, Carl von Ossietzky University of Oldenburg, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Faculty of Human Sciences, University of Cologne
| | | | | | | | | |
Collapse
|
32
|
Gustafsson BM, Gustafsson PA, Proczkowska-Björklund M. The Strengths and Difficulties Questionnaire (SDQ) for preschool children-a Swedish validation. Nord J Psychiatry 2016; 70:567-74. [PMID: 27241951 DOI: 10.1080/08039488.2016.1184309] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Sweden, 80-90% of children aged 1-5 years attend preschool, and that environment is well suited to identify behaviours that may be signs of mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is a well-known short and structured instrument measuring child behaviours that indicate mental health problems well suited for preschool use. AIM To investigate whether SDQ is a reliable and valid instrument for identifying behavioural problems in children aged 1-3 years and 4-5 years in a Swedish population, as rated by preschool teachers. METHODS Preschools situated in different sized municipalities in Sweden participated. The preschool teacher rated each individual child. Concurrent validity was tested using the Child-Teacher Report Form (C-TRF) and Child Engagement Questionnaire (CEQ). Exploratory factor analysis was conducted for age groups, 1-3 years and 4-5 years. RESULTS The preschool teachers considered most of the SDQ items relevant and possible to rate. For the children aged 1-3 years, the subscales 'Hyperactivity' (Cronbach alpha = 0.84, split half = 0.73) and 'Conduct' (Cronbach alpha = 0.76, split half = 0.80) were considered to be valid. For the age group 4-5 years, the whole original SDQ scale, 4-factor solution was used and showed reasonable validity (Cronbach alpha = 0.83, split half = 0.87). CONCLUSION SDQ can be used in a preschool setting by preschool teachers as a valid instrument for identifying externalizing behavioural problems (hyperactivity and conduct problems) in young children. CLINICAL IMPLICATIONS SDQ could be used to identify preschool children at high-risk for mental health problems later in life.
Collapse
Affiliation(s)
- Berit M Gustafsson
- a Center for Social and Affective Neuroscience Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden ;,b Child Psychiatric Clinic, Högland Hospital , Division of Psychiatrics & Rehabilitation/Region Jönköping , Sweden ;,e CHILD research environment , Jönköping University , Sweden
| | - Per A Gustafsson
- a Center for Social and Affective Neuroscience Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden ;,c Department of Child and Adolescent Psychiatry , Linköping University , Linköping , Sweden
| | - Marie Proczkowska-Björklund
- a Center for Social and Affective Neuroscience Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden ;,d Psychiatric Clinic, Hospital of Jönköping , Division of Psychiatrics & Rehabilitation/Jönköping Country , Sweden
| |
Collapse
|
33
|
Reigstad B, Kvernmo S. Concurrent adversities among adolescents with conduct problems: the NAAHS study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1429-1438. [PMID: 27352358 DOI: 10.1007/s00127-016-1258-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Several studies have confirmed that maltreatment and abuse in childhood are related to conduct problems. Less is known about such relationships with concurrent adversities in adolescence and, also, when compared with other severe adversities and possible multiple additive effects. METHODS The study encompassed a community population of 4881 adolescents 15-16 years of age 50.1 % boys and 49.9 % girls. Youth with and without conduct problem scores within the deviant range on the Strength and Difficulties Questionnaire (SDQ) was compared on 12 concurrent adversities. RESULTS Based on self-reports, 4.4 % of the adolescents had conduct problem scores within the deviant range and more girls (5.1 %) than boys (3.7 %). In the deviant conduct problem group, 65.1 % had experienced two or more concurrent adversities compared with 26.3 % of youths in the non-deviant group (OR 5.23, 95 % CI 3.91-7.01). Likewise, the deviant conduct problem group was from 1.71 to 8.43 times more at the risk of experiencing the different adversities. Parental mental health problems and experiences of violence were multivariately strongest associated with conduct problem scores within the deviant range on the SDQ. A strong multiple additive relationship with adversities was found. CONCLUSIONS Two-thirds of youth with SDQ conduct problem scores within the deviant range reported two or more concurrent adversities. Clinicians should seek information about kinds and amount of possible traumatic adversities in youth with conduct problems and offer evidence based treatment.
Collapse
Affiliation(s)
- Bjørn Reigstad
- Division of Research and Patient Safety, Department of Research, Nordlandssykehuset, 8092, Bodø, Norway.
| | - Siv Kvernmo
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
34
|
Wlodarczyk O, Pawils S, Metzner F, Kriston L, Wendt C, Klasen F, Ravens-Sieberer U. Mental Health Problems Among Preschoolers in Germany: Results of the BELLA Preschool Study. Child Psychiatry Hum Dev 2016; 47:529-38. [PMID: 26353908 DOI: 10.1007/s10578-015-0586-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In a cross-sectional study, the prevalence rates of overall and specific mental health problems (MHP), as well as consequential impairments, were examined in a representative community sample of German preschoolers. MHP in 391 children were assessed by applying the Strength and Difficulties Questionnaire, as well as its impact supplement. Furthermore, the child behaviour checklist 1½-5 (CBCL 1½-5) and the IOWA-Conners behaviour rating scale were applied. Prevalence rates of MHP with 95 % confidence intervals (95 % CI) were determined. Odds ratios were calculated to analyse the relationships between MHP, age, gender, socioeconomic status, and geographical region using logistic regression. Overall, 7.4 % of the children showed symptoms of MHP. 12.9 % of the children were considered to be impaired by psychosocial problems. Depressive and anxiety symptoms were present in 4.2 % of the children; 11.8 % showed hyperactivity symptoms. The observed prevalence rates call for early mental health prevention in preschoolers.
Collapse
Affiliation(s)
- Olga Wlodarczyk
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (W26), 20246, Hamburg, Germany.
| | - Silke Pawils
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (W26), 20246, Hamburg, Germany
| | - Franka Metzner
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (W26), 20246, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (W26), 20246, Hamburg, Germany
| | - Carolin Wendt
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52 (W26), 20246, Hamburg, Germany
| | - Fionna Klasen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
35
|
Dang HM, Weiss B, Trung LT. Functional impairment and mental health functioning among Vietnamese children. Soc Psychiatry Psychiatr Epidemiol 2016; 51:39-47. [PMID: 26315942 PMCID: PMC4724307 DOI: 10.1007/s00127-015-1114-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 08/12/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Functional impairment is a key indicator of need for mental health services among children and adolescents, often a stronger predictor of service usage than mental health symptoms themselves. Functional impairment may be of particular importance in low- and middle-income countries (LMIC) because of its potential to focus policy on treatment of child mental health problems which is generally given low priority in LMIC. However, few studies have assessed functional impairment in LMIC. The present study assessed rates of functional impairment among children in Vietnam, as a case example of an LMIC, as well as effects of other risk/protective factors of particular relevance to LMIC (e.g., whether the family lived in an urban or rural area; family structure variables such as grandparents living with the family). METHODS 1314 parents of children 6-16 years old from 10 Vietnamese provinces were interviewed. RESULTS The overall rate of functional impairment among Vietnamese children was 20 %, similar to rates in high-income countries such as Germany and the United States, suggesting that LMIC status may not be associated with dramatic increases in functional impairment in children. Functional impairment was significantly greater among mental health cases than non-cases, with increases of over 550 % associated with mental health caseness. A number of other risk factors (e.g., marital status) had smaller but significant effects. CONCLUSIONS Mental health problems are a major but not the sole contributor to functional impairment among Vietnamese children. The pragmatic significance of this research lies in its potential to affect public awareness and policy related to child mental health in LMIC.
Collapse
Affiliation(s)
- Hoang-Minh Dang
- Vietnam National University, 144 Xuan Thuy Road, Cau Giay District, Hanoi, Vietnam.
| | - Bahr Weiss
- Vanderbilt University, Nashville, Tennessee, USA
| | | |
Collapse
|
36
|
Hintzpeter B, Klasen F, Schön G, Voss C, Hölling H, Ravens-Sieberer U. Mental health care use among children and adolescents in Germany: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 2015; 24:705-13. [PMID: 25651821 DOI: 10.1007/s00787-015-0676-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
Data on mental health care use of children and adolescents in Germany is scarce. This study investigates the degree of mental health care use, its trajectories and influencing factors among children and adolescents in Germany, using longitudinal data of the BELLA study. The BELLA study is the mental health module of the representative German National Health Interview and Examination Survey for children and adolescents (KiGGS). Baseline data of N = 2,863 participants aged 7-17 years were collected between 2003 and 2006. The study sample was followed up in three additional measurement points, assessing general mental health problems and impairment, specific mental health problems, and mental health care use. In the current study, we analysed data from the first three measurement points. At baseline, 5.9 % of all participants used mental health care in the past 12 months. Among those with general mental health problems, 29.5 % sought professional help. Only a minority of participants reporting mental health care use at baseline also sought help at the following two measurement points. Analysing a random intercept only model, mental health care use was found to be more likely among participants living in larger communities as well as in the Eastern part of Germany, among those participants with impairment of mental health problems, and signs of externalizing problems. Our results indicate a temporary character of mental health care use. Participants' impairment was identified to be the strongest predictor of mental health care use.
Collapse
Affiliation(s)
- Birte Hintzpeter
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND Increasing mental health treatment of young people and broadening conceptualizations of psychopathology have triggered concerns about a disproportionate increase in the treatment of youths with low levels of mental health impairment. METHODS We analyzed the 1996-1998, 2003-2005, and 2010-2012 Medical Expenditure Panel Surveys, which were nationally representative surveys of U.S. households, for trends in outpatient use of mental health services by persons 6 to 17 years of age; 53,622 persons were included in the analysis. Mental health impairment was measured with the use of the Columbia Impairment Scale (range, 0 to 52, with higher scores indicating more severe impairment); we classified youths with scores of 16 or higher as having more severe impairment and those with scores of less than 16 as having less severe impairment. RESULTS The percentage of youths receiving any outpatient mental health service increased from 9.2% in 1996-1998 to 13.3% in 2010-2012 (odds ratio, 1.52; 95% confidence interval, 1.35 to 1.72). The proportionate increase in the use of mental health services among youths with more severe impairment (from 26.2% to 43.9%) was larger than that among youths with less severe or no impairment (from 6.7% to 9.6%). However, the absolute increase in annual service use was larger among youths with less severe or no impairment (from 2.74 million to 4.19 million) than among those with more severe impairment (from 1.56 million to 2.28 million). Significant overall increases occurred in the use of psychotherapy (from 4.2% to 6.0%) and psychotropic medications (from 5.5% to 8.9%), including stimulants and related medications (from 4.0% to 6.6%), antidepressants (from 1.5% to 2.6%), and antipsychotic drugs (from 0.2% to 1.2%). CONCLUSIONS Outpatient mental health treatment and psychotropic-medication use in children and adolescents increased in the United States between 1996-1998 and 2010-2012. Although youths with less severe or no impairment accounted for most of the absolute increase in service use, youths with more severe impairment had the greatest relative increase in use, yet fewer than half accessed services in 2010-2012. (Funded by the Agency for Healthcare Research and Quality and the New York State Psychiatric Institute.).
Collapse
Affiliation(s)
- Mark Olfson
- From the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute - both in New York (M.O.); the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (B.G.D.); and the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and the School of Social Practice and Policy, University of Pennsylvania - both in Philadelphia (S.C.M.)
| | | | | |
Collapse
|
38
|
Seyf Hashemi M, Yarian E, Bahadoran P, Jandaghi J, Mirmohammad Khani M. Prevalence of Mental Health Problems in Children and Its Associated Socio-Familial Factors in Urban Population of Semnan, Iran (2012). IRANIAN JOURNAL OF PEDIATRICS 2015. [PMID: 26195992 PMCID: PMC4505996 DOI: 10.5812/ijp.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The World Health Organization (WHO) defines mental health as “a state of well-being in which every individual realizes own potential, can cope with the normal pressures of life, is able to work effectively, and can make a contribution to community”. Objectives: Mental Health Problems (MHP) is a great concern for all societies in terms of its burden and impact. This survey screened MHP and its impact in an Iranian urban population aged 6 - 12 years old, and explored its associated socio-familial factors. Patients and Methods: The survey was conducted in the elementary schools of Semnan, using random cluster sampling. Collection and analysis of data was performed using the parent version of the “Strengths and Difficulties Questionnaire (SDQ)” and survey commands of Stata-nine, taking into account cluster effect and population weights. Associations were assessed by fitting simple and multiple logistic regression models. P < 0.05 was considered significant. Results: With regard to the SDQ total score, 19.3% (95% CI: 8.6, 30.1) scored above the normal threshold (9.6% abnormal, 9.7% borderline). The frequency of problems ranged between 16.1% (peer problems) and 8.4% (emotional symptoms), and in all subscales boys were affected more than girls. The impact score was abnormal in 68.4% of all children, and was greater in girls than in boys. “A previously diagnosed mental health disorder” (OR = 11.11, 95% CI: 5.55, 25.00), “male gender” (OR = 1.43, 95% CI: 1.10, 1.87 and “less time spent with the child by father” (OR = 1.61, 95% CI: 1.20, 2.17) were significantly associated with an abnormal SDQ. Conclusions: The high rate of MHP in 6 - 12 year-old children and the lack of any significant correlation with their age, underpins the importance of early screening for MHP in schools, with particular focus on high risk groups.
Collapse
Affiliation(s)
- Maryam Seyf Hashemi
- Department of Pediatrics, Semnan University of Medical Sciences, Semnan, IR Iran
| | - Elham Yarian
- Department of Pediatrics, Semnan University of Medical Sciences, Semnan, IR Iran
| | | | - Jafar Jandaghi
- Department of Pediatrics, Semnan University of Medical Sciences, Semnan, IR Iran
| | - Majid Mirmohammad Khani
- Department of Epidemiology, Semnan University of Medical Sciences, Semnan, IR Iran
- Department of Community Medicine , Research Centre for Social Determinants of Health, School of Medicine, Semnan University of Medical Sciences, Semnan, IR Iran
- Corresponding author: Majid Mirmohammad Khani, Department of Community Medicine ,Research Centre for Social Determinants of Health, School of Medicine, Semnan University of Medical Sciences, Semnan, IR Iran, E-mail:
| |
Collapse
|
39
|
Hölling H, Schlack R, Petermann F, Ravens-Sieberer U, Mauz E. [Psychopathological problems and psychosocial impairment in children and adolescents aged 3-17 years in the German population: prevalence and time trends at two measurement points (2003-2006 and 2009-2012): results of the KiGGS study: first follow-up (KiGGS Wave 1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:807-19. [PMID: 24950830 DOI: 10.1007/s00103-014-1979-3] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Child and adolescent mental health problems burden not only the individual, but also their families and their social environment and may, therefore, be regarded as a highly relevant public health issue. The data on mental health problems of children and adolescents from the KiGGS Wave 1 study (sample period 2009-2012) make it possible to report on both current prevalence rates and time trends over the 6-year period beginning with the KiGGS baseline survey (2003-2006). The assessment of emotional and behavioral problems in KiGGS Wave 1 was carried out with the symptoms questionnaire of the Strengths and Difficulties Questionnaire (SDQ) in a telephone interview with 10,353 guardians of children and adolescents aged 3-17 years. Moreover, using the SDQ impact supplement, the KIGGS Wave 1 data provide information on psychosocial impairment following child and adolescent mental health problems. Subjects with a borderline or abnormal SDQ score, according to German normative data, were considered at risk. A total of 20.2% (95% CI: 18.9-21.6%) of the study subjects were identified as being at risk for a mental health disorder, compared with 20.0% (19.1-20.9%) during the KiGGS baseline study (age-standardized based on population from 12 December 2010). Thus, no significant changes over time in the prevalence of mental health problems were detected. Also, there were no statistically significant differences in prevalence by sex, age group, or socioeconomic status between the KiGGS baseline survey and KiGGS Wave 1. The statistical comparison of the subscale mean values for both girls and boys showed higher values with respect to the subscales for emotional problems, behavioral problems, and prosocial behavior and lower mean values for the peer problems subscale in KiGGS Wave 1. These partly small temporal trends, however, may be due to possible mode effects (written questionnaire in the KiGGS baseline study versus telephone interview in KiGGS Wave 1). The hyperactivity subscale remained stable across the two sample periods. Regarding impairments following mental health problems at the second sample period, boys were more affected in the areas of chronicity, family burden, and impact score. The high and stable prevalence rates and magnitude of emotional and behavioral problems should prompt increased preventive efforts.
Collapse
Affiliation(s)
- H Hölling
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Straße 62-66, 12101, Berlin, Deutschland,
| | | | | | | | | |
Collapse
|
40
|
Lai KYC, Leung PWL, Luk ESL, Wong ASL. Use of the extended Strengths and Difficulties Questionnaire (SDQ) to predict psychiatric caseness in Hong Kong. Child Psychiatry Hum Dev 2014; 45:703-11. [PMID: 24488045 DOI: 10.1007/s10578-014-0439-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The extended Strengths and Difficulties Questionnaire (SDQ) provides information on problem behaviours and impairment measures. Western studies found impairment measures to be as good as symptom scores in predicting clinical caseness. The high levels of comorbidities among child psychiatric disorders also meant that disorders not specifically captured by the questionnaire could be identified. This study examines its applicability among Chinese school children in Hong Kong. Results found that impairment measures were more predictive of clinical status than were symptom scores. Children with low symptom but high impairment ratings had profiles that were intermediate between the low symptom low impairment and high symptom low impairment groups. The extended SDQ is useful in identifying children who might otherwise be missed if symptom scores alone were used in screening. The acceptance of child psychiatric care in Hong Kong is a multi-step process that depends on how symptoms are perceived.
Collapse
Affiliation(s)
- Kelly Y C Lai
- Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong,
| | | | | | | |
Collapse
|
41
|
Crutzen R, Bosma H, Havas J, Feron F. What can we learn from a failed trial: insight into non-participation in a chat-based intervention trial for adolescents with psychosocial problems. BMC Res Notes 2014; 7:824. [PMID: 25409911 PMCID: PMC4247599 DOI: 10.1186/1756-0500-7-824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/06/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psychosocial problems are highly prevalent among Dutch adolescents. We have conducted a trial to test whether offering chat-based consultations could be of added value within the context of Dutch Youth Health Care. This trial was ended prematurely because of recruitment issues. The aim of this study is to learn from this failed trial and to provide more insight into non-participation. Sources of data were non-participation forms, oral clarification, patient records, telephone interviews with adolescents that declined to participate, and a questionnaire-based process evaluation among nurses. RESULTS Non-participation appears to be a multi-factorial problem. Of those 290 adolescents eligible to participate, the majority (n = 165, 57%) declined to do so. Two-third of those (n = 109) also refused usual care, which might be indicative of not wanting help and/or experiencing problems and the validity of the assessment instrument. The other one-third (n = 56) did enrol in usual care and indicated other reasons for non-participation, such as a preference for face-to-face consultations, the extensive information that was provided, and not liking the idea of being randomized. CONCLUSIONS This study shows that even if a trial fails, we can learn about the challenges of recruiting adolescents in intervention trials. TRIAL REGISTRATION NL37668.068.11/METC11-3-077.
Collapse
Affiliation(s)
- Rik Crutzen
- />Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Hans Bosma
- />Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jano Havas
- />Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- />Youth Health Care Division, Regional Public Health Service GGD Zuid Limburg, Geleen, The Netherlands
| | - Frans Feron
- />Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- />Youth Health Care Division, Regional Public Health Service GGD Zuid Limburg, Geleen, The Netherlands
| |
Collapse
|
42
|
Bendiksen B, Aase H, Svensson E, Friis S, Myhre AM, Reichborn-Kjennerud T, Zeiner P. Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2014-014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
43
|
ADad 10: the impairment in Anxiety Disorders among adolescents in a rural community population in India. Indian J Pediatr 2013; 80 Suppl 2:S181-5. [PMID: 24043515 DOI: 10.1007/s12098-013-1213-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES There is significant paucity of studies on the impairment associated with Anxiety Disorders (AD) among adolescents. This study focuses on the prevalence and pattern of impairment as well as impairment in the context of severity of AD, co-morbidities, suicide, age and gender in this population. METHODS In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders (SCARED) and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime to collect the required data. Descriptive statistics and Chi-square tests were done to evaluate the prevalence and profile of impairment, compare the impairment among different types of AD, severity of AD, number of co-morbidities, age and gender on impairment, effect of impairment on the need for suicide prevention. RESULTS Impairment in adolescents with AD was a rule, noted in 94.4%. Irrespective of the type of AD diagnosed, impairment at home was significant in adolescents with AD. The presentation of impairment among different Anxiety Disorders was different with different functional settings. Severity of AD and the number of co-morbidities was related to the impairment. Need for suicide related interventions were not different in those with and without impairment. Age and gender did not influence the presence of impairment. CONCLUSIONS Anxiety Disorders among adolescents in India result in significant functional impairment. Clinically, in this population assessment of impairment is required. Community policies and plans should have special management strategy to address impairment in adolescents with Anxiety Disorders.
Collapse
|
44
|
Huculak S, McLennan JD. Using Teacher Ratings to Assess the Association Between Mental Health Symptoms and Impairment in Children. SCHOOL MENTAL HEALTH 2013. [DOI: 10.1007/s12310-013-9107-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
45
|
Fuchs S, Klein AM, Otto Y, von Klitzing K. Prevalence of emotional and behavioral symptoms and their impact on daily life activities in a community sample of 3 to 5-year-old children. Child Psychiatry Hum Dev 2013; 44:493-503. [PMID: 23111504 DOI: 10.1007/s10578-012-0343-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the study was to evaluate prevalence and impact of behavioral/emotional symptoms in preschoolers. The sample comprised 1,738 preschoolers with an age range between 37 and 63 months. Parents rated children's symptoms using the Strengths and Difficulties Questionnaire (SDQ) and the impact of perceived difficulties using the impact supplement of the SDQ. The prevalence of a total difficulties score in an abnormal/borderline range was 16.0 % that means lower than rates in schoolchildren. 8.6 % of the preschoolers were rated as symptomatic (borderline/abnormal) and their symptoms were rated as having some or considerable impact on their lives. Parents mostly reported problems of hyperactivity/inattention and their interference with learning abilities. All symptoms scales of the SDQ, except prosocial behavior, significantly explained impact of perceived difficulties. Parents of boys rated significantly higher levels of symptoms and impact. Low parental education was associated with more symptoms and higher impact.
Collapse
Affiliation(s)
- Sandra Fuchs
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
| | | | | | | |
Collapse
|
46
|
Fuchs M, Bösch A, Hausmann A, Steiner H. [«The child is father of the man» - review of literature on epidemiology in child and adolescent psychiatry]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013; 41:45-55; quiz 56-7. [PMID: 23258437 DOI: 10.1024/1422-4917/a000209] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
One of the goals of epidemiological research is to describe the frequency and patterns in the distribution of diseases among certain groups of a statistical population. According to the literature available, mental disorders in children and adolescents are a common phenomenon worldwide. This article provides a review of the most important and recent international studies on the magnitude, on patterns of distribution, on the course and on gender differences of psychiatric disorders in children and adolescents. Additional data from scientific textbooks are added to the original articles.
Collapse
Affiliation(s)
- Martin Fuchs
- Department Psychiatrie und Psychotherapie, Medizinische Universität Innsbruck, Innsbruck, Österreich.
| | | | | | | |
Collapse
|
47
|
Rapee RM, Bőgels SM, van der Sluis CM, Craske MG, Ollendick T. Annual research review: conceptualising functional impairment in children and adolescents. J Child Psychol Psychiatry 2012; 53:454-68. [PMID: 22067073 DOI: 10.1111/j.1469-7610.2011.02479.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Functional impairment is a key factor in the clinical importance of mental health problems in children. Yet, the nature of impairment and criteria for defining and assessing impairment in childhood disorders has been surprisingly overlooked in much of the literature. The current article examines the extant literature on the conceptualisation, nature and assessment of impairment in childhood disorders. Relations between diagnostic symptoms and functional impairment are discussed together with the influence of impairment on diagnostic decisions and prevalence rates. Several factors influencing impairment in childhood such as culture, development and gender are considered. This article concludes with a discussion of the utility of separating judgements of impairment from specific diagnoses, which is proposed for consideration in the forthcoming DSM-5.
Collapse
Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia University of Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
48
|
The influence of parental education on child mental health in Spain. Qual Life Res 2012; 22:203-11. [DOI: 10.1007/s11136-012-0130-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2012] [Indexed: 01/31/2023]
|
49
|
Abstract
OBJECTIVE To review evidence of trauma and exile-related mental health in young refugees from the Middle East. METHOD A review of four empirical studies: i) a qualitative study of 11 children from torture surviving families, ii) a cohort study of 311 3-15-year-old asylum-seeking children, iii) a qualitative study of 14 members of torture surviving families and iv) a follow-up study of 131 11-23-year-old refugees. RESULTS The reactions of the children were not necessarily post-traumatic stress disorder specific. Seventy-seven per cent suffered from anxiety, sleep disturbance and/or depressed mood at arrival. Sleep disturbance (prevalence 34%) was primarily predicted by a family history of violence. At follow-up, 25.9% suffered from clinically relevant psychological symptoms. Traumatic experiences before arrival and stressful events in exile predicted internalizing behaviour, witnessing violence and frequent school changes in exile predicted externalizing behaviour. School participation, Danish friends, language proficiency and mother's education predicted less long-term psychological problems. CONCLUSION Psychological problems are frequent in refugee children, but the extents are reduced over time in exile. Traumatic experience before arrival is most important for the short-term reaction of the children while aspects of life in exile are important for the children's ability to recover from early traumatization.
Collapse
Affiliation(s)
- E Montgomery
- Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark.
| |
Collapse
|
50
|
Al-Fayez GA, Ohaeri JU. Profile of subjective quality of life and its correlates in a nation-wide sample of high school students in an Arab setting using the WHOQOL-Bref. BMC Psychiatry 2011; 11:71. [PMID: 21518447 PMCID: PMC3098152 DOI: 10.1186/1471-244x-11-71] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 04/25/2011] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The upsurge of interest in the quality of life (QOL) of children is in line with the 1989 Convention on the Rights of the Child, which stressed the child's right to adequate circumstances for physical, mental, and social development. The study's objectives were to: (i) highlight how satisfied Kuwaiti high school students were with life circumstances as in the WHOQOL-Bref; (ii) assess the prevalence of at risk status for impaired QOL and establish the QOL domain normative values; and (iii) examine the relationship of QOL with personal, parental, and socio-environmental factors. METHOD A nation-wide sample of students in senior classes in government high schools (N = 4467, 48.6% boys; aged 14-23 years) completed questionnaires that included the WHOQOL-Bref. RESULTS Using Cummins' norm of 70% - 80%, we found that, as a group, they barely achieved the well-being threshold score for physical health (70%), social relations (72.8%), environment (70.8%) and general facet (70.2%), but not for psychological health (61.9%). These scores were lower than those reported from other countries. Using the recommended cut-off of <1SD of population mean, the prevalence of at risk status for impaired QOL was 12.9% - 18.8% (population age-adjusted: 15.9% - 21.1%). In all domains, boys had significantly higher QOL than girls, mediated by anxiety/depression; while the younger ones had significantly higher QOL (p < 0.001), mediated by difficulty with studies and social relations. Although poorer QOL was significantly associated with parental divorce and father's low socio-economic status, the most important predictors of poorer QOL were perception of poor emotional relationship between the parents, poor self-esteem and difficulty with studies. CONCLUSION Poorer QOL seemed to reflect a circumstance of social disadvantage and poor psychosocial well-being in which girls fared worse than boys. The findings indicate that programs that address parental harmony and school programs that promote study-friendly atmospheres could help to improve psychosocial well-being. The application of QOL as a school population health measure may facilitate risk assessment and the tracking of health status.
Collapse
Affiliation(s)
- Ghenaim A Al-Fayez
- Department of Psychiatry, Faculty of Medicine, Kuwait University, Kuwait
| | - Jude U Ohaeri
- Department of Psychiatry, Psychological Medicine Hospital, Gamal Abdul Naser Road, P.O. Box 4081, Safat, Kuwait
| |
Collapse
|