Life events and child psychiatric disorders

Assessing Life Stressors and Social Resources among Adolescents

A growing body of evidence points to the importance of life stressors and social resources in adolescent functioning. This article describes the Life Stressors and Social Resources Inventory-Youth Form (LISRES-Y), which provides an integrated assessment of life stressors and social resources in eight domains: physical health, home/money, parent, sibling, extended family, school, friend, and boy/girlfriend. The indices were developed on data obtained from four groups of youth: depressed youth, youth with conduct disorder, youth with rheumatic disease, and healthy youth. As expected, depressed youth reported more acute and chronic stressors and fewer social resources than did healthy youth. In addition, the indices were predictably associated with individual differences in depressed mood, anxiety, behavior problems, and self-confidence. Negative life events, ongoing stressors in different domains, and stable social resources all contributed unique variance to the functioning criteria. The findings point to the value of an integrated measure of adolescent life context.

The prevalence of potentially traumatic events in childhood and adolescence

This paper examines exposure to potentially traumatic events from middle childhood through adolescence, and vulnerability to such exposure. Analyses are based on the first 4 annual waves of data from a longitudinal general population study of youth in western North Carolina, involving 4,965 interviews with 1,420 children and adolescents and their parents or guardians. Participants reported on DSM extreme stressors ("high magnitude events"), other potentially traumatic events ("low magnitude events"), and background vulnerability factors. In this general population sample, one-quarter experienced at least one high magnitude event by age 16, 6% within the past 3 months. One third experienced a low magnitude event in the past 3 months. The likelihood of such exposure increased with the number of vulnerability factors.

Die Zürcher Lebensereignis-Liste (ZLEL): Ergebnisse einer Schweizer epidemiologischen Untersuchung

Zusammenfassung. Die Zürcher Lebensereignis-Liste (ZLEL) enthält 36 Merkmale aus den Bereichen Schule, Familie, Freundschaften sowie Krankheit-Unfall-Verlust. Zusätzlich zum Auftreten dieser Ereignisse in den letzten 12 Monaten wird die Belastung auf einer 5stufigen Likert-Skala (-2 bis +2) erfasst. Die ZLEL wurde in einer Repräsentativstudie mit N = 1188 Kindern und Jugendlichen eingesetzt. Es werden die Häufigkeiten für die einzelnen Lebensereignisse berichtet. Die Reliabilität der ZLEL ist gut. Mit zunehmendem Alter nimmt die Anzahl berichteter Lebensereignisse sowie der Belastungswert zu. Ebenso sind diese beiden Werte bei Mädchen, städtischen sowie ausländischen Kindern und Jugendlichen jeweils höher als bei Jungen, ländlichen und einheimischen Kindern und Jugendlichen. Die Anzahl von Lebensereignissen sowie der Belastungsgrad stehen in bedeutsamen Beziehungen zu Indikatoren psychischer Auffälligkeiten.

Independence of childhood life events and chronic adversities: a comparison of two patient groups and controls

OBJECTIVE

To examine the differences between independent and behavior-dependent stressful life events and chronic adversities in child psychiatric patients, community controls, and children with asthma.

METHOD

The Psychosocial Assessment of Childhood Experiences was used to assess recent severe events (life events with high long-term threat) and major adversities (long-term experiences with high negative impact on child) in children attending a psychiatric clinic (n = 99), community controls (n = 26), and children with chronic asthma (n = 94).

RESULTS

In the previous year, the psychiatric patients had, on average, experienced significantly more independent and behavior-dependent severe events and major adversities than either the controls or the asthmatic patients. The differences were most pronounced in relation to behavior-dependent high-threat life events and long-term-experiences. Among the psychiatric patients, one third of all severe events and one quarter of all major adversities were dependent on the child's behavior. The corresponding proportions in the controls and children with asthma were between one fifth and one twelfth.

CONCLUSIONS

Psychiatrically disturbed children have an increased risk of experiencing behavior-dependent life events and long-term adversities compared with their peers in the community at large and compared with children suffering from a chronic physical illness such as asthma. Future studies need to examine the possible contributions of such experiences to the development and maintenance of psychiatric and physical illness in children.

Adolescent depression. Epidemiology, nosology, life stress and social network. Minireview based on a doctoral thesis

The study engaged a total population of 16-17-year-old urban high-school students and 2300 (93%) were screened for depression and previous suicide attempts. Adolescents with high depression scores in self-evaluation (12.3%) or reporting previous suicide attempts (2.4%) were diagnostically interviewed together with one control for each, matched for gender and educational program. After the interview self-ratings were completed regarding social network, family climate, and life events. Major depression was prevalent during the last year in 5.8% and during life time in 11.4%, 4 girls for every boy. A depression with remaining symptoms for a year or more was the most common type. Dysthymia without major depressive episodes was diagnosed in 1.1%, two girls for every boy. Short hypomanic episodes had been experienced by 13.2% of those with major depressive disorder. Anxiety disorder was comorbid to depression in one half and conduct disorder in one forth of the depressed adolescents. Alcohol was abused by 6.5% and used regularly by another 12%. Other drugs were used by 6.5% of depressed adolescents and not at all by controls. The depressed used tobacco twice as frequently as non-depressed. Social network and family climate were compared within the originally matched pairs. Adolescents with long-lasting depressions had a smaller and unsatisfying social network. They also had experienced many stressful life events related to family adversities, while those with shorter depressive episodes had stress related to the peer group. Depressed adolescents with comorbid conduct disorder reported insufficient support from the close network and a more negative family climate.

Family stress, family functioning and emotional/behavioural problems following child psychiatric treatment

This study assesses family stress, family functioning and emotional/behavioural problems in a sample of 80 formerly daytreated or residentially treated boys after a mean discharge period of four years. Family stress was assessed with a Questionnaire of Life Events (QLE) and family functioning with the Family Adaptability and Cohesion Evaluation Scales (FACES). Emotional/behavioural problems were measured with the Child Behavior Checklist (CBCL). The results showed that there were significant relationships between the QLE, FACES and CBCL scores. In particular, experiencing less negative life events and a more rigid type of family functioning appeared favourable with respect to several types of behavioural problems. When the interrelationships between the family factors and other factors such as age and socio-economic status were taken into account statistically, the number of negative life events appeared the most influential family factor.

Adolescent girls. II. Background factors in anxiety and depressive states

BACKGROUND

This study investigated the prevalence and background variables associated with anxiety and depressive disorders occurring in a community population of older teenage girls.

METHOD

Girls aged 15-20 years (n = 529) whose names were drawn from general practitioner age/sex registers completed self-report Great Ormond Street Mood Questionnaires. From this sample, 143 girls (69 with high self-report scores and 74 controls) were intensively interviewed. Information was obtained on confiding/supportive relationships, family arguments and rows, quality of marital relationship, and degree of parental control. Psychiatric state was assessed by use of the Clinical Interview Schedule to provide a Total Weighted Score. A modified form of the Bedford Life Events and Difficulties Schedule was applied.

RESULTS

The estimated one-year prevalence rate for psychiatric disorder was 18.9%, and 16.9% for depression and anxiety disorders. Using a logit analysis, it was shown that maternal distress (P < 0.02) and the quality of the mother's marriage (P < 0.02) were independently associated with the presence of depression and anxiety disorders.

CONCLUSIONS

About 17% of girls in a community sample living at home showed a depression or anxiety disorder. Even in late adolescence, the presence of a mood disorder is closely linked to the quality of family relationships within the home.

The effect of family counselling on the mental health of 10-11-year-old children in low- and high-risk families: a longitudinal approach

This study investigated the effect of family counselling on the child's mental health in low- and high-risk families. The material consisted of 160 families with a baby born in 1975-76. First, the families were classified with a weighted risk index into low- and high-risk families. Eighty of the families attended a five-year-long family counselling program. The results of a ten year follow-up study showed that both the initial family risk and the counselling made a statistically significant contribution to the 10-11-year-old child's mental health. The counselling had a positive effect both in low- and high-risk families.

Child maltreatment, stressful life events, and behavior problems in school-aged children in residential treatment

This study examined the prevalence of child maltreatment, stressful life events, and behavior problems in school-aged children in residential treatment. The sample included 44 children, ages 5-13 years; 61% were male and 39% female. Results indicated that the entire sample had experienced one or more types of maltreatment, with physical abuse being more prevalent. Seventy-four percent of subjects scored in the clinical range on the Child Behavior Checklist (Achenbach & Edelbrock, 1983). Proportionally more physically abused children scored in the clinical range when compared to nonphysically abused children. The number of stressful life events experienced after admission to the treatment facility was found to be related to increased behavior problems.

Major life events and changes in the behavioural functioning of children

The relationship between major life events and changes, across a 2-yr period, in the level of parent-reported behavioural/emotional problems in 1397 children from a general population sample was investigated using a highly modified version of the Coddington Life Events Record and the Achenbach Child Behavior Checklist. The life event questionnaire used in the present study proved to have a satisfactory reliability. The number of life events increased significantly with increasing age of the child, and a higher incidence of such events was found for families with lower socio-economic status. A significant relationship was found between the total score of negative life events across the 2-yr period and changes in the level of behavioural/emotional problems of the children.

On the usefulness of the DSM-III-R versus the DSM-III for child psychiatrists

The purpose of this paper is to compare and contrast the disorders of infancy, childhood and adolescence in the DSM-III-R with those of its predecessor, the DSM-III. Design features of the child psychiatry sections of the DSM-III-R are described, with comparisons of reliability and validity assessments in the two classifications. Categorical and dimensional systems of psychiatric nosology are described; the DSM-III-R has features of both systems. To be most useful for child psychiatrists in ordinary clinical practice, DSM-III-R symptom criteria should be available in a standardized but brief fashion to ensure adequate data gathering from both child and parent. This avoids problems inherent in lengthy standardized interviews are based on DSM-III-R criteria; although these interviews are excellent for research purposes, clinicians tend to avoid them as clinically constraining. The commonly used alternate of clinicians' overall evaluations is of uncertain reliability and validity, since it is unclear whether all symptoms have been asked for. A symptom checklist approach is therefore suggested as a intermediate procedure to ensure that appropriate questions are asked from the parent and child, while allowing fuller exploration by the clinician. This approach also indicates parent-child variance, and allows for rank ordering of diagnoses which may indicate priorities for treatment of child psychiatric disorders. Overall, the DSM-III-R is a positive step towards more adequate diagnosis and treatment for child and adolescent psychiatric disorders, which will lead to further improvement in the future DSM-IV.

A three-year follow-up of Cambodian young people traumatized as children

Twenty-seven Cambodian young people, who were severely traumatized at ages 8 to 12, were followed up 3 years after an original study. A structured interview and self-rating scales showed that post-traumatic stress disorders (PTSD) were still highly prevalent (48%). Depression existed in 41%. Those with PTSD differed significantly from those without PTSD on the Global Adjustment Scale, the Social Adjustment Scale, the Beck Depression Inventory, and the Impact of Event Scale. Eight subjects had PTSD at both interviews, while 11 had none at either time. Eight showed a variable course. Avoidance behavior was highly prevalent, even among those without PTSD diagnosis. Although functioning relatively well, these youths continued to show symptoms related to their trauma of 8 to 12 years before.

Recent life events and psychiatric disorder in children: the interaction with preceding extreme adversity

This prospective study investigated the role that life events play in causing emotional and behavioural problems in a population of 240 primary school children who had recently survived a natural disaster. Life events experienced after the disaster were not found to contribute directly to the number of emotional or behavioural problems when the effect of the disaster was taken into account. This suggested that, in children, life events may not have a simple mechanically additive aetiological effect.

Childhood and adolescent depression. I. Epidemiological and aetiological aspects

Depression in childhood and adolescence has become a topic of considerable research interest in the last decade. A number of studies ranging over the last half-century provide information about the prevalence of depressive symptoms and syndromes in non-referred populations. These studies are critically reviewed in the light of an analysis of the various meanings that the term 'depression' may carry, and a variety of methodological issues. The sparse evidence for the involvement of a number of potential risk factors for depressive disorders is then considered and suggestions for future work in this area are outlined.