Childhood predictors of psychiatric disorders among boys: a prospective community-based follow-up study from age 8 years to early adulthood

Online positive parenting programme for promoting parenting competencies and skills: randomised controlled trial

Positive parenting programmes (PPP), albeit effective, are not readily accessible to the general public, particularly during the COVID-19 pandemic. In 103 healthy caregiver-child dyads, we investigated the effectiveness of online PPP on parenting sense of competencies (primary outcome), parenting styles and behavioural concerns of children aged 3-6 years (secondary outcomes) between 2 blinded, parallel groups. After block of 4 randomisations, intervention group (n = 52) attended live, group-based, internet delivered PPP while both intervention and active control group (n = 51) received weekly general education via communication application. Outcomes were measured at baseline, 8 and 14 weeks. Most parents from both groups had high education and household income. From the intervention group, 87.5% of the parents attended live sessions while 8.6% subsequently watched recorded sessions. At 14 weeks, the intervention group reported higher sense of competence (Wald 9.63, p = 0.008); both groups reported using more authoritative parenting style (Wald 15.52, p ≤ 0.001) from Generalised Estimating Equations model. Compared to baseline, both groups had significant reduction of children's emotional problems at 14 weeks (mean change: Intervention = - 0.44, p = 0.033; Control = - 0.30, p = 0.046) and behavioural problems over time (Wald 7.07, p = 0.029). Online PPP offered an easily accessible, primary preventive measure to mitigate behavioural concerns and improve parental competency. Clinical Trial Registration: Thai Clinical Trials Registry ( https://www.thaiclinicaltrials.org/ ); TCTR20201030001 on 30/10/2020.

Predictors of dropout, time spent on the program and client satisfaction in an internet-based, telephone-assisted CBT anxiety program among elementary school children in a population-based sample

Increasing evidence has shown that childhood anxiety can be effectively treated by Internet-based cognitive behavioral therapy (ICBT). Being able to predict why participants decide to drop out of such programs enables scarce resources to be used appropriately. The aim of this study was to report dropout predictors for a population-based ICBT intervention aimed at children with anxiety, together with the time they and their parents spent on the program and client satisfaction rates. The study focused on 234 Finnish children aged 10-13 who received an ICBT intervention, with telephone support, for anxiety symptoms, as a part of a randomized control trial. Their parents also had access to Internet-based material and participated in the weekly telephone calls with the coach. Possible drop out factors were explored and these included various family demographics, child and parent psychopathology and therapeutic alliance. Just under a fifth (23.9%) of the children dropped out of the intervention. The risk was higher if the child did not fulfill the criteria for any anxiety diagnosis or reported a poorer therapeutic alliance. Family demographics and the COVID-19 pandemic did not increase the risk. The families spent an average of 127 min on the webpage each week and an average of 32 min on the phone calls. The overall satisfaction with the program was 87% for the children and 95% for the parents. Both the children and the parents found the telephone calls helpful. These findings are important in clinical practice when assessing a family's eligibility for ICBT.

Social leisure time activities as a mediating link between self-reported psychological symptoms in adolescence and psychiatric morbidity by young adulthood: the Northern Finland 1986 Birth Cohort study

Research indicates that adolescent psychological symptoms are associated with subsequent mental health disorders. Studies also show the association of leisure activity with improved current and future mental health. However, research is limited on whether social leisure time activity is a mediating link in the association between psychological symptoms and later psychiatric morbidity. We examined whether adolescence-related social leisure time activity, per se, is a mediating link in the association between adolescent psychological symptoms and later psychiatric morbidity. The study population was based on the Northern Finland Birth Cohort 1986 Study (NFBC 1986; n = 6709; 3227 males). Psychological symptoms at age 15-16 years were measured with the Youth Self Report (YSR) questionnaire. Study participants' psychiatric morbidity by the age of 33 years was assessed using the diagnoses from the nationwide health care registers. Our results showed an association between psychological symptoms and leisure time activities that varied depending on the level of social activity. Leisure time activity was found to be a mediating link between psychological symptoms in adolescence and psychiatric disorders in early adulthood. Adolescence-related leisure time activities, which differed with regard to social interactions, appeared to serve as a mediating link between adolescent psychological symptoms and later onset of psychiatric disorders. Socially active leisure time during adolescence is related to better long-term mental health, while socially inactive leisure time associates with the likelihood of later psychiatric morbidity. To prevent psychiatric disorders, enhancing such leisure time activities in society is highly recommended.

An Internet-Based Parent Training With Telephone Coaching on Managing Disruptive Behavior in Children at Special Family Counseling Centers During the COVID-19 Pandemic: Feasibility Study

BACKGROUND

There is growing concern about the short- and long-term impacts that the COVID-19 pandemic will have on the mental health and psychosocial well-being of children and families. There are no existing studies about feasibility and outcomes using internet-based parent training programs with telephone coaching for disruptive behavioral problems in childhood during the COVID-19 pandemic in clinical settings.

OBJECTIVE

This study explored how the Strongest Families Smart Website (SFSW) parent training program, with telephone coaching, provided support during the COVID-19 pandemic at specialist family counseling centers in Helsinki, Finland, when restrictions made face-to-face counseling impossible. This study followed the success of a randomized controlled trial (RCT) and its implementation study of the SFSW parent training program by primary care child health clinics. The aim was to improve parenting skills, so that parents could tackle disruptive behavior by developing positive parent-child relationships. It started in May 2020, when the COVID-19 pandemic was at its height in Finland.

METHODS

In total, 8 family counseling centers in Helsinki identified 50 referrals aged 3-8 years with high levels of parent-reported disruptive behavioral problems. Child psychopathology and functioning and parental skills and well-being were measured at baseline, posttreatment, and 6 months later using a range of tools. The data were extracted from questionnaires completed by the parents.

RESULTS

We found that 44 (88%) of the 50 families completed the whole 11-session parent training program. Most of the children (n=48, 96%) had definitive or severe behavioral problems when they were initially screened by the centers, but with those assessed at the 6-month follow-up (n=45, 90%), this dropped to 58% (n=26). There were significant changes from baseline to 6-month follow-up in most of the child psychopathology measures, including the Child Behavior Checklist-Parent Report Form (CBCL) total score (mean change 16.3, SE 3.0, 95% CI 10.2-22.3; P<.001) and externalizing score (mean change 7.0, SE 1.0, 95% CI 4.9-9.0; P<.001). When parenting skills were measured with the Parenting Scale (PS), they showed significant changes from baseline to 6-month follow-up in total scores (mean change 0.5, SE 0.1, 95% CI 0.4-0.7; P<.001). Parents showed significant change in the stress subscore (mean change 3.9, SE 0.8, 95% CI 2.2-5.6; P<.001). Of the parents who filled in the satisfaction questionnaire (n=45, 90%), 42 (93%) reported high satisfaction in the skills and 44 (98%) in the professionalism of the family coaches.

CONCLUSIONS

The program proved to be an effective method for improving parenting skills and child psychopathology and functioning. The parents were satisfied with the program, and the dropout rate was exceptionally low. The study shows that the training program could be implemented in specialist clinical settings and during crisis conditions, such as the COVID-19 pandemic.

Online positive parenting programme for promoting parenting competencies and skills: randomised controlled trial

Positive parenting programmes (PPP), albeit effective, are not readily accessible to the general public, particularly during the COVID-19 pandemic. In 103 healthy caregiver-child dyads, we investigated the effectiveness of online PPP on parenting sense of competencies (primary outcome), parenting styles and behavioural concerns of children aged 3-6 years (secondary outcomes) between 2 blinded, parallel groups. After block of 4 randomisations, intervention group (n = 52) attended live, group-based, internet delivered PPP while both intervention and active control group (n = 51) received weekly general education via communication application. Outcomes were measured at baseline, 8 and 14 weeks. Most parents from both groups had high education and household income. From the intervention group, 87.5% of the parents attended live sessions while 8.6% subsequently watched recorded sessions. At 14 weeks, the intervention group reported higher sense of competence (Wald 9.63, p = 0.008); both groups reported using more authoritative parenting style (Wald 15.52, p ≤ 0.001) from Generalised Estimating Equations model. Compared to baseline, both groups had significant reduction of children's emotional problems at 14 weeks (mean change: Intervention = - 0.44, p = 0.033; Control = - 0.30, p = 0.046) and behavioural problems over time (Wald 7.07, p = 0.029). Online PPP offered an easily accessible, primary preventive measure to mitigate behavioural concerns and improve parental competency.Clinical trial registration Thai Clinical Trials Registry; https://www.thaiclinicaltrials.org/ ; TCTR20201030001; October 30, 2020.

The Long-Term Outcomes of Prepubertal Depression and Internalizing Problems: A Scoping Review

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Discuss whether prepubertal depression shows longitudinal continuity with depression in adulthood.• Summarize existing literature on adult emotional and functional outcomes of prepubertal depression and internalizing problems.

BACKGROUND

Adolescent- and young adult-onset depression are common, recurrent, and can cause significant distress and psychosocial impairment across the life span, but recognition of prepubertal internalizing problems and depression, along with their prevalence, clinical course, and long-term outcomes, remains elusive.

OBJECTIVE

To examine whether prepubertal depression, which can manifest differently from adult depression, shows longitudinal continuity with depression in adulthood, and to summarize existing literature on adult emotional and functional outcomes of prepubertal depression and internalizing problems.

METHODS

A scoping review was conducted for peer-reviewed cohort articles published between 2000 and 2020 using PubMed and PsycINFO. From 4309 identified references, 17 articles were included.

RESULTS

Prepubertal depression confers increased risk of recurrence of depression in adulthood, with similar findings for prepubertal internalizing problems. No studies found prepubertal depression or internalizing problems predicting adult substance abuse, and no studies asked about adult bipolar diagnoses. More research is needed to draw clear conclusions regarding their implications for other psychiatric, medical, or psychosocial outcomes.

CONCLUSION

The reviewed studies provide limited evidence that prepubertal depression onset predicts adult depression. The small evidence base and heterogeneous methodological assessments may limit, however, the ability to draw meaningful conclusions about the long-term course of prepubertal-onset depression. Well-designed studies with longer follow-up and multiple assessments in adulthood are needed to clarify and assess the potential effects of prepubertal depression on adult health and functioning. This information will eventually become available as the samples in recently initiated longitudinal cohort studies of children mature further.

A systematic review of the persistence of childhood mental health problems into adulthood

Many adult mental disorders have their origins in childhood yet our knowledge about this largely comes from studies assessing adults utilising retrospective recall of age of onset. In this systematic review we evaluate the current state of knowledge of how childhood exposure to mental health problems is associated with adult mental disorders using data from prospective longitudinal studies. We identified 40 studies that assessed mental health in childhood or adolescence and reassessed adults for mental disorders. Although there was substantial heterogeneity across studies in terms of methodology and findings, there was a clear pattern that experiencing mental health problems prior to 14 years of age increases risk of adult mental disorder. Importantly, elevated symptoms rather than diagnosis in childhood were generally more strongly associated with adult disorder. These findings provide strong support for the argument that prevention needs to be targeted to children in the primary school years and early intervention efforts to those who are beginning to experience elevated symptoms rather than waiting until a diagnosable disorder is evident.

Anxiety and depression among Chinese children with and without reading disabilities

This study aims to compare anxiety and depression among male and female Chinese children with and without reading disabilities (RDs) and to examine the diverse impacts of anxiety and depression on children's reading comprehension. A total of 132 Chinese children from third to sixth grade living in Taiwan were recruited; half had RD, and the other half were typically developing children. Our results from the first analysis revealed that the anxiety level of female children with RD was significantly higher than that of the other three groups of participants, while the depression level of typically developing children was significantly lower than that of children with RD in general. Additionally, our results regarding the predictive abilities of gender and anxiety for reading comprehension as well as the moderating effect of gender on the ability of anxiety to predict reading comprehension were all statistically significant for the typically developing group but not the RD group. These differences between these two groups were further confirmed by multi-group analysis. Our results enhance the existing knowledge on Chinese children with RD and can increase practitioners' awareness of the possibility of higher levels of anxious and depressive symptoms among these children.

Development, Psychopathology, and Ethnicity II: Psychiatric Disorders Among Young Adults

OBJECTIVE

To estimate the prevalence of psychiatric disorders and their continuity since childhood among young adults from the same ethnic group living in 2 low-income contexts.

METHOD

Young adults (N = 2,004; ages 15-29) were followed (82.8% retention) as part of the Boricua Youth Study, a study of Puerto Rican youths recruited at ages 5-13 in the South Bronx (SBx), New York, and Puerto Rico (PR). We estimated prevalence (lifetime; past year) of major depressive (MDD), mania, hypomania, generalized anxiety (GAD), tobacco dependence, and any other substance use disorders (SUD).

RESULTS

The prevalence of every disorder was higher among young women from the SBx compared with those from PR (eg, 9.2% versus 4.1% past-year SUD; 14% versus 6.8% for MDD/GAD). Among SBx young men, tobacco dependence and illicit SUD were elevated. Across both contexts, men had higher adjusted odds of illicit SUD than women, while women had higher GAD than men. MDD did not differ by gender. Young adulthood disorders (except for alcohol use disorder and GAD) followed childhood disorders. For example, childhood externalizing disorders preceded both MDD (young men and women) and illicit SUD (young women only).

CONCLUSION

Young women raised in a context where adversities like ethnic discrimination concentrate are at high risk for psychiatric disorders. In certain high-poverty contexts, young men may present with MDD as often as women. Interventions to prevent psychiatric disorders may need to address gender-specific processes and childhood disorders. However, SUD prevention among young men may need to address other factors.

Teacher-rated aggression and co-occurring behaviors and emotional problems among schoolchildren in four population-based European cohorts

Aggressive behavior in school is an ongoing concern. The current focus is on specific manifestations such as bullying, but the behavior is broad and heterogenous. Children spend a substantial amount of time in school, but their behaviors in the school setting tend to be less well characterized than at home. Because aggression may index multiple behavioral problems, we used three validated instruments to assess means, correlations and gender differences of teacher-rated aggressive behavior with co-occurring externalizing/internalizing problems and social behavior in 39,936 schoolchildren aged 7-14 from 4 population-based cohorts from Finland, the Netherlands, and the UK. Correlations of aggressive behavior were high with all other externalizing problems (r: 0.47-0.80) and lower with internalizing problems (r: 0.02-0.39). A negative association was observed with prosocial behavior (r: -0.33 to -0.54). Mean levels of aggressive behavior differed significantly by gender. Despite the higher mean levels of aggressive behavior in boys, the correlations were notably similar for boys and girls (e.g., aggressive-hyperactivity correlations: 0.51-0.75 boys, 0.47-0.70 girls) and did not vary greatly with respect to age, instrument or cohort. Thus, teacher-rated aggressive behavior rarely occurs in isolation; boys and girls with problems of aggressive behavior likely require help with other behavioral and emotional problems. Important to note, higher aggressive behavior is not only associated with higher amounts of other externalizing and internalizing problems but also with lower levels of prosocial behavior.

Cumulative incidences of hospital-treated psychiatric disorders are increasing in five Finnish birth cohorts

OBJECTIVE

The aim of this study was to explore changes in the incidences of childhood and early adulthood hospital-treated psychiatric disorders in five large Finnish birth cohorts of individuals born between 1966 and 1997.

METHODS

The five birth cohorts were as follows: Northern Finland Birth Cohort 1966 (NFBC 1966) and 1986 (NFBC 1986), 1987 Finnish Birth Cohort (FBC 1987) and 1997 (FBC 1997), and Finnish 1981 Birth Cohort Study (FBCS 1981). Incidences of hospital-treated psychiatric disorders in each cohort were calculated separately for males (N = 71,209) and females (N = 65,190). Poisson regression was used to test difference in proportions of psychiatric disorders in wide range of diagnosis classes separately in childhood and adolescence, and early adulthood.

RESULTS

The total incidences of psychiatric disorders in childhood and adolescence among males has increased in the birth cohorts over decades (Incidence Rate Ratio, IRR = 1.04 (1.04-1.05); p < 0.001). Similar result was seen among females (IRR = 1.04 (1.03-1.04); p < 0.001). In early adulthood, there was significant increase among females (IRR = 1.04 (1.03-1.05); p < 0.001), but among males, the change was not significant (IRR = 0.99 (0.99-1.00), p = 0.051).

CONCLUSIONS

The main finding was that the cumulative incidence of hospital-treated psychiatric disorders increased over the decades in Finland. The increasing trend in hospital-treated psychiatric disorders in early adulthood was detected in females but not in males. In the youngest cohorts, the cumulative incidence of hospital-treated psychiatric disorders was at the same level in males and females, whereas in oldest cohort, males had higher incidence than females.

Do childhood psychotic experiences improve the prediction of adolescent psychopathology? A longitudinal population-based study

AIMS

(a) To investigate the utility of childhood PE as a predictor of adolescent psychopathology while accounting for three known risk factors: childhood mental disorder; traumatic experiences and poor childhood functioning, and (b) to investigate the additive effects of including childhood PE in predictive clinical model of adolescent psychopathology.

METHOD

The study sample comprised of 86 Irish youths who completed two waves of the "Adolescent Brain Development" study (baseline age: 11.7 and follow-up age: 15.7). At baseline, participants completed a clinical interview assessing for PE, mental disorders, traumatic experiences and global functioning in childhood. The internalizing and externalizing problems sub-scales from the Youth Self Report questionnaire were used as follow-up outcomes variables in adolescence.

RESULTS

Logistic regression analyses revealed that childhood PE was the only predictor significantly associated with both internalizing (univariate OR: 7.58, CI: 2.59-22.15; multivariate OR: 5.43, CI: 1.53-19.29) and externalizing (univariate OR: 11.76, CI: 3.70-37.41; multivariate OR: 30.39, CI: 5.28-174.80) problems in adolescence. All predictive models with PE significantly predicted adolescent outcomes (area under the curve range: 0.70-0.81; all P < 0.05) and adding PE to the models improved the predictive value for externalizing problems (P = 0.02).

CONCLUSION

Childhood PE is a powerful predictor of adolescent psychopathology, particularly for externalizing problems. Routine assessment of PE and targeted support for children who report PE may reduce the incidence of mental disorder in adolescence.

Public health nurses' experiences of assessing disruptive behaviour in children and supporting the use of an Internet-based parent training programme

BACKGROUND

In Finland, although families generally receive support from child health clinics, some need more help in dealing with their child's emotions, behaviour and psychosocial development. Public health nurses play a central role in providing vital psychosocial support for families, but they often lack the confidence and competence to tackle mental health problems.

AIM

To describe how public health nurses used and experienced a working model that combined a psychosocial tool (Strengths and Difficulties Questionnaire, SDQ) to identify disruptive behaviour in four-year-old children and an Internet-based parent training programme with telephone coaching.

METHODS

This is a descriptive, cross-sectional survey study. The sample consists of public health nurses (n = 138) who were working in child health clinics in Finland that had used the working model. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open-ended question were analysed using inductive content analysis.

RESULTS

The experiences about the working model were mainly positive. The public health nurses felt that the psychosocial tool, the SDQ, was easy and suitable to use in child health clinics. The availability of an Internet-based parent training programme provided greater support for parents by overcoming practical barriers. Overall, the working model helped nurses to develop their mental health competencies.

CONCLUSION

Within primary care, the need to tackle psychosocial problems is increasing, and for this, public health nurses need extra support and tools. It seems that the working model, including the SDQ and the online and telephone coaching programme, worked well in child health clinics. This working model can be used to provide parental support and improve nurses' mental health competencies.

Infant regulatory behavior problems during first month of life and neurobehavioral outcomes in early childhood

Whether infant regulatory behavior problems already in the first month of life indicate an increased risk of childhood neurobehavioral problems, and whether maternal depression in the postpartum and early childhood underpins these associations remain unclear. Altogether, 2049-2364 mothers from the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study completed the Neonatal Perception Inventory on regulatory behavior problems at the infant's age of 15.6 days (SD 3.2, range 1-30), the Infant Behavior Questionnaire-Revised on temperament at 6.5 months (SD 0.9, range 4.2-12.4), and the Ages and Stages Questionnaire-3 on developmental milestones and the Child Behavior Checklist on behavioral problems at 3.5 years (SD 0.7, range 1.9-6.0). Maternal depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (infancy follow-ups) and Beck Depression Inventory-II (childhood follow-up). Father-rated infant temperament and paternal depressive symptoms were also available (n = 1474). Higher levels of infant regulatory behavior problems predicted higher levels of mother- and father-rated negative affectivity temperament (0.13 SD units per SD unit, 95% confidence interval 0.09-0.17; and 0.09, 0.04-0.14, respectively), lower levels of mother-rated orienting/regulation temperament (- 0.09, - 0.13 to - 0.05) and problem-solving skills (- 0.12, - 0.21 to - 0.04), and higher levels of Externalizing (0.07, 0.03-0.11) and Total behavioral problems (0.07, 0.03-0.11). Regulatory behaviors partially mediated the effect of maternal depressive symptoms. Regulatory behavior problems already during the first month of life predict neurobehavioral outcomes, and partially mediate the effect of maternal depressive symptoms. Our study may inform design of interventions aimed at timely prevention in children at risk.

Two-Year Follow-Up of Internet and Telephone Assisted Parent Training for Disruptive Behavior at Age 4

OBJECTIVE

To determine whether an internet-based and telephone-assisted parent training intervention, which used whole population screening and which comprehensively targeted symptomatic 4-year-old children, was effective 24 months after the start of treatment. No long-term follow-up studies using a randomized controlled trial (RCT) existed on this subject.

METHOD

Of the 4,656 children 4 years old who were screened in Southwest Finland, 730 met the criteria for high-level disruptive behavioral problems, and 464 parents agreed to be randomized to the 11-week Strongest Families Smart Website (SFSW) intervention (n = 232) or an educational control (EC) (n = 232). After 24 months, 163 SFSW parents (70%) and 165 EC parents (71%) were still participating.

RESULTS

When we compared the results at baseline and 24 months, the primary outcome of the Child Behavior Checklist (CBCL) externalizing score showed significantly higher improvements in the SFSW group (effect size 0.22; p < 0.001). This group also showed greater improvements in the secondary outcomes: the CBCL total and internalizing scales, 5 of the 7 CBCL symptom domains, 3 of the 5 DSM subscores, and self-reported parenting skills. Fewer SFSW children (17.5%) than EC children (28.0%) had been referred to child mental health services between baseline and 24 months (odds ratio = 1.8; 95% confidence interval = 1.1-3.1).

CONCLUSION

The SFSW internet-based and telephone-assisted parental training program was effective 24 months after initiation, underlining the value of identifying children at risk in the community early and providing evidence-based parent training for a large number of families.

CLINICAL TRIAL REGISTRATION INFORMATION

STRONGEST FAMILIES FINLAND CANADA: Family-based Prevention and Treatment Program of Early Childhood Disruptive Behavior (Fin-Can). http://www.clinicaltrials.gov; NCT01750996.

Risk factors in the development of behaviour difficulties among students with special educational needs and disabilities: A multilevel analysis

BACKGROUND

Students with special educational needs and disabilities (SEND) are more likely to exhibit behaviour difficulties than their typically developing peers.

AIM

The aim of this study was to identify specific risk factors that influence variability in behaviour difficulties among individuals with SEND.

SAMPLE

The study sample comprised 4,228 students with SEND, aged 5-15, drawn from 305 primary and secondary schools across England.

METHOD

Explanatory variables were measured at the individual and school levels at baseline, along with a teacher-reported measure of behaviour difficulties (assessed at baseline and at 18-month follow-up).

RESULTS

Hierarchical linear modelling of data revealed that differences between schools accounted for between 13% (secondary) and 15.4% (primary) of the total variance in the development of students' behaviour difficulties, with the remainder attributable to individual differences. Statistically significant risk markers for these problems across both phases of education were being male, eligibility for free school meals, being identified as a bully, and lower academic achievement. Additional risk markers specific to each phase of education at the individual and school levels are also acknowledged.

CONCLUSION

Behaviour difficulties are affected by risks across multiple ecological levels. Addressing any one of these potential influences is therefore likely to contribute to the reduction in the problems displayed.

Changes in Mental Health, Bullying Behavior, and Service Use Among Eight-Year-Old Children Over 24 Years

OBJECTIVE

The aim of this study was to examine changes in the mental health problems, bullying, and service use of 8-year-old children at 4 different time points (1989, 1999, 2005, and 2013) using population-based, time-trend data.

METHOD

Information from 4 cross-sectional samples was compared over a 24-year period. The target population was Finnish-speaking children born in 1981 (n = 1,038), 1991 (n = 1,035), 1997 (n = 1,030), and 2004 (n = 1,114) and living in selected school districts in the Turku University Hospital area in southwestern Finland. The participation rates varied from 84% (2005) to 95% (1989). Information about the children's psychiatric symptoms, bullying experience, and service use was obtained from parents and teachers using Rutter questionnaires. Child depression was measured using the Children's Depression Inventory (CDI).

RESULTS

Parental reports showed that emotional (p < .001) and conduct (p = .001) problems among boys and emotional (p = .002) problems among girls decreased over the 24-year period. In teacher reports, there were no significant changes in hyperactivity, emotional, and conduct problems between 1989 and 2013. Girls' self-reported depression scores increased between 1989 and 2005, but leveled off in 2013. There were no significant decreases in bullying behavior between 2005 and 2013 despite the introduction of a nationwide school-based anti-bullying program in 2009. Mental health service use increased constantly during the study period: in 1989, 4.2% of boys and 0.9% of girls were in contact with services, and by 2013 this had risen to 15.1% and 6.1% (p < .001).

CONCLUSION

No substantial increases in children's mental health problems were seen between 1989 and 2013. Service use increased constantly, indicating lower thresholds for seeking help. Bullying behavior is strongly related to mental health problems, and that is why school-based bullying interventions, including mental health perspectives, are needed.

Treatment via Television: The Relation Between Watching Dr. Phil and Viewers' Intentions to Seek Mental Health Treatment

Many people with a mental disorder fail to obtain professional treatment for a diagnosable mental disorder, and some turn to media outlets for diagnosis and treatment recommendations; however, little is known about outcomes associated with exposure to media mental health professionals. We reasoned that exposure to Dr. Phil would be associated with greater intentions to seek mental health treatment for oneself and for one's child and that this relationship would be serially mediated by higher levels of parasocial relationship with Dr. Phil and greater efficacy beliefs in treating the mental illness of oneself and one's child. As predicted, frequent viewing of Dr. Phil was associated with higher levels of parasocial relationship with Dr. Phil, which in turn was itself associated with greater efficacy beliefs in treating a mental illness of oneself and of one's child, which was ultimately related to greater intentions to seek treatment for oneself or for one's child. The findings suggest that the relationship that develops between media mental health professionals and their audience can encourage intentions to seek mental health treatment.

Anxiety and Depression in Children With Nonverbal Learning Disabilities, Reading Disabilities, or Typical Development

The main goal of the present study was to shed further light on the psychological characteristics of children with different learning disability profiles aged between 8 and 11 years, attending from third to sixth grade. Specifically, children with nonverbal learning disabilities (NLD), reading disabilities (RD), or a typical development (TD) were tested. In all, 15 children with NLD, 15 with RD, and 15 with TD were administered self-report questionnaires to assess different types of anxiety and depression symptoms. Both NLD and RD children reported experiencing more generalized and social anxiety than TD, the NLD children reported more severe anxiety about school and separation than TD, and the children with RD had worse depressive symptoms than those with NLD or TD.

Does childhood bullying predict eating disorder symptoms? A prospective, longitudinal analysis

OBJECTIVE

Bullying is a common childhood experience with enduring psychosocial consequences. The aim of this study was to test whether bullying increases risk for eating disorder symptoms.

METHOD

Ten waves of data on 1,420 participants between ages 9 and 25 were used from the prospective population-based Great Smoky Mountains Study. Structured interviews were used to assess bullying involvement and symptoms of anorexia nervosa and bulimia nervosa as well as associated features. Bullying involvement was categorized as not involved, bully only, victim only, or both bully and victim (bully-victims).

RESULTS

Within childhood/adolescence, victims of bullying were at increased risk for symptoms of anorexia nervosa and bulimia nervosa as well as associated features. These associations persisted after accounting for prior eating disorder symptom status as well as preexisting psychiatric status and family adversities. Bullies were at increased risk of symptoms of bulimia and associated features of eating disorders, and bully-victims had higher levels of anorexia symptoms. In terms of individual items, victims were at risk for binge eating, and bully-victims had more binge eating and use of vomiting as a compensatory behavior. There was little evidence in this sample that these effects differed by sex. Childhood bullying status was not associated with increased risk for persistent eating disorder symptoms into adulthood (ages 19, 21, and 25).

DISCUSSION

Bullying predicts eating disorder symptoms for both bullies and victims. Bullying involvement should be a part of risk assessment and treatment planning for children with eating problems.

Adolescents in a residential school for behavior disorders have an elevated mortality risk in young adulthood

BACKGROUND

Conduct problems during adolescence are associated with an elevated mortality risk. This study investigated the mortality rate, causes of death, and changes over time in a Finnish residential school (RS) population.

METHODS

All adolescents (N = 885, M/F = 594/291, age mean 15.2 years at baseline) residing in the RS system in 1991, 1996, 2001, and 2006 and matched controls were included in a register-based study with a follow-up time of up to 22 years.

RESULTS

The all-cause mortality rate for people with an RS background was 6.7 % compared to 1.0 % in the controls (Hazard Ratio HR = 6.95, 95 % 4.66-10.37, p < 0.001). 8.1 % of the RS boys had died compared to 2.2 % of the girls (HR = 2.2, p = 0.02). The HR for substance-related death was 24.31 (95 % CI 9.3-65.53, P < 0.001), for suicide 7.23 (95 % CI 3.24-16.11, P < 0.001) and for other external causes 5.45 (95 % CI 2.41-12.36, P < 0.001) compared to controls. Mortality peaked among RS boys at approximately 25 years, whereas for girls it peaked after 30 years.

CONCLUSIONS

Adolescents with severe disruptive behavior problems have a seven-fold risk for premature adult-age death compared to matched controls. The most common causes for death were avoidable, substance-related followed by suicide. Effective treatment of mental and substance use related problems during and after the placement is needed to reduce mortality.

Life-course fertility patterns associated with childhood externalizing and internalizing behaviors

Childhood behavioral problems have been associated with earlier childbearing, but their life-course reproductive consequences are unknown. The present study examined whether and how behavioral problems assessed in childhood predict fertility patterns over the life course in women and men. Participants were 9,472 individuals from the British National Child Development Study (4,739 men and 4,733 women). Childhood externalizing and internalizing behaviors were rated by teachers at ages 7 and 11. Information on fertility history was derived from interviews at ages 33, 42, and 46, including date of pregnancy, whether the pregnancy was planned or non-planned, and pregnancy outcome (live birth, miscarriages/stillbirth, induced abortion). Transition to parenthood and fertility rate were assessed using survival analysis and age-stratified regression models. In both sexes, higher externalizing behavior was associated with higher rate of pregnancies, especially non-planned pregnancies in adolescence and early adulthood, but this association attenuated or even reversed later in adulthood. Internalizing behavior was associated with lower pregnancy rates, especially planned pregnancies and later in adulthood, and particularly in men. In women, higher internalizing behavior was also associated with earlier transition to parenthood. Externalizing behavior in women predicted higher risk of miscarriages and induced abortions, while internalizing behavior predicted lower risk for these outcomes. These findings suggest that childhood behavioral problems have long-term associations with fertility behavior over the life course, including earlier transition to parenthood, lower probability of normative family formation later in adulthood, and higher risk of adverse pregnancy outcomes.

Childhood bullying involvement predicts low-grade systemic inflammation into adulthood

Bullying is a common childhood experience that involves repeated mistreatment to improve or maintain one's status. Victims display long-term social, psychological, and health consequences, whereas bullies display minimal ill effects. The aim of this study is to test how this adverse social experience is biologically embedded to affect short- or long-term levels of C-reactive protein (CRP), a marker of low-grade systemic inflammation. The prospective population-based Great Smoky Mountains Study (n = 1,420), with up to nine waves of data per subject, was used, covering childhood/adolescence (ages 9-16) and young adulthood (ages 19 and 21). Structured interviews were used to assess bullying involvement and relevant covariates at all childhood/adolescent observations. Blood spots were collected at each observation and assayed for CRP levels. During childhood and adolescence, the number of waves at which the child was bullied predicted increasing levels of CRP. Although CRP levels rose for all participants from childhood into adulthood, being bullied predicted greater increases in CRP levels, whereas bullying others predicted lower increases in CRP compared with those uninvolved in bullying. This pattern was robust, controlling for body mass index, substance use, physical and mental health status, and exposures to other childhood psychosocial adversities. A child's role in bullying may serve as either a risk or a protective factor for adult low-grade inflammation, independent of other factors. Inflammation is a physiological response that mediates the effects of both social adversity and dominance on decreases in health.

Modeling mental health information preferences during the early adult years: a discrete choice conjoint experiment

Although most young adults with mood and anxiety disorders do not seek treatment, those who are better informed about mental health problems are more likely to use services. The authors used conjoint analysis to model strategies for providing information about anxiety and depression to young adults. Participants (N = 1,035) completed 17 choice tasks presenting combinations of 15 four-level attributes of a mental health information strategy. Latent class analysis yielded 3 segments. The virtual segment (28.7%) preferred working independently on the Internet to obtain information recommended by young adults who had experienced anxiety or depression. Self-assessment options and links to service providers were more important to this segment. Conventional participants (30.1%) preferred books or pamphlets recommended by a doctor, endorsed by mental health professionals, and used with a doctor's support. They would devote more time to information acquisition but were less likely to use Internet social networking options. Brief sources of information were more important to the low interest segment (41.2%). All segments preferred information about alternative ways to reduce anxiety or depression rather than psychological approaches or medication. Maximizing the use of information requires active and passive approaches delivered through old-media (e.g., books) and new-media (e.g., Internet) channels.

Teachers' assessments of children's mental problems with respect to adolescents' subsequent self-reported mental health

PURPOSE

To investigate whether teachers' assessments of children are predictive of subsequent self-reported mental problems in adolescence and how these problems are concurrently linked with adolescents' overall life satisfaction.

METHOD

The study subjects originated from the prospective population-based Northern Finland Birth Cohort 1986 (N = 9,432). At age 8 years first-grade students' emotional and behavioral problems were assessed by their teachers with Rutter Children's Behavioural Questionnaires for teachers (RB2). At the age of 16 years, adolescents responded to the eight Youth Self-report (YSR) subscales and the one-item overall life satisfaction scale. Multivariate logistic regression was used to study the longitudinal relationship between RB2 and YSR.

RESULTS

Children who had emotional problems according to their teachers (RB2) were more prone to withdrawal and social problems in adolescence (YSR). Behavioral problems in childhood (RB2) were predictive of attention problems, and delinquent and aggressive behavior (YSR), while hyperactivity (RB2) was only predictive of attention problems and delinquent behavior (YSR). Additionally, each YSR subscale was strongly and linearly associated with concurrent self-reported life satisfaction in adolescence.

CONCLUSIONS

Teachers' assessments of children were predictive of self-reported mental problems in adolescence, which, in turn, were strongly associated with concurrent self-reported life satisfaction. In order to support favorable growth of children to well-adjusted adolescents and to intervene as early as possible in the event of adverse progression, both teachers' assessments of children and adolescent's self-rated overall life satisfaction should be acknowledged.

Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

PURPOSE

In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment.

METHODS

In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed.

RESULTS

During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.

CONCLUSION

A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada)

BACKGROUND

Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour.

METHODS/DESIGN

This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization.

DISCUSSION

The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems.

TRIAL REGISTRATION

ClinicalTrials.gov # NCT01750996.

The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders?

Mental disorders traditionally have been viewed as distinct, episodic, and categorical conditions. This view has been challenged by evidence that many disorders are sequentially comorbid, recurrent/chronic, and exist on a continuum. Using the Dunedin Multidisciplinary Health and Development Study, we examined the structure of psychopathology, taking into account dimensionality, persistence, co-occurrence, and sequential comorbidity of mental disorders across 20 years, from adolescence to midlife. Psychiatric disorders were initially explained by three higher-order factors (Internalizing, Externalizing, and Thought Disorder) but explained even better with one General Psychopathology dimension. We have called this dimension the p factor because it conceptually parallels a familiar dimension in psychological science: the g factor of general intelligence. Higher p scores are associated with more life impairment, greater familiality, worse developmental histories, and more compromised early-life brain function. The p factor explains why it is challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders. Transdiagnostic approaches may improve research.

Childhood determinants of adult psychiatric disorder

The aim of this project was to assess the current evidence from longitudinal studies for childhood determinants of adult mental illness. Because of the variable and often prolonged period between factors in childhood and the identification of mental illness in adults, prospective studies, particularly birth cohorts, offer the best chance of demonstrating associations in individuals.

A review was undertaken in 2006 of the published literature from longitudinal studies, together with some large-scale retrospective studies and relevant reviews which provided supplementary evidence. The main focus was upon potentially ameliorable characteristics, experiences or situations of childhood; however, other factors, not determinants but pre-cursors, associated with later mental illness could not be left out.

Seven major electronic data-bases of published research were interrogated with a range of key-words and the results supplemented from personal searches, enquiries and reference trails. In excess of 1,500 abstracts were read to select 250 papers for full review. The material was assessed in relation to ten factors:

Psychological disturbance; Genetic Influences; Neurological Deviance; Neuroticism; Behaviour; School Performance; Adversity; Child Abuse or Neglect; Parenting and parent-child relationships; Disrupted and Disfunctional Families.

In 2011 the search was repeated for the period 2006 to mid-2011, using the same search terms and supplemented in the same manner. Over 1,800 abstracts emerged and almost 200 papers selected for more detailed review. These were then integrated into the original text with modifications where necessary. The whole text was then revised and edited in January / February 2012.

There is continuing evidence for the association with later mental ill-health for each of these ten factors, but with different degrees of conviction. The evidence for each is discussed in detail and weighed both separately and in relation to others. These are then summarised, and the research implications are considered. Finally, the implications for prevention are discussed together with the practical potential for preventive and health-promoting programmes.

Early adult outcomes for Irish children with behavioural difficulties

BACKGROUND

There are few longitudinal studies of Irish children and, to date, no studies reporting long-term outcome for those with behavioural disorder in childhood. This paper describes psychological and educational outcomes for a group of Irish children initially assessed at age 11 years and re-examined 10 years later. The period during which the research was conducted coincided with a time of increasing wealth in Ireland and the consequent development of psychological and educational services.

AIMS

To follow up and assess psychological and educational outcomes for a group of young people aged 21 years, half of whom had high levels of behavioural problems at age 11.

METHOD

Data were gathered at two time points for 97 children and their families. Childhood measures included psychological and behavioural functioning, IQ, family background and economic circumstances. Outcome measures assessed in young adulthood included psychological functioning, educational attainment and trouble with the law.

RESULTS

Behavioural deviance at age 11 was found to be highly predictive of negative outcomes in early adulthood including a greater likelihood of involvement in criminal activity and less educational success. The likelihood of educational failure increased with the accumulation of risk factors including economic disadvantage and low IQ.

CONCLUSIONS

These findings, supported in other international studies, underline the importance of behavioural difficulties in childhood for adult outcome, even in an environment of greater service and educational opportunities and access.

What is the long-term outcome of boys who steal at age eight? Findings from the Finnish nationwide "From A Boy To A Man" birth cohort study

OBJECTIVE

The aim was to study predictive associations between childhood stealing behavior at the of age 8 years with later psychiatric disorders, criminality or suicide attempts and completed suicides up to the age 25 years in a large representative population-based birth cohort.

METHOD

The sample includes 2,592 Finnish males born in 1981 with information about stealing from both parents and teachers. Information about psychiatric disorders, criminality, suicide attempts requiring hospital admission and completed suicides was gathered from four different Finnish nationwide registries until the study participants were 25 years old.

RESULTS

One out of ten boys had stealing behavior during the previous 12 months. After adjusting for parental education level and conduct problems or hyperactivity (i.e. potential confounds), stealing at eight independently predicted substance use and antisocial personality disorders, and high level of crimes. Stealing was also associated with completed suicide or severe suicide attempt requiring hospital admission. Comorbid stealing and frequent aggression had the strongest predictive association with any psychiatric diagnosis, crime and completed suicide or severe suicide attempt, while stealing without aggression was not associated with any of the negative outcomes.

CONCLUSIONS

Stealing accompanied with aggressivity at age eight is predictive of wide range of adversities. However, no increased risk was observed among the group with stealing behaviors but without aggression.

Item analysis and differential item functioning of a brief conduct problem screen

Research has shown that boys display higher levels of childhood conduct problems than girls, and Black children display higher levels than White children, but few studies have tested for scalar equivalence of conduct problems across gender and race. The authors conducted a 2-parameter item response theory (IRT) model to examine item characteristics of the Authority Acceptance scale from the Teacher Observation of Classroom Adaptation-Revised (AA-TOCA-R; L. Larsson-Werthamer, S. G. Kellam, & L. Wheeler, 1991) in 8,820 kindergarten children and estimated the degree of differential item functioning (DIF) by gender and race/urban status. The mean level of latent conduct problems was best represented by behaviors such as being stubborn, breaking rules, and being disobedient, whereas breaking things and taking others' property best represented the construct at one standard deviation above the mean. DIF by gender was detected, such that at equivalent levels of latent conduct problems, males received more endorsements of overt behaviors from teachers, whereas females received more endorsements of nonphysical behaviors. Moreover, overt behaviors were better discriminators of latent conduct problems for males, and nonphysical behaviors were better discriminators of latent conduct problems for females. Differences across race/urban status were not found to be conceptually meaningful. The authors' analyses also suggest that the item scaling of the AA-TOCA-R may be best represented by 5e categories instead of 6. These findings provide support for the use of IRT modeling to examine item characteristics of conduct problem scales and DIF to test for scalar equivalence across diverse subpopulations.

Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice

BACKGROUND

Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed.

METHOD

Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents.

RESULTS

FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS.

CONCLUSION

Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.

Teachers' assessments of children aged eight predict life satisfaction in adolescence

The objective was to investigate how teachers' assessments of children predict life satisfaction in adolescence. This is a prospective cohort study on the population-based Northern Finland Birth Cohort 1986 (n = 8,959). Information was gathered from parents, teachers and adolescents using questionnaires at the age of 7, 8 and 15. Response rates were 80-90%. Emotional and behavioural problems were assessed with Rutter Children's Behavioural Questionnaires for teachers (RB2) and parents (RA2) during the first grade at age 8. At adolescence, self-reported life satisfaction was measured with a question including five response alternatives. According to teachers' assessments, 13.9% of the children had high emotional or behavioural problems (RB2 ≥9). These assessments predicted life dissatisfaction in adolescence (OR(crude) = 1.77; 95% CI 1.43-2.20) in several models including also health behaviour and use of psychotropic medicine. However, introducing all the significant variables in the same model, RB2 lost its significance (OR = 1.28; 0.96-1.70), but good school achievement assessed by teachers was still a significant predictor. Life satisfaction in adolescence was associated with a variety of favourable concurrent factors. In conclusion teachers' assessments of children during the first school year predicted life satisfaction in adolescence. In mental health promotion, teachers' early assessments should be utilized for the benefit of children.

Factors associated with reported childhood depressive symptoms at age 8 and later self-reported depressive symptoms among boys at age 18

AIMS

This study aimed to study conditions associated with depressive symptoms at ages 8 and 18 in a representative birth cohort of Finnish males.

METHODS

The participants in this community-based 10-year follow-up study consisted of 2,348 boys born in 1981. At age 8, three informant sources were used: parents, teachers, and the children themselves. Depressive symptoms were established using the Children's Depression Inventory (CDI). At age 18, self-report questionnaires were used to study the boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI).

RESULTS

Poor adaptive functioning at age 18 was independently associated with both child and late adolescent depressive symptoms. Use of illicit drugs and somatic health problems were independently associated with later depressive symptoms. Parental divorce in early childhood independently predicted depressive symptoms both in childhood and in late adolescence. Teacher reports of child's total problems at age 8 independently predicted depressive symptoms at age 18.

CONCLUSIONS

Depression in males at ages 8 and 18 is particularly associated with stressful life events in childhood, whereas late depression is associated with somatic health problems and substance use. Further population-based studies comparing conditions associated with childhood and adolescent depression are needed.

Childhood bullying behaviors at age eight and substance use at age 18 among males. A nationwide prospective study

Childhood bullying behaviors (bullying and victimization) were studied as risk factors for substance use among Finnish males. The study design was a nationwide prospective general population study, where information was collected in 1989 and 1999. Bullying behaviors and childhood psychopathology at age eight were collected from teachers, parents and boys themselves. At age 18, self-reports of frequent drunkenness (once a week or more often), daily heavy smoking (10 cigarettes or more per day), and illicit drug use during the past six months were obtained from 78% of the boys attending the study at age eight (n=2946). Being frequently victimized at age eight predicted daily heavy smoking, and this was evident even after adjusting for childhood family background, psychopathology at age eight and at age 18, and other forms of substance use. In multivariate analysis, bullying others frequently predicted illicit drug use, while being a victim of bullying associated with a lower occurrence of illicit drug use. Bullying behaviors had no association with frequent drunkenness independent of other factors. Accordingly, being a victim of bullying predisposes in particular to subsequent smoking. Bullying others in childhood can be regarded as an early indicator to illicit drug use later in life. The screening and intervention possibilities in order to recognize the risk group for later health compromising behaviors are emphasized.

The association of suicide and bullying in childhood to young adulthood: a review of cross-sectional and longitudinal research findings

OBJECTIVE

To review the research addressing the association of suicide and bullying, from childhood to young adulthood, including cross-sectional and longitudinal research findings.

METHOD

Relevant publications were identified via electronic searches of PsycNet and MEDLINE without date specification, in addition to perusing the reference lists of relevant articles.

RESULTS

Cross-sectional findings indicate that there is an increased risk of suicidal ideation and (or) suicide attempts associated with bullying behaviour and cyberbullying. The few longitudinal findings available indicate that bullying and peer victimization lead to suicidality but that this association varies by sex. Discrepancies between the studies available may be due to differences in the studies' participants and methods.

CONCLUSIONS

Bullying and peer victimization constitute more than correlates of suicidality. Future research with long-term follow-up should continue to identify specific causal paths between bullying and suicide.

Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: the TRAILS study

BACKGROUND

It is well known that functional somatic symptoms (FSS) are associated with anxiety and depression. However, evidence is lacking about how they are related to FSS. The aim of this study was to clarify these relationships and examine whether anxiety and depression are distinctly related to FSS. We hypothesized that anxiety contributes to the development of FSS and that depression is a consequence of FSS.

METHODS

FSS, anxiety, and depression were measured in adolescents (N = 2230, 51% women) by subscales of the Youth Self-Report during three assessment waves (adolescents successively aged: 10-12, 12-14, and 14-17) and by corresponding subscales of the Child Behavior Checklist. Using structural equation models, we combined trait and state models of FSS with those of anxiety and depression, respectively. We identified which relationships (contemporaneous and two-year lagged) significantly connected the states of FSS with the states of anxiety and depression.

RESULTS

Trait variables were all highly interrelated (r = .54-.63). Contrary to our hypothesis, both state anxiety (beta = .35) and state depression (beta = .45) had a strong contemporaneous effect on state FSS. In turn, state FSS had a weak two-year lagged effect on state anxiety (beta = .11) and an even weaker effect on state depression (beta = .06).

CONCLUSIONS

While the effect of anxiety and depression on FSS is strong and immediate, FSS exert a weaker and delayed influence on anxiety and depression. Further research should be done to detect the exact ways in which anxiety and depression lead to FSS, and FSS lead to anxiety and depression.

Young men exempted from compulsory military or civil service in Finland--a group of men in need of psychosocial support?

AIMS

The aim of this study was to find out whether young men exempted from compulsory military or civil service constitute a group of young men in need of psychosocial support from the social and health services.

METHODS

The study involved a total of 356 men exempted from military or civil service and 440 young men conscripted into service. The research data were collected using questionnaires and register data.

RESULTS

Men exempted from military or civil service differed from conscripts in terms of psychosocial well-being. Compared with conscripts, they had already been in a more disadvantaged position with regard to their childhood living conditions. As young adults, they had met with a greater number of mental and social problems than conscripts: alcohol-related problems, unemployment, financial problems, homelessness, lack of social support and psychological distress. Young men exempted from service typically suffered from an accumulation of problems. Diverse problems were common particularly among men who had interrupted their service. There was a moderate correlation between current and childhood adversities.

CONCLUSIONS

Men exempted from military or civil service comprise a group with a wide range of psychosocial problems and are a target group for supportive interventions. Special attention should be paid to the prevention of problems and promotion of well-being of men who interrupt their service. The accumulation of problems poses a challenge for the development of such interventions.

Testing developmental pathways to antisocial personality problems

This study examined the development of antisocial personality problems (APP) in young adulthood from disruptive behaviors and internalizing problems in childhood and adolescence. Parent ratings of 507 children's (aged 6-8 years) symptoms of attention deficit hyperactivity disorder, oppositional defiant disorder, and anxiety, were linked to self-ratings of adolescents' (aged 14-16 years) symptoms of depression, substance use, conduct problems, and somatic problems, to predict self-ratings of APP in young adulthood (age 20-22 years). The findings suggested a hierarchical development of antisocial behavior problems. Despite being positively associated with conduct problems in adolescence, neither internalizing problems nor substance use added to the prediction of APP in young adulthood from conduct problems in adolescence. The developmental pathways to APP in young adulthood did not differ by gender.

Using Prevention Science to Promote Children’s Mental Health: The Founding of the Missouri Prevention Center

Decades of research have demonstrated, now convincingly, that emotional and behavioral syndromes and many of their antecedent risks can be prevented. Much of this progress can be traced to the founding and expansion of the relatively young field called prevention science, an interdisciplinary field that emerged in the early 1990s to address the need for an integrated model for prevention-related research. The present article is intended to provide a specific example of prevention science in action for counseling psychologists. To illustrate key preventive science principles, the authors describe the formation and activities of the Missouri Prevention Center, a program that uses prevention science to promote children’s mental health. In particular, the authors use research produced by the center to highlight the various phases of prevention intervention research. They conclude with implications for counseling psychologists.

Internalizing correlates of dyslexia

BACKGROUND

Over the last ten years a considerable amount of literature has described the socio-emotional discomfort that is often associated with learning disorders at all ages, but a comprehensive review about internalizing symptoms in dyslexia is needed.

DATA SOURCES

Medical and psychological search engines (PubMed, PsychArticles and Academic Search Elite) were used to identify all those studies published in peer-reviewed journals, relative to the association of reading difficulties, dyslexia, or learning disorders/disabilities, and internalizing symptoms, anxiety, or depression.

RESULTS

The present review of studies confirms dyslexia as a specific risk factor for an increased internalizing, anxious and depressive symptomatology. The severity of dyslexia, its comorbidity with attention deficit disorder/hyperactivity disorder, the level of perceived social support and female gender are some of the factors that mostly influence its psycho-social outcomes.

CONCLUSION

Findings of this review confirm that suitable social, health and school policies aimed at identifying and treating dyslexia as a cause of discomfort are called for, and confirm the clinical need to assess and contrast additional risk factors that may increase the probability of this suffering in dyslexic students.

Predicting negative life outcomes from early aggressive-disruptive behavior trajectories: gender differences in maladaptation across life domains

Transactional theories of development suggest that displaying high levels of antisocial behavior early in life and persistently over time causes disruption in multiple life domains, which in turn places individuals at risk for negative life outcomes. We used longitudinal data from 1,137 primarily African American urban youth (49.1% female) to determine whether different trajectories of aggressive and disruptive behavior problems were associated with a range of negative life outcomes in young adulthood. General growth mixture modeling was used to classify the youths' patterns of aggressive-disruptive behavior across elementary school. These trajectories were then used to predict early sexual activity, early pregnancy, school dropout, unemployment, and drug abuse in young adulthood. The trajectories predicted the number but not type of negative life outcomes experienced. Girls with the chronic high aggression-disruption (CHAD) pattern experienced more negative outcomes than girls with consistently moderate levels, who were at greater risk than nonaggressive-nondisruptive girls. Boys with CHAD and boys with an increasing pattern had equal levels of risk for experiencing negative outcomes. The findings are consistent with transactional models of development and have implications for preventive interventions.

Early childhood psychological problems predict a poor sense of coherence in adolescents: a 15-year follow-up study

The aim of the present 15-year follow-up was to study the association between childhood psychological symptoms and sense of coherence (SOC) in adolescence. Destructive behaviour at three years, attention problems and thought problems at 12 years, attention problems, anxiety/depression, delinquency and somatic complaints at 15 years predicted a poor SOC at 18 years. Problems reported by adolescents themselves explained a poor SOC much more often than problems reported by parents. The identification of early childhood behavioural problems helps us to identify children at risk of ill-being in adolescence since problems seem to persist unchanged until that period of life.

Childhood and adolescent psychiatric disorders as predictors of young adult disorders

CONTEXT

Most adults with a psychiatric disorder first met diagnostic criteria during childhood and/or adolescence, yet specific homotypic and heterotypic patterns of prediction have not been firmly established.

OBJECTIVE

To establish which childhood and adolescent psychiatric disorders predict particular young adult disorders when accounting for comorbidities, disaggregating similar disorders, and examining childhood and adolescent predictors separately.

DESIGN

Eleven waves of data from the prospective population-based Great Smoky Mountains Study (N = 1420) were used.

SETTING

The Great Smoky Mountains Study is a longitudinal study of the development of psychiatric disorder and need for mental health services in rural and urban youth. A representative sample of children was recruited from 11 counties in western North Carolina.

PARTICIPANTS

Children in the community aged 9 to 16, 19, and 21 years.

MAIN OUTCOME MEASURES

Common psychiatric disorders were assessed in childhood (ages 9-12 years) and adolescence (ages 13-16 years) with the Child and Adolescent Psychiatric Assessment and in young adulthood (ages 19 and 21 years) with the Young Adult Psychiatric Assessment.

RESULTS

Adolescent depression significantly predicted young adult depression in the bivariate analysis, but this effect was entirely accounted for by comorbidity of adolescent depression with adolescent oppositional defiant disorder, anxiety, and substance disorders in adjusted analyses. Generalized anxiety and depression cross-predicted each other, and oppositional defiant disorder (but not conduct disorder) predicted later anxiety disorders and depression. Evidence of homotypic prediction was supported for substance use disorders, antisocial personality disorder (from conduct disorder), and anxiety disorders, although this effect was primarily accounted for by DSM-III-R overanxious disorder.

CONCLUSIONS

Stringent tests of homotypic and heterotypic prediction patterns suggest a more developmentally and diagnostically nuanced picture in comparison with the previous literature. The putative link between adolescent and young adult depression was not supported. Oppositional defiant disorder was singular in being part of the developmental history of a wide range of young adult disorders.