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Fulfs T, Poulain T, Vogel M, Nenoff K, Kiess W. Associations between sleep problems and emotional/behavioural difficulties in healthy children and adolescents. BMC Pediatr 2024; 24:15. [PMID: 38183087 PMCID: PMC10768421 DOI: 10.1186/s12887-023-04487-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE This study aimed to (1) characterise sleep disturbances and emotional/behavioural difficulties among healthy German children and adolescents aged 3 to 13 years, (2) examine the association between parent-reported sleep problems and emotional/behavioural difficulties, (3) point out possible relations between specific kinds of sleep disturbances and different behavioural difficulties. METHODS Data were collected between 2011 and 2015 within the LIFE Child study in Germany. The sample included 1101 3- to 13-year-old children and adolescents. Information on sleep disturbances-assessed via the Children's Sleep Habits Questionnaire (CSHQ), emotional/behavioural difficulties-assessed via the Strengths and Difficulties Questionnaire (SDQ), and socioeconomic status was provided by participants' parents. Multiple regressions were applied to analyse the associations between general and specific sleep disturbances (independent variables) and emotional/behavioural difficulties (dependent variables). RESULTS The total CSHQ score was positively associated with the total SDQ score and all SDQ subscales (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems). Most of the CSHQ subscales were related to SDQ subscale scores, except for a few non-significant relations with hyperactivity/inattention and conduct problems. The CSHQ total score, daytime sleepiness, sleep duration and parasomnias showed the strongest associations with the SDQ total score. CONCLUSION This study confirms an association between children's and adolescents' sleep habits and psychological health. We were able to demonstrate the association between sleep problems and emotional/behavioural difficulties in a large sample of healthy participants. In particular, we observed a significant relation between parasomnias and hyperactive/inattentive behaviour as well as a significant association between emotional problems and sleep problems, especially daytime sleepiness, sleep anxiety and parasomnias.
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Affiliation(s)
- Theresa Fulfs
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.
| | - Tanja Poulain
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Kolja Nenoff
- Medical Department for Hematology, Cell Therapy and Hemostaseology, Leipzig University, Liebigstrasse. 20/22, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
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Ramamurthy MB, Jayaprakash S. Introduction to Pediatric Sleep Medicine. Indian J Pediatr 2023; 90:927-933. [PMID: 37378884 DOI: 10.1007/s12098-023-04697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
Sleep is a key component of life to maintain our health, performance, safety and quality of life. In fact, sleep has been implicated in the optimal functioning of all organ systems - brain, heart, lung, metabolism, immune function, and hormonal balance too. One of the most common reasons for poor-quality sleep in children is a group of conditions termed sleep disordered breathing (SDB). Obstructive sleep apnea (OSA) is the most severe form of SDB. A good history and clinical examination is likely to reveal features of SDB including snoring, restless sleep, morning sleepiness, irritability or exhibit signs of hyperactivity. Examination may also reveal evidence of underlying pathology e.g., Craniofacial abnormalities, obesity and neuromuscular disorders that creates higher risk of developing SDB. Further investigation using polysomnography (PSG) is considered a gold-standard assessment of SDB and allows for scoring using Obstructive Apnoea-Hypopnea scale. Adenotonsillectomy is used as the first-line management in patients who otherwise have normal anatomy. Parents often approach their pediatricians with concerns regarding their child's sleeping habits and given the significant role sleep has on child development, it is essential that doctors are equipped to provide good care and advice for this population. This article aims to summarise presentation of SDB and common risk factors, investigations and management options to aid clinicians in managing SDB.
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Affiliation(s)
- Mahesh Babu Ramamurthy
- Department of Pediatrics, KTP-National University Children's Medical Institute, National University Hospital, Singapore, Singapore.
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Lannes ÉEM, Kenny S, Hershon M, Talwar V, Kiafar A, Pennestri MH. Associations between parental relationship dissolution and child sleep: A systematic review. Sleep Med Rev 2023; 70:101804. [PMID: 37390636 DOI: 10.1016/j.smrv.2023.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023]
Abstract
Parental relationship dissolution is considered one of the most common adverse childhood experiences. Although sleep is crucial for healthy development of children and very sensitive to environmental changes, it is poorly studied in the context of parental relationship dissolution. The aim of the current study was to systematically review and critically assess the existing literature on the associations between parental relationship dissolution and child sleep (0-18 years old; registered on PROSPERO (CRD42021272720)). PsycInfo, MEDLINE, Scopus, ProQuest Dissertations and Theses Global, Social Work abstracts, and Web of Science Core Collection were searched. Published empirical quantitative studies were included if they reported statistics regarding the association between parental relationship dissolution and any child sleep variable. Out of the 358 articles screened, 14 articles met inclusion criteria and reported on several sleep dimensions: sleep quality, dreams and nightmares, and sleep disorders (enuresis, night terrors, and bruxism). Out of the 14 articles, six were longitudinal studies and eight were cross-sectional studies. While most studies found that parental relationship dissolution was associated with some indices of poorer child sleep, studies were generally of low to moderate quality. Health professionals should assess child sleep in the context of a parental relationship dissolution.
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Affiliation(s)
- Émilie E M Lannes
- Department of Educational and Counselling Psychology, McGill University, Quebec, Canada; Hôpital en Santé Mentale Rivière-des-Prairies (CIUSSS-NIM), Quebec, Canada
| | - Samantha Kenny
- Department of Educational and Counselling Psychology, McGill University, Quebec, Canada; Hôpital en Santé Mentale Rivière-des-Prairies (CIUSSS-NIM), Quebec, Canada
| | - Malka Hershon
- Department of Educational and Counselling Psychology, McGill University, Quebec, Canada; Hôpital en Santé Mentale Rivière-des-Prairies (CIUSSS-NIM), Quebec, Canada
| | - Victoria Talwar
- Department of Educational and Counselling Psychology, McGill University, Quebec, Canada
| | - Anita Kiafar
- Department of Educational and Counselling Psychology, McGill University, Quebec, Canada; Hôpital en Santé Mentale Rivière-des-Prairies (CIUSSS-NIM), Quebec, Canada
| | - Marie-Hélène Pennestri
- Department of Educational and Counselling Psychology, McGill University, Quebec, Canada; Hôpital en Santé Mentale Rivière-des-Prairies (CIUSSS-NIM), Quebec, Canada.
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Higgins S, Stoner L, Black K, Wong JE, Quigg R, Meredith-Jones K, Skidmore PM. Social jetlag is associated with obesity-related outcomes in 9-11-year-old children, independent of other sleep characteristics. Sleep Med 2021; 84:294-302. [PMID: 34217919 DOI: 10.1016/j.sleep.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/24/2021] [Accepted: 06/10/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Social jetlag has been reported to predict obesity-related indices, independent of sleep duration, with associations in female adolescents but not males. However, such sex-specific relationships have not been investigated in pre-adolescents. OBJECTIVES To examine: (i) the relationships between sleep characteristics, including social jetlag, and obesity-related outcomes during childhood, and (ii) whether these relationships are moderated by sex. METHODS This cross-sectional study included 381 children aged 9-11 years (49.6% female). Average sleep duration, social jetlag, and physical activity were assessed via wrist-worn accelerometry. Sleep disturbances were quantified from the Children's Sleep Habits Questionnaire. Obesity-related outcomes included age-specific body mass index Z-scores (zBMI) and waist-to-height ratio. Additionally % fat, total fat mass, and fat mass index were assessed via bioelectrical impedance analysis. Linear mixed models that nested children within schools were used to identify relationships among sleep characteristics and obesity-related outcomes. RESULTS Positive associations between social jetlag with zBMI, % fat, and fat mass index were seen in univariable and unadjusted multivariable analyses. Following adjustments for known confounders, social jetlag remained significantly associated with zBMI (β = 0.12, p = 0.013). Simple slopes suggested a positive association in girls (β = 0.19, p = 0.006) but not in boys (β = 0.03, p = 0.703). CONCLUSIONS Obesity prevention efforts, particularly in girls, may benefit from targeted approaches to improving the consistency of sleep timing in youth.
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Affiliation(s)
- Simon Higgins
- Department of Exercise Science, Elon University, Elon, NC, USA.
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine Black
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Jyh Eiin Wong
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Robin Quigg
- Department of Preventative and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Paula Ml Skidmore
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Zheng M, Rangan A, Olsen NJ, Heitmann BL. Longitudinal association of nighttime sleep duration with emotional and behavioral problems in early childhood: results from the Danish Healthy Start Study. Sleep 2021; 44:5874165. [PMID: 32691048 DOI: 10.1093/sleep/zsaa138] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/06/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To examine the longitudinal and bidirectional association between nighttime sleep duration and emotional and behavioral problems (EBPs) over 15 months among preschool children. METHODS Data of children aged 2 to 6 years from the control group of the Danish Healthy Start Study, a 15-month obesity prevention intervention, were used. Nighttime sleep duration was measured using a 7-day sleep record. EBPs were assessed by the Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score and Prosocial Behavior (SDQ-PSB) score. Multivariable regression models were conducted to examine the bidirectional associations between changes in nighttime sleep duration and SDQ scores. RESULTS With adjustment for child, family factors, and parental stress level, every hour extra nighttime sleep at baseline was associated with a 1.02 decrease in SDQ-TD score and 77% lower odds of having an abnormal SDQ-TD score (≥90th percentile) at the follow-up (p = 0.01). Children who increased their nighttime sleep duration over the 15-month demonstrated a similar concurrent reduction in SDQ-TD score (β = -1.28, p = 0.02) compared with those who decreased or had no change in nighttime sleep duration. After additional adjustment for sleep problem and habit variables, the significant associations remained. No associations were found between nighttime sleep duration and SDQ-PSB scores. Examination of SDQ scores as predictors of subsequent changes in nighttime sleep duration showed no significant associations. CONCLUSIONS Among preschool children, longer nighttime sleep duration was associated with a decline in EBPs, but not vice versa. Our study provides new longitudinal evidence to support sleep interventions to improve EBPs in early childhood.Clinical trials: The Healthy Start Study: https://clinicaltrials.gov/ct2/show/NCT01583335Trial registration: ID NCT01583335.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Anna Rangan
- Nutrition and Dietetics Group, Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - Nanna Julie Olsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
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Mohammadi MR, Salmanian M, Keshavarzi Z. The Global Prevalence of Conduct Disorder: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PSYCHIATRY 2021; 16:205-225. [PMID: 34221047 PMCID: PMC8233559 DOI: 10.18502/ijps.v16i2.5822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: There has been little effort to conduct systematic reviews or meta-analyses of the available literature to find global prevalence rates of conduct disorder and analyze the sources of heterogeneity. Method : We searched multiple databases, including Web of Science, PubMed, Scopus, and Google Scholar to identify cross-sectional studies with random or nonrandom sampling to assess the global prevalence of conduct disorder in children and adolescents aged under 18 in the general or school-based populations. Quality assessment and data extraction were independently carried out by two authors. Subgroup analysis was used to find the potential sources of heterogeneity. Results: We reached 50 studies, incorporating 186,056 children and adolescents from 35 countries. The total prevalence of conduct disorder was 8% (CI: 7-9%; I2: 99.77%), including 7% in females (CI: 4-9%; I2: 99.56%) and 11% in males (CI: 7-15%; I2: 99.74%). The results of subgroup analysis showed that total heterogeneity could be explained by measurement tools. When diagnostic interviews such as the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) and Development and Well-Being Assessment (DAWBA) were employed, the pooled prevalence rates for conduct disorder were 0.4% and 0.7%, respectively, and heterogeneity decreased. However, the use of the screening tools such as the Strengths and Difficulties Questionnaire (SDQ)-parent or teacher report and SDQ-self report increased the pooled prevalence of conduct disorder to 10% and 16% respectively. Conclusion: The prevalence of conduct disorder in the epidemiological studies should be estimated by employing the diagnostic interviews to reach accurately assessments.
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Affiliation(s)
- Mohammad-Reza Mohammadi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Salmanian
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Keshavarzi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Jeon M, Dimitriou D, Halstead EJ. A Systematic Review on Cross-Cultural Comparative Studies of Sleep in Young Populations: The Roles of Cultural Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042005. [PMID: 33669583 PMCID: PMC7922907 DOI: 10.3390/ijerph18042005] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 01/21/2023]
Abstract
Recent studies have shown that sleep is influenced and shaped by cultural factors, including cultural values, beliefs and practices. However, a systematic understanding of how cultural factors in countries may influence sleep duration and sleep disturbances is still lacking. Therefore, we focused on a comparison of sleep duration and disturbances in young populations between countries. We report cross-cultural differences between the child, parent and environmental factors, and their association with sleep duration and disturbances. The review is based on literature searches of seven databases published until December 2020. Studies were included if they investigated sleep duration and disturbances of individuals up to 18 years across at least two or more countries. The results of this review have shown that sleep duration and disturbances vary between countries and regions and certain factors (e.g., bedtime routines, sleeping arrangement, physical activity and psychological functioning) have been associated with sleep duration or disturbances. This review also demonstrates that certain factors which were associated with sleep duration or disturbances in one country, were not shown in other countries, suggesting a need for recommendations for age-related sleep duration and sleep interventions to consider cultural differences that influence sleep duration or disturbances in individual countries or regions.
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Huhdanpää H, Klenberg L, Westerinen H, Fontell T, Aronen ET. Sleep and psychiatric symptoms in young child psychiatric outpatients. Clin Child Psychol Psychiatry 2018; 23:77-95. [PMID: 28715946 DOI: 10.1177/1359104517718366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sleep may underlie psychiatric symptoms in young children. However, not many studies have reported on sleep and its associations with symptoms in young child psychiatric patients. OBJECTIVES To assess the amount and quality of sleep and how sleep associates with psychiatric symptoms in young child psychiatric patients. Furthermore, we evaluated how sleep and daytime somnolence differed in patients and their age- and gender-matched controls. METHOD The sample consisted of 139 3- to 7-year-old child psychiatric outpatients and 139 age- and gender-matched controls from community. We evaluated sleep and daytime somnolence with the Sleep Disturbance Scale for Children in all children and psychiatric symptoms with Child Behaviour Checklist (CBCL) in the patient group. Family background information was collected from the patients. RESULTS Of the patients, 31.6% had a significant sleep problem and 14.4% slept too little. The most typical sleep problems were restless sleep (31.7%), morning tiredness (21.6%) and difficulties getting to sleep at night (18.7%). All types of sleep problems were associated with CBCL total, internalising and externalising problems (all p-values < .01). We observed a strong association between all types of sleep problems and emotionally reactive subscale ( p-value < .001). Furthermore, parent-reported sleep problems increased significantly the risk of having high scores on total (odds ratio (OR) = 5.3, 95% confidence interval (CI) = [2.2, 12.6], p < .001), external (OR = 3.7, 95%, CI = [1.6, 8.5], p < .01) and internal (OR = 2.5, 95% CI = [1.1, 5.5], p < .05) scores after controlling for age, gender, family structure and parent's educational level. Even mild sleep disturbance increased the intensity of psychiatric symptoms. Compared to controls, patients slept less ( p < .001) and had significantly more frequent restless sleep, nightmares and morning and daytime somnolence. CONCLUSION Sleep problems and too little sleep are prevalent in young child psychiatric patients, and they relate strongly to the intensity of psychiatric symptoms. Identification and treatment of sleep problems should be a routine part of the treatment plan for young child psychiatric patients. The results emphasise the need for assessing sleep in young child psychiatric patients, as treating the sleep problem may reduce psychiatric symptoms.
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Affiliation(s)
- Hanna Huhdanpää
- 1 Laboratory of Developmental Psychopathology, Children's Hospital/Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Liisa Klenberg
- 2 Department of Psychology and Logopedics, University of Helsinki, Finland
| | - Hannu Westerinen
- 3 Department of Child Psychiatry, Helsinki University Hospital, Finland
| | - Tuija Fontell
- 3 Department of Child Psychiatry, Helsinki University Hospital, Finland
| | - Eeva T Aronen
- 1 Laboratory of Developmental Psychopathology, Children's Hospital/Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Finland
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Wong MM, Brower KJ, Conroy DA, Lachance KA, Craun EA. Sleep Characteristics and Behavioral Problems Among Children of Alcoholics and Controls. Alcohol Clin Exp Res 2017; 42:603-612. [PMID: 29265382 DOI: 10.1111/acer.13585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/11/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Past research has indicated that both sleep difficulties and a parental history of alcoholism increase the risk of behavioral problems. But it is not known whether sleep difficulties differentially increase the risk of problem behaviors among children of alcoholics (COAs) and controls. We compared multiple measures of sleep and the relationships between sleep and behavioral problems in these 2 groups of children. METHODS One hundred and fifteen children aged 8 to 12 (67% COAs; 56% girls; Mage = 10.85, SDage = 1.51) participated in this study. Data presented here were taken from Time 1 of a larger prospective study designed to understand the relationship between sleep and alcohol use. All participants were naïve to alcohol and other illicit drugs. Participants were asked to wear an actigraph watch on their nondominant wrist for 1 week. Parents completed the Pediatric Sleep Questionnaire and the Achenbach Child Behavior Checklist. RESULTS Parents of COAs were more likely to rate their children as overtired compared with parents of non-COAs. Structural equation modeling analyses focusing on overall internalizing and externalizing problems did not reveal any group differences on the relationships between sleep measures and behavioral problems. Regression analyses focusing on specific behavioral problems showed that longer total sleep time, parental ratings of "sleep more" and "sleep less" than other children interacted with COA status to predict specific behavioral problems. CONCLUSIONS Sleep difficulties and duration appear to be a general risk factor for behavioral problems in both COAs and non-COAs, yet the relationships between specific sleep parameters and behavioral problems appear to be different between the 2 groups.
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Affiliation(s)
- Maria M Wong
- Department of Psychology, Idaho State University, Pocatello, Idaho
| | - Kirk J Brower
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Deirdre A Conroy
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Maasalo K, Wessman J, Aronen ET. Low mood in a sample of 5-12 year-old child psychiatric patients: a cross-sectional study. Child Adolesc Psychiatry Ment Health 2017; 11:50. [PMID: 29042906 PMCID: PMC5629809 DOI: 10.1186/s13034-017-0183-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/11/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Not much is known about low mood and its associates in child psychiatric patients. In this study, we examined the prevalence of low mood, how it associates with disruptive behaviour, and affects clinician-rated global functioning in child psychiatric outpatients. METHODS The study population consisted of 862 5-12 year-old child psychiatric patients. The study sample was a subsample of all 1251 patients attending a child psychiatric outpatient clinic at Helsinki University Hospital in 2013-2015 formed by excluding 4 year-old and 13 year-old patients and those with missing or incomplete data. The parent-rated Strengths and Difficulties Questionnaire, collected as part of the routine clinical baseline measure, was used as a measure of psychiatric symptoms. The diagnoses were set according to ICD-10 by the clinician in charge after an initial evaluation period. The Children's Global Assessment Scale (CGAS) score set by clinicians provided the measure of the patients' global functioning. All information for the study was collected from hospital registers. Associations between emotional symptoms and conduct problems/hyperactivity scores were examined using ordinal regression in univariate and multivariate models, controlling for age and sex. The independent samples T test was used to compare the CGAS values of patient groups with low/normal mood. RESULTS In our sample, 512 children (59.4%) showed low mood. In multivariate ordinal regression analysis, low mood associated with conduct problems (OR 1.93, 95% CI 1.39-2.67), but no association was found between low mood and hyperactivity. Low mood was prevalent among children with oppositional defiant disorder or conduct disorder (51.8%). The global functioning score CGAS was lower among children with parent-reported low mood (52.21) than among children with normal mood (54.62, p < 0.001). The same was true in the subgroup of patients with no depression diagnosis (54.85 vs. 52.82, p = 0.001). CONCLUSIONS Low mood is prevalent in child psychiatric outpatients regardless of depression diagnosis and it has a negative effect on global functioning. Low mood and behavioural problems are often associated. It is important to pay attention to low mood in all child psychiatric patients. We recommend prevention measures and low-threshold services for children with low mood.
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Affiliation(s)
- Katri Maasalo
- 0000 0004 0410 2071grid.7737.4University of Helsinki and Helsinki University Hospital, Children’s Hospital, Child Psychiatry, Tukholmankatu 8 C 613, 00290 Helsinki, Finland ,Helsinki Pediatric Research Center, Laboratory of Developmental Psychopathology, Helsinki, Finland
| | - Jaana Wessman
- 0000 0004 0410 2071grid.7737.4University of Helsinki and Helsinki University Hospital, Children’s Hospital, Child Psychiatry, Tukholmankatu 8 C 613, 00290 Helsinki, Finland ,Helsinki Pediatric Research Center, Laboratory of Developmental Psychopathology, Helsinki, Finland
| | - Eeva T. Aronen
- 0000 0004 0410 2071grid.7737.4University of Helsinki and Helsinki University Hospital, Children’s Hospital, Child Psychiatry, Tukholmankatu 8 C 613, 00290 Helsinki, Finland ,Helsinki Pediatric Research Center, Laboratory of Developmental Psychopathology, Helsinki, Finland
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