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Ashok P, Fäldt A, Dahlberg A, Durbeej N. Early emotional and behavioural problems predict use of habilitation services among children: Findings from a longitudinal follow-up study. PLoS One 2024; 19:e0303685. [PMID: 38753629 PMCID: PMC11098387 DOI: 10.1371/journal.pone.0303685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To explore the association between early emotional and behavioural problems and use of habilitation services among children in Sweden. METHODS In this longitudinal cohort study, we used data on children, 3-5 years of age, whose mothers (n = 7343) and fathers (n = 6322) had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems, and who were followed for approximately 6.5 years with regard to use of habilitation services. The relations between emotional and behavioural problems and use of habilitation services were explored through cox regression models. RESULTS In unadjusted models, children with identified emotional and behavioural problems were more likely to utilise habilitation services compared to those with no identified problems. These associations were shown for both mothers' (HR: 5.02) and fathers' (HR: 4.25) SDQ ratings. In adjusted cox-regression models, the associations remained significant for both mothers' (AHR: 4.24) and fathers' (AHR: 4.03) ratings. CONCLUSIONS Early emotional and behavioural problems predict later habilitation service use among children in Sweden. Assessment of these problems in all children at child health services could facilitate early identification and timely interventions. Habilitation centres in Sweden could integrate mental health care into the standard treatment for children using these services.
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Affiliation(s)
- Pavithra Ashok
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Fäldt
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anton Dahlberg
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Mølland E, Haraldstad K, Abildsnes E, Håland ÅT, Köpp UMS, Fegran L, Westergren T. Use of the Strengths and Difficulties Questionnaire in child and school health services among children aged 4 and 6 years in Southern Norway: clinical considerations. BMC Pediatr 2023; 23:30. [PMID: 36658563 PMCID: PMC9850695 DOI: 10.1186/s12887-023-03837-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Parent reported mental health can be assessed by the Strengths and Difficulties Questionnaire (SDQ). Currently, Norwegian norms for parent-reported SDQ do not exist, whereas Swedish, Danish, and United Kingdom (UK) norms have been published. We aimed to (1) describe parent-reported SDQ among children aged 4 and 6 years in Southern Norway, (2) evaluate empirical cutoff values within the context of the Starting RightTM project in relation to the Swedish, Danish, and UK cutoffs, and (3) evaluate the representativeness of the study sample with regard to parental socioeconomic status. METHODS This study included parent-reported observations for 665 children (63% consent rate). Means and standard deviations were calculated for the domains of SDQ, and gender differences were assessed. Based on the Swedish, Danish, and UK cutoffs and the 80th and 90th percentile cutoff values within the study, we calculated the total number of children with borderline and abnormal scores. RESULTS Boys had higher mean total difficulties (7.3 vs 5.6) and impact scores (0.3 vs 0.1) and lower prosocial scores (8.3 vs 8.8) than girls. The differences in means were largest in the case of externalizing symptoms (5.0 vs 3.6) and hyperactivity subscore (3.2 vs 2.3). Using the UK cutoff values, 28 and 25 children had borderline and abnormal total difficulties scores, respectively. The corresponding numbers using the within study or Scandinavian cutoff values were 84-99 and 54-79, respectively. Overall, our study sample was well representative of the target population. CONCLUSIONS Our findings consistently indicated that girls had better SDQ scores than boys among children aged 4 and 6 years. Fewer children would be identified as having mental health difficulties using the UK cutoff values than using the Scandinavian age- and gender-relevant cutoff values.
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Affiliation(s)
- Eirin Mølland
- grid.23048.3d0000 0004 0417 6230Department of Economics and Finance, School of Business and Law, University of Agder, PO Box 422, 4604 Kristiansand, Norway ,grid.509009.5NORCE, Kristiansand, Norway
| | - Kristin Haraldstad
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Eirik Abildsnes
- grid.458169.70000 0004 0474 7697Kristiansand Municipality, Kristiansand, Norway ,grid.23048.3d0000 0004 0417 6230Department of Psychosocial Health, Faculty of Health and Sport Science, University of Agder, Kristiansand, Norway
| | - Åshild Tellefsen Håland
- grid.23048.3d0000 0004 0417 6230Department of Psychosocial Health, Faculty of Health and Sport Science, University of Agder, Kristiansand, Norway ,grid.417290.90000 0004 0627 3712Department of Children and Adolescents Mental Health (ABUP), Sørlandet Hospital HF, Kristiansand, Norway
| | - Unni Mette Stamnes Köpp
- grid.417290.90000 0004 0627 3712Department of Peadiatrics, Sørlandet Hospital HF, Kristiansand, Norway
| | - Liv Fegran
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Thomas Westergren
- grid.509009.5NORCE, Kristiansand, Norway ,grid.23048.3d0000 0004 0417 6230Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Fält E, Fabian H, Durbeej N. Parental sociodemographic characteristics and mental health referrals by nurses in Swedish child health centres. Acta Paediatr 2022; 111:1743-1751. [PMID: 35673845 PMCID: PMC9545827 DOI: 10.1111/apa.16448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/14/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
AIM To explore the influence of parents' socio-economic characteristics on child healthcare nurses' mental health referrals of 3- to 5-year-olds and also to test the association between mental health problems and referrals. METHODS Repeated cross-sectional data including parents' Strengths and Difficulties Questionnaire (SDQ) assessments and referral data (psychologist and speech and language pathologist). Hierarchical regression was used to analyse whether parents' country of birth, education level, marital status and mental health problem scores (SDQ; total difficulties and impact scores) were associated with nurses' referrals. RESULTS About 9% of mothers and 12% of fathers rated high SDQ scores (total difficulties) in their children. Approximately, 1% of the children were referred. The influence of parents' socio-economic characteristics on referral rates was not observed. However, for children with Swedish-born mothers, referral rates were significantly lower. Scores for SDQ total difficulties and impact were associated with the child's referral to specialists. CONCLUSION In general, parental sociodemographic characteristics do not influence Swedish child healthcare nurses' mental health referrals. Although there was a significant association between problem behaviour and referral, a disproportion between children rated with high SDQ scores (9% and 12%) and children referred to specialists (1%) should be addressed.
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Affiliation(s)
- Elisabet Fält
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Fabian
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Natalie Durbeej
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Robstad N, Westergren T, Mølland E, Abildsnes E, Haraldstad K, Stamnes Köpp UM, Håland ÅT, Fegran L. Experiences of Norwegian child and school health nurses with the "Starting Right™" child health assessment innovation: a qualitative interview study. BMC Health Serv Res 2022; 22:728. [PMID: 35650581 PMCID: PMC9157476 DOI: 10.1186/s12913-022-08088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although child health services are well established in Norway, the use of information technology for the systematic collection of evidence-based child- and proxy-reported health measures may be beneficial in the early identification of child development problems. The Norwegian “Starting Right™” health service innovation consists of parent- and child-reported online structured health assessments tools, including practical routines for child and school health assessments. The aim of this study was to explore the experiences of child and school health nurses with the Starting Right innovation. Methods We used a qualitative design and conducted three focus group interviews with 18 child and school health nurses from three child health centres one year after the implementation of the innovation. Results The experiences of professionals with the Starting Right innovation were captured by three themes: (1) the digital innovation could be used to obtain a good overview of a child’s health and development; (2) interpreting the questionnaires was a challenge; and (3) implementing the new digital innovation was time-consuming. Conclusions Overall, the child and school health nurses experienced that the Starting Right innovation was useful for providing a comprehensive overview of child development and health. The challenges related to interpreting the parents’ scores and follow-up of children, as well as providing the questionnaires in relevant foreign languages, should be addressed to allow all children and families to be reached.
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Affiliation(s)
- Nastasja Robstad
- Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway.
| | - Thomas Westergren
- Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway.,NORCE, Universitetsveien 19, 4630, Kristiansand, Norway
| | - Eirin Mølland
- NORCE, Universitetsveien 19, 4630, Kristiansand, Norway.,Department of Economics and Finance, School of Business and Law, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway
| | - Eirik Abildsnes
- Kristiansand municipality, P.O. Box 4, 4685, Nodeland, Norway.,Department of Psychosocial Health, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway
| | - Kristin Haraldstad
- Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway
| | - Unni Mette Stamnes Köpp
- Department of Pediatrics, Sørlandet Hospital, P.O. Box 416, Lundsiden, 4604, Kristiansand, Norway
| | - Åshild Tellefsen Håland
- Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway.,Department of Pediatrics, Sørlandet Hospital, P.O. Box 416, Lundsiden, 4604, Kristiansand, Norway
| | - Liv Fegran
- Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway
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