Cultural adaptation, content, and protocol of a feasibility study of school-based "Let's learn about emotions" intervention for Finnish primary school children

Introduction

Emotional awareness and emotion regulation are crucial for cognitive and socio-emotional development in children. School-based interventions on socio-emotional skills have the potential to prevent these problems and promote well-being of children. The Japanese school-based program, Universal Unified Prevention Program for Diverse Disorders (Up2-D2), has shown preventive effects on mental health of children in Japan. The aims of this protocol paper are to describe the unique process of adapting the Up2-D2 from Eastern to Western context, and to present a feasibility study of the intervention, conducted in Finland.

Methods

The cultural adaptation process started with the linguistic translation of materials, followed by the modification of language to fit the Finnish context. While the Japanese ideology was saved, some content was adapted to fit Finnish school children. Further modifications were made based on feedback from pupils and teachers. The Finnish version of the program was named "Let's learn about emotions" and consisted of 12 sessions and targeted 8- to 12-year-old pupils. A teacher education plan was established to assist Finnish teachers with the intervention, including a workshop, teachers' manual, brief introductory videos, and online support sessions. A feasibility study involving 512 4th graders in the City of Hyvinkää, South of Finland, was conducted. It assessed emotional and behavioral problems, classroom climate, bullying, loneliness, perception of school environment, knowledge of emotional awareness, and program acceptability.

Discussion

The originality of this study underlies in the East-West adaptation of a cognitive behavioral therapy-based program. If promising feasibility findings are replicated in Finland, it could pave the way for further research on implementing such programs in diverse contexts and cultures, promoting coping skills, awareness, social skills and early prevention of child mental health problems.

Ethics

The ethical board of the University of Turku gave ethics approval for this research. The educational board of the City of Hyvinkää accepted this study.

Digital universal parent training program to promote positive parenting skills – A randomized waiting-list study

Introduction

Parent training programs have high potential to promote positive parent-child relationships as well as reach and engage parents to participate. Digitally delivered programs may overcome the barriers associated with face-to-face interventions, such as stigma, logistic challenges and limited resources.

Objectives

To assess the effectiveness and feasibility of digital universal parent training program for families with 3 years-old children, focusing on parenting skills and child´s behavior.

Methods

A non-blinded randomized controlled trial (RCT) with two groups: (I) the intervention group, in which participants receive the parent training and (II) the waiting list group, in which participants are placed on a waiting list to receive the parent training intervention after the first follow-up measurement have been completed. Participants must meet the following inclusion criteria: a) guardians having a child age 3 years, b) participating to annual health checkup in child health clinic, c) at least one of the guardian is able to understand the languages that intervention is provided.

Results

Pilot study with feasibility assessment finished at early 2021. Recruitment of the wider RCT study is currently ongoing. The results from the pilot study and more detailed description about the intervention will be presented.

Conclusions

This study with good national geographical coverage is a unique possibility to evaluate universal parenting program on promoting parenting behaviors associated with the promotion of optimal child emotional development. This study also provides population level information about parenting skills and child´s behavior.

Disclosure

No significant relationships.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

Introduction

Anxiety disorders (ADs) are common in childhood and adolescence and global estimates suggest they affect 6.5% of individuals under 19 years of age.Yet, there has been a lack of research on time trends and socio-demographic risks for children and adolescents who receive treatment for ADs.

Objectives

We aim to fill gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.

Methods

We used register data of all singleton children born in Finland from 1992-2006 and diagnosed with ADs from 1998-2012. Changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006. The 22,388 individuals with ADs were matched with 76,139 controls. Nested case-control design was used to study the socio-demographic risk factors.

Results

Comparing the 1992-1996 and 2002-2006 cohorts showed the cumulative incidence of treated ADs at the age of 10 increased from 0.3% to 1.2% (females) and 0.46% to 1.9% (males). Subjects had higher odds of being diagnosed with an AD if mothers had low SES (OR 1.49, 95% CI 1.42-1.58) and were single parents (OR 1.99, 95% CI 1.84-2.15) at birth. Unipolar depression was the most common psychiatric comorbidity (31.2%).

Conclusions

ADs diagnosed by specialized services increased from 1998-2012 in both genders. This could indicate real increase in overall ADs, an increase in seeking treatment or both phenomena. The findings on maternal socioeconomic status and single parenting help improve understanding of environmental risk for anxiety disorders among children and adolescents.

Disclosure

No significant relationships.

Economic evidence of preventive interventions for anxiety disorders in children and adolescents – a systematic review

Introduction

Anxiety disorders are common in children and youth. Also, in prevention, be it universal, selective or indicated, economic evaluation supports decision-making in the allocation of scarce resources.

Objectives

This review identified and summarised the existing evidence of economic evaluations for the prevention of anxiety disorders in children and adolescents.

Methods

A systematic search was conducted on the EBSCO, Scopus, Web of Science, ProQuest, Cochrane and PubMed databases. We included studies that focused on children and adolescents under 18 years of age, aimed to prevent anxiety disorders, and presented an incremental analysis of costs and effectiveness. A registered checklist was used that assessed the quality of the included articles.

Results

The search yielded 1,697 articles. Five articles were included in this review. Three were RCT-based and two were model-based studies. Out of five included interventions, one was a universal school-based intervention, two selective interventions and two indicated interventions. Universal school-based prevention of anxiety was not cost-effective compared to usual teaching. Selective parent training and indicative child- and parent-focused CBT prevention were likely cost-effective compared to usual care or doing nothing.

Conclusions

Parent education and cognitive behaviour therapy interventions can be cautiously interpreted as being a cost-effective way of preventing anxiety in children and adolescents. However, the evidence is weak related to cost-effectiveness as there are only a few studies, with relatively small sample sizes and short follow-ups.

Disclosure

No significant relationships.

Internet-assisted cognitive behavioural therapy with telephone coaching for anxious Finnish children aged 10-13 years: study protocol for a randomised controlled trial

INTRODUCTION

Childhood anxiety is common, causes significant functional impairment and may lead to psychosocial problems by adulthood. Although cognitive behavioural therapy (CBT) is effective for treating anxiety, its availability is limited by the lack of trained CBT therapists and easily accessible local services. To address the challenges in both recognition and treatment, this study combines systematic anxiety screening in the general population with a randomised controlled trial (RCT) on internet-assisted CBT (ICBT) with telephone coaching. Child, family and intervention-related factors are studied as possible predictors or moderators, together with the COVID-19 pandemic.

METHODS AND ANALYSIS

The study is an open two-parallel group RCT, stratified by sex, that compares ICBT with telephone coaching to an education control. Children aged 10-13 are screened at yearly school healthcare check-ups using five items from the Screen for Child Anxiety Related Disorders (SCARED) Questionnaire. The families of children who screen positive for anxiety are contacted to assess the family's eligibility for the RCT. The inclusion criteria include scoring at least 22 points in the 41-item SCARED Questionnaire. The primary outcome is the SCARED child and parent reports. The secondary outcomes include the impact of anxiety, quality of life, comorbidity, peer relationships, perceptions of school, parental well-being and service use. Additional measures include demographics and life events, anxiety disorder diagnoses, as well as therapeutic partnerships, the use of the programme and general satisfaction among the intervention group.

ETHICS AND DISSEMINATION

The study has been approved by the research ethics board of the Hospital District of South West Finland and local authorities. Participation is voluntary and based on informed consent. The anonymity of the participants will be protected and the results will be published in a scientific journal and disseminated to healthcare professionals and the general public.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT03310489, pre-results, initially released on 30 September 2017.

The Finnish psychiatric birth cohort consortium (PSYCOHORTS) - content, plans and perspectives

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality.

Validation of the Youth Efficacy/Empowerment Scale - Mental Health Finnish version

Αdolescents face mental health problems and still their mental health needs are often neglected. Empowerment provides adolescents with the skills to impact their own lives and communities in general. The aim of the study is to examine the validity and reliability of the Finnish version of the Youth Efficacy/Empowerment Scale - Mental Health (YES-MH). Data was collected through an online questionnaire from pupils aged 12-17 years in Western Finland, comprised of the following instruments; the YES-MH, the Goodman's the Strengths and Difficulties Questionnaire (SDQ), and the Warwick-Edinburgh Mental Wellbeing Scale. Exploratory factor analysis was carried out to evaluate construct validity and disclose underlying structures which yielded the following subscales: Self, Services, System. The internal consistency of subscales was analyzed with Cronbach's α. Construct validity was further investigated by computing the Pearson's correlations coefficients between the subscales. Furthermore, correlations with SDQ and mental well-being dimensions were explored as measures of convergent validity. In the final model all items the Youth Efficacy/ Empowerment Scale - Mental Health were entered into the factor analysis. All factor loadings were more than 0.40, ranging from 0.63 to 0.89. All the scales exceeded the minimum reliability standard of 0.70 and all corrected item-total correlations were high. All the YES-MH subscales were significantly and positively correlated each other with correlations coefficients ranging from medium to high. Correlations of Mental Well-being score with Self and Services subscales were significant. Moreover, Self subscale was significantly correlated with all SDQ dimensions. Services subscale was significantly correlated with Emotional symptoms and total SDQ score, while System subscale was significantly correlated with Conduct problems. The exploratory factor analysis showed a clear factor structure and the results suggest that the YES-MH is a reliable scale for assessing empowerment among young people. The YES-MH can be useful for health professionals not only as an assessment tool but also when they need to evaluate mental health interventions and examine empowerment as an outcome. However, further research can provide insights for the use of the scale in specific adolescent target groups and among different ethnic groups as well.

Violence and child mental health in Brazil: The Itaboraí Youth Study methods and findings

OBJECTIVES

To demonstrate a study design that could be useful in low-resource and violent urban settings and to estimate the prevalence of child violence exposure (at home, community, and school) and child mental health problems in a low-income medium-size city.

METHODS

The Itaboraí Youth Study is a Norway-Brazil collaborative longitudinal study conducted in Itaboraí city (n = 1409, 6-15 year olds). A 3-stage probabilistic sampling plan (random selection of census units, eligible households, and target child) generated sampling weights that were used to obtain estimates of population prevalence rates.

RESULTS

Study strengths include previous pilot study and focus groups (testing procedures and comprehension of questionnaire items), longitudinal design (2 assessment periods with a mean interval of 12.9 months), high response rate (>80%), use of standardized instruments, different informants (mother and adolescent), face-to-face interviews to avoid errors due to the high frequency of low-educated respondents, and information gathered on a variety of potential predictors and protective factors. Children and adolescents presented relevant levels of violence exposure and clinical mental health problems.

CONCLUSIONS

Prevalence estimates are probably valid to other Brazilian low-income medium-size cities due to similarities in terms of precarious living conditions. Described study methods could be useful in other poor and violent world regions.

Eating problems and body image among Finnish adolescents

Objective

To study prevalence of self-reported body image and eating distress symptoms among Finnish adolescents, and to study associations between psychopathology, body image and eating distress.

Design

Cross-sectional population-based, survey subjects, 7th to 9th grade students aged 13–15: 3154 in Finland in 2014.

Methods

Data were collected by student self-reported questionnaire including scale designed for evaluating attitudes and behaviors towards body shape and eating, and Strengths and Difficulties Questionnaire (SDQ) for assessing emotional and behavioral problems.

Results

The female adolescents reported much more dissatisfaction and concerns with their bodies than the males, high levels of distress with body emotional, behavioral and peer problems measured with SDQ. Body image and eating problems were higher in Finnish than Japanese females with peer problems.

Conclusion

The finding was in accordance with previous studies that found that body image and eating distress are associated with to gender and wide range of psychiatric problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Developing and implementing digital-assisted parent training intervention for disruptive behavior in primary health care

Background

According to many epidemiological studies early prevention of mental health problems is essential in childhood. The objectives are:

– to determine whether a digital-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 12 months after the start of treatment;

– to describe the Finnish Strongest Families intervention model in primary health care.

Methods

The target population was children with high level of DBD symptoms screened from the population of 4-year olds attending annual child health clinic check-ups. The RCT study was conducted in southwest-Finland between 2011 and 2013. In the control group, participants (n = 232) were given access to a parent training website and a telephone call from a coach. Participants (n = 232) in the intervention group received internet and telephone delivered the Finnish Strongest Families program.

Results

During the 12-months follow-up results of the intervention showed the behavioural problems of the four-year-old children reduced significantly in the families who participated in the 11-week program compared to the control group. So far, this evidence-based intervention has been implemented in 13 municipalities in Finland and the nationwide implementing process is in progress.

Conclusions

Training parents online and over the telephone significantly decreases preschool children's disruptive behavior. Therefore, it is important to provide low threshold, digitally delivered, family oriented promotion, prevention and early intervention programs in the primary care. More studies are needed to evaluate the long-term effects and cost-effectiveness of digital interventions in preventive mental health care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Maternal smoking during pregnancy and offpsring's psychiatric morbidity in early adulthood. Findings from the Finnish Family Competence Birth Cohort Study

Introduction

Prenatal smoking exposure is one of the most common insults during the fetal period prevalence varying from 5 to 19% in the European countries [1].

Objectives

Prenatal smoking exposure increases the risk of psychiatric morbidity in the offspring, externalizing disorders in particular. However, less is known whether maternal smoking during pregnancy increases the risk for anxiety disorders [1].

Aims

To study the associations between maternal smoking during pregnancy and offspring psychiatric morbidity in early adulthood in a Finnish birth cohort study.

Methods

A prospective data collection from 10th gestational week (GW10) to early adulthood (n = 475, 37% from the original sample). Information on self-reported smoking during pregnancy was collected using questionnaires at GW10 and GW28. Offspring psychiatric diagnoses and clinically relevant symptoms were assessed using Development and Well-being Assessment (DAWBA)-interviews at age 18 to 20 years. Information on parental alcohol use, depressive mood, anxiety, and education level, as well as offspring's gender, education level, and birth weight were used as covariates.

Results

Maternal smoking during pregnancy associated independently associated with PTSD (OR = 6.9, 95% CI 1.3–35.6, P = 0.021), and conduct disorder (OR = 2.7, 95% CI 1.02–6.9, P = 0.046) in a multivariate analysis after adjusting for other psychiatric diagnoses, offspring and parental variables (OR = 1.9, 95% CI 0.5–6.9, P = 0.359).

Conclusions

In addition to conduct problems, prenatal nicotine exposure may increase the offspring's risk for posttraumatic stress disorder (PTSD). This relationship may be explained, in part, by effects on nicotinic acetylcholine receptors and uteroplacental mechanisms [1].

Disclosure of interest

The authors have not supplied their declaration of competing interest.

ViPAR: a software platform for the Virtual Pooling and Analysis of Research Data

Background: Research studies exploring the determinants of disease require sufficient statistical power to detect meaningful effects. Sample size is often increased through centralized pooling of disparately located datasets, though ethical, privacy and data ownership issues can often hamper this process. Methods that facilitate the sharing of research data that are sympathetic with these issues and which allow flexible and detailed statistical analyses are therefore in critical need. We have created a software platform for the Virtual Pooling and Analysis of Research data (ViPAR), which employs free and open source methods to provide researchers with a web-based platform to analyse datasets housed in disparate locations.

Methods: Database federation permits controlled access to remotely located datasets from a central location. The Secure Shell protocol allows data to be securely exchanged between devices over an insecure network. ViPAR combines these free technologies into a solution that facilitates ‘virtual pooling’ where data can be temporarily pooled into computer memory and made available for analysis without the need for permanent central storage.

Results: Within the ViPAR infrastructure, remote sites manage their own harmonized research dataset in a database hosted at their site, while a central server hosts the data federation component and a secure analysis portal. When an analysis is initiated, requested data are retrieved from each remote site and virtually pooled at the central site. The data are then analysed by statistical software and, on completion, results of the analysis are returned to the user and the virtually pooled data are removed from memory.

Conclusions: ViPAR is a secure, flexible and powerful analysis platform built on open source technology that is currently in use by large international consortia, and is made publicly available at [ http://bioinformatics.childhealthresearch.org.au/software/vipar/ ].

The impact of an educational mental health intervention on adolescents' perceptions of mental illness

Nowadays, in many countries, mental health care is primarily community based. Community perceptions of mental illness are an essential issue for the quality of life of people with mental health problems and the promotion of mental health in general. The aim of this study was to explore adolescents' perceptions of mental illness and to examine the extent to which those perceptions changed after an educational mental health intervention. The data were collected twice, before and after the educational mental health intervention. Fifty-nine pupils from two Greek secondary schools were individually interviewed, and data were analyzed by inductive content analysis. The findings show that adolescents can provide a rich description of mental illness in a multidimensional way. After the intervention, they provide different descriptions, identify various forms of mental illness and express opinions on what mentally ill people need and how they should be treated. It is concluded that mental health educational interventions in schools can be effective in changing adolescents' perceptions towards mental illness.

Autism spectrum disorders in IVF children: a national case-control study in Finland

STUDY QUESTION

Does IVF increase the risk of autism spectrum disorders (ASDs)?

SUMMARY ANSWER

No association between IVF and ASDs or any of its subtypes was found in this sample.

WHAT IS KNOWN ALREADY

Certain prenatal factors may increase the risk of ASDs. Studies on the association between IVF and ASDs have shown inconsistent results. IVF is known to increase the risk of perinatal problems but many of them are related to multiple pregnancies.

STUDY DESIGN, SIZE, DURATION

This case-control study included 4164 autistic cases and 16 582 matched controls born in Finland in 1991-2005. The cases were diagnosed with ASDs by the year 2007. The maximum age at diagnosis was 16 years.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Four controls were matched to each case. For singletons the matching criteria were date of birth, place of birth, sex and residency in Finland. For twins the birth order within a twin pair was included as well. In the whole sample, there were 63 cases (1.51%) and 229 controls (1.38%) born after IVF.

MAIN RESULTS AND THE ROLE OF CHANCE

No significant association was found between IVF and ASDs (adjusted odds ratio (OR): 0.9, 95% confidence interval (CI): 0.7-1.3) or its subtypes childhood autism (OR: 0.8, 95% CI: 0.4-1.5), Asperger's syndrome (OR: 0.9, 95% CI: 0.5-1.6) or other pervasive developmental disorder (OR: 1.0, 95% CI: 0.6-1.6). When only singletons were included, there was an association between IVF and Asperger's syndrome in an unadjusted analysis (OR: 2.0, 95% CI: 1.1-3.5) but this was not significant when adjusted for mother's socioeconomic status or parity. When the analyses were conducted separately for boys and girls, there was a significant association between IVF and Asperger's syndrome for boys in an unadjusted analysis (OR: 2.1, 95% CI: 1.2-3.7) but this was not significant in the final adjusted model.

LIMITATIONS, REASONS FOR CAUTION

Information both on IVF and on ASDs was based on registers and it is possible that there is some misclassification. No information on different subtypes of IVF or other assisted reproduction techniques was available. Statistical power may have been insufficient.

WIDER IMPLICATIONS OF THE FINDINGS

This study showed no increased risk of ASDs in children born after IVF but studies with larger sample sizes and information on different subtypes of IVF are needed to confirm the finding.

STUDY FUNDING/COMPETING INTEREST(S)

The study was supported by Autism Speaks, NIMH 1K02-MH65422 and NIEHS 1R01ES019004. There are no competing interests.

Use of ADHD drugs in the Nordic countries: a population-based comparison study

OBJECTIVE

To compare national use of attention-deficit/hyperactivity disorder (ADHD) drugs between five Nordic countries.

METHOD

A population-based drug utilisation study based on nationwide prescription databases, covering in total 24 919 145 individuals in 2007. ADHD drugs defined according to the World Health Organization Anatomic Therapeutic Chemical classification system as centrally acting sympathomimetics (N06BA).

RESULTS

The 2007 prevalence of ADHD drug use among the total Nordic population was 2.76 per 1000 inhabitants, varying from 1.23 per 1000 in Finland to 12.46 per 1000 in Iceland. Adjusting for age, Icelanders were nearly five times more likely than Swedes to have used ADHD drugs (Prev.Ratio = 4.53, 95% CI: 4.38-4.69). Prevalence among boys (age 7-15) was fourfold the prevalence among girls (Prev.Ratio = 4.28, 95% CI: 3.70-4.96). The gender ratio was diminished among adults (age 21 +) (Prev.Ratio = 1.24, CI: 1.21-1.27).

CONCLUSION

A considerable national variation in use of ADHD drugs exists between the Nordic countries.

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.

Brief report: validity of Finnish registry-based diagnoses of autism with the ADI-R

AIMS

The aim of the study was to explore the validity of registry-based diagnoses of autism in Finland using the Autism Diagnostic Interview - Revised (ADI-R). This study was designed for the Finnish Prenatal Study of Autism and Autism Spectrum Disorders (FIPS-A), an ongoing research project where registry-based diagnoses will be used for epidemiological studies.

METHODS

In this small pilot study, a clinical sample of 95 subjects diagnosed with childhood autism or pervasive developmental disorder/pervasive developmental disorder - not otherwise specified (PDD/PDD-NOS) or Asperger's syndrome according to the Finnish Hospital Discharge Register (FHDR) was gathered nationwide. A small control group consisting of siblings without any registered diagnoses of those being examined was also included in the study. Diagnoses were further re-evaluated by interviewing parents with the ADI-R.

RESULTS

The mean scores of autistic subjects clearly exceeded cut-off limits for autism on all three ADI-R domains and 96% of the subjects with registered diagnosis of childhood autism fulfilled the criteria based on the instrument as well.

CONCLUSION

These results suggest that the validity of Finnish registry-based diagnoses of childhood autism can be considered good. Our findings lay important groundwork for further population- based studies of the aetiology of autism.

Do mental health problems in childhood predict chronic physical conditions among males in early adulthood? Evidence from a community-based prospective study

BACKGROUND

Previous studies have documented associations between mental and physical health problems in cross-sectional studies, yet little is known about these relationships over time or the specificity of these associations. The aim of the current study was to examine the relationship between mental health problems in childhood at age 8 years and physical disorders in adulthood at ages 18-23 years.

METHOD

Multiple logistic regression analyses were used to examine the relationship between childhood mental health problems, reported by child, parent and teacher, and physical disorders diagnosed by a physician in early adulthood.

RESULTS

Significant linkages emerged between childhood mental health problems and obesity, atopic eczema, epilepsy and asthma in early adulthood. Specifically, conduct problems in childhood were associated with a significantly increased likelihood of obesity and atopic eczema; emotional problems were associated with an increased likelihood of epilepsy and asthma; and depression symptoms at age 8 were associated with an increased risk of asthma in early adulthood.

CONCLUSIONS

Our findings provide the first evidence of an association between mental health problems during childhood and increased risk of specific physical health problems, mainly asthma and obesity, during early adulthood, in a representative sample of males over time. These data suggest that behavioral and emotional problems in childhood may signal vulnerability to chronic physical health problems during early adulthood.

Life events, self-reported psychopathology and sense of coherence among young men--a population-based study

The aim is to study the associations between sense of coherence (SOC), and psychopathology and major life events among adolescent boys. The study population consisted of 2314 Finnish boys born during 1981 who attended military call-up (79% of the original sample). At military call-up in 1999, the boys filled in the Young Adult Self-Report (YASR) and Antonovsky's Orientation to Life Questionnaire (SOC-13), which measure SOC. In univariate analysis, low parental education level, death and serious illness of parent, parental divorce and high symptom level in all YASR scales were associated with poor SOC. In multivariate analysis, most YASR syndrome scales and father's education level were independently associated with SOC. The study demonstrates the sensitivity of the SOC-13 scale to a wide range of mental health problems. The results offer additional support to the argument that SOC may be an important global measure for use in both clinical and research purposes in adolescent psychiatry.

Characteristics and staff resources of child and adolescent psychiatric hospital wards in Finland

The aim of this study is to describe structural characteristics and staff resources of child psychiatric and adolescent psychiatric hospital wards in Finland. The target group of the survey consisted of 69 child and adolescent psychiatric hospital units in Finland. Information was obtained from 64 units (93%). Most of the wards were based on 24-h-a-day provision. There were only 7-day-treatment programmes including two family wards. When compared internationally, the numbers of units, beds and staff levels were high in Finland, with all members of staff qualified. The nurse-patient ratio and psychiatrist resources were rather satisfactory. However, in many units there was a lack of psychologists, social workers and occupational therapists. General recommendations and guidelines for staff resources in child and adolescent hospital treatment wards are warranted.

Military fitness class of Finnish 18-year-old men--prediction of military fitness class at call-up with the YASR and sociodemographic factors

OBJECTIVE

The aim of this study was to examine psychosocial factors associated with military fitness class, classified as capability of service, vs. temporary or permanent exemption from service.

METHOD

Participants were 2,340 (80% of the original sample) Finnish 18-year-old men at call-up for obligatory military service who filled in the Young Adult Self-Report (YASR) questionnaire.

RESULTS

Temporary exemption from military service was independently associated with the YASR total problem score, externalizing and internalizing problems, excessive alcohol use, drug use, problems with peers and family, and mental health service use. Permanent exemption was independently associated with problems with peers and family.

CONCLUSION

The YASR is a potential selection tool to be used at call-up. Temporary exemption was more strongly associated with psychosocial problems than permanent exemption. Because of the high level of psychological problems among those temporarily exempted, the call-up situation offers a unique opportunity to identify those with problem behaviour and risk of marginalization.

Suicidal ideation and behavior in children's homes

The aim of this cross-sectional study is to report the self-destructive and suicidal behavior of 98 children and adolescents in child welfare institutions. The children were evaluated using the Child Behavior Checklist (CBCL), the Children's Global Assessment Scale (CGAS) and questionnaires about suicidal and violent behavior, filled in by the child's key worker. Thirty-two per cent of the sample had presented suicidal thoughts, threats or suicide attempts during the previous 6 months. Suicidality was associated with low general functioning level (CGAS<61), self-mutilating behavior and violence. Furthermore, suicidal children had significantly higher CBCL total, externalizing, internalizing, anxious-depressive and aggressive scores. Children with suicide attempts (8% of the sample) had a significantly higher number of different types of traumatic experiences before the placement and higher somatization syndrome scores compared to children with suicidal ideation or non-suicidal children.

Use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment

The aim of the study was to analyse the use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment in Finland. The study included 504 child and adolescent psychiatric in-patients in the year 2000. Time-out had been used for 28 %, holding for 26 %, seclusion for 8 %, and mechanical restraints for 4 % of the in-patients. In multivariate analysis, aggressive acts were the strongest factor associated with all kinds of restraint practices. Psychosis, suicidal acts and older age (13-18 years) were associated with seclusion and mechanical restraints. Younger age (< 13 years), attachment disorder and autism were associated with holding. The longer children had been in treatment, the more likely they were to have been restrained. The high prevalence of restraint techniques used indicates a need for guidelines of restraint and seclusion which take into account the child's need for protection from his/her own impulses and the legal rights of the child.

Determinants of tension-type headache in children

The objective of this study was to study the prevalence, characteristics and predisposing factors of tension-type headache in children. An unselected population-based questionnaire study was carried out in 1409 Finnish schoolchildren aged 12 years. Of them, 1135 (81%) returned an acceptably completed questionnaire. The prevalence of episodic tension-type headache in children was 12% (138 of 1135). Children with episodic tension-type headache also often reported characteristics of pain typical for migraine. Children with frequent and persistent episodic tension-type headache reported stabbing and severe occipital pain, phonophobia and abdominal pain significantly more often than children with infrequent episodic tension-type headache. Neck-shoulder symptoms, symptoms of depression and oromandibular dysfunction were each independently associated with episodic tension-type headache. The father's occupation of a lower-level white-collar worker put the child at a four-fold risk for episodic tension-type headache. We conclude that episodic tension-type headache is as common as migraine in children. It can be associated with depression, oromandibular dysfunction and muscular stress. Especially children with frequent and persistent episodic tension-type headache report characteristics of pain typical for migraine.

Self-reported strengths and difficulties in a community sample of Finnish adolescents

The psychometric properties of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) among Finnish 13- to 17-year-old adolescents (n = 1,458) were studied. The results show that the psychometric properties of the Finnish SDQ self-report were adequate. The results of the correlation analysis confirmed the postulated structure of the SDQ self-report. The correlations of the items to their respective subscales ranged from moderate to high (r = 0.47-0.73). The internal consistency was acceptable on three and somewhat lower on two of the five subscales (alpha=0.53-0.71). In addition, the factor analysis sufficiently confirmed the postulated structure of the SDQ for girls and boys, except for the conduct problems scale of boys, which was fused with emotional symptoms and with hyperactivity. The means of the SDQ self-report total difficulties scores were very similar to those in a previous study in Great Britain. The results provide additional confirmation of the usefulness of the SDQ as a screening instrument in epidemiological research and clinical practice.

Emotional and behavioural problems in a sample of Finnish three-year-olds

Behavioural and emotional problems in Finnish three-year-olds was studied using the Child Behavior Checklist for ages 2-3 as a standardised rating scale at well-baby clinics in two cities in Finland. Altogether 374 questionnaires were analysed which is 71% of the target population. When compared with studies from other countries the mean scores and prevalences of preschool children's problem behaviours were rather similar. Boys were reported to be more destructive than girls. Parental education level, living in one-parent family and parental unemployment were associated with a higher level of problem behaviours. No significant differences were found in emotional or behavioural problems related to the child's day care. Co-sleeping with parents was associated with sleep problems.

Antenatal depression, substance dependency and social support

BACKGROUND

The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women.

METHOD

391 women who were 14-37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2).

RESULTS

7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression.

LIMITATION

The caseness was defined with a self-report instrument.

CONCLUSION

Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.

Child and adolescent mental health service use in Finland

BACKGROUND

The study examines the associations of parent, teacher and self-report evaluations of child psychopathology, help-seeking variables and family factors with the use of child mental health services.

METHOD

The study comprised an 8-year follow-up of the Epidemiological Child Psychiatry Study in Finland. Children were evaluated at age 8 with Rutter parent and teacher scales and with the Child Depression Inventory, and at age 16, with the Child Behavior Checklist and the Youth Self Report. Information was obtained from about 70% of the follow-up sample (n=857).

RESULTS

About 7% of the sample had been in contact with child mental health services during the follow-up. The most potent predictors at age 8 of later referral were total problem behaviours and antisocial problems in parental evaluation, teacher's evaluation of the child's need for referral and living in other than a biological two-parent family. At age 16, externalizing and internalizing problems, total competence and family composition were independently associated with service use.

CONCLUSIONS

Both child psychopathology and family disruption were associated with service use. Only a minority of children at risk of psychiatric disorders had used child mental health services.

Suicidal thoughts and attempts among adolescents: a longitudinal 8-year follow-up study

BACKGROUND

To study the prevalence of and factors associated with suicidal behaviour among 580 adolescents.

METHODS

An 8-year longitudinal study included questions about suicidal attempts and thoughts at age 16. Children were evaluated with parent and teacher Rutter scales and self-reported Child Depression Inventory at age 8. At age 16, parents filled in the Child Behaviour Check List and adolescents the Youth Self Report.

RESULTS

14% of girls and 7% of boys reported suicidal thoughts or preoccupations at age 16. Emotional and behavioural problems at age 8, especially antisocial symptoms, reported by parents and teachers and depressive symptoms reported by the child were correlated with suicidal thoughts and behaviour 8 years later. At age 16, internalizing and externalizing problems and low social competence were associated with suicidal features. Only about 20% of those who reported suicidal features had been referred to child mental health services.

CONCLUSIONS

Many adolescents with suicidal thoughts and behaviour had a high rate of behavioural and emotional problems already at age 8.

CLINICAL IMPLICATIONS

The early school years represent an opportunity for interventions which may prevent self-destructive behaviours in adolescence.

An early report on the mother-baby interactive capacity of substance-abusing mothers

OBJECTIVE

Examination of maternal interactive behavior and psychosocial situation of substance-abusing mothers in treatment.

METHOD

Twelve mothers with an alcohol or drug abuse problem and 12 control mothers were assessed in random order with the Parent-Child Early Relational Assessment, for the analysis of videotaped mother-infant interactions at 3 and 6 months' postpartum. Depressive symptoms were assessed with Edinburgh Postnatal Depression Scale and aspects of social support with two Social Support Questionnaires.

RESULTS

Substance-abusing mothers tended to have more problematic areas in their interactive behavior, a tendency which increased during the study period. As was expected, they were more often depressive, and experienced more social environment difficulties and less social support.

CONCLUSIONS

Mothers with alcohol and drug abuse problems need intensive professional support in early motherhood, and are seen to be particularly motivated to strive for abstinence and accept help at this stage of life.

Self-reported competence and emotional and behavioral problems in a sample of Finnish adolescents

The Youth Self-Report (YSR) was completed by 586 15- to 16-year-old Finnish adolescents. The internal consistency of the YSR problem scales ranged from 0.61 to 0.90. Girls reported significantly more internalizing, withdrawn, somatic, anxious-depressive thought and attention problems. The adolescent was defined as having maladjustment if he she had used mental health services or had more severe problems than the peer group according to parent or self-report (11% of the sample). There were significant differences at the 0.001 level on all YSR scales between maladjustment and non-maladjustment groups. In logistic regression analysis anxious-depressive and delinquency scales had the strongest association with maladjustment. The results are compared with results from previous population-based studies using the YSR in Nordic countries.

Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study

OBJECTIVE

The present study is part of a Nordic multicentre study investigating the life and care situation of community samples of schizophrenic patients. The specific aim of the present part of the study was to examine the agreement between patients and their key worker concerning the presence of met and unmet needs in a number of life domains, and help or support given in these domains.

METHOD

The comparisons were based on 300 matched pairs of assessments of need using the Camberwell Assessment of Need interview.

RESULTS

The results showed that key workers identified slightly more needs, 6.17 vs. 5.76, a significant difference. There was a moderate or better agreement on the presence of a need in 17 of 22 life domains investigated, but in only 11 life domains concerning the presence of an unmet need. Disagreement concerning whether the patient was given the right kind of help or support was even more substantial.

CONCLUSION

It is concluded that key workers and patients disagree particularly concerning unmet needs and that this is potentially related to a number of factors associated with the key worker and patient. It is also concluded that further research is needed to increase the knowledge concerning the sources of this disagreement if need assessment is to become a valid basis for service planning and individual treatment planning.

Parent-reported competence and emotional and behavioral problems in Finnish adolescents

This study was part of an 8-year follow-up study of the Epidemiological Multicenter Child Psychiatric Study in Finland. The Child Behavior Checklists (CBCLs) were analyzed for 598 15- to 16-year-old adolescents living in the southwestern area of Finland in 1997. The internal consistency of the CBCL syndrome scales was adequate (the alpha coefficient ranged from 0.66 to 0.89). The CBCL scores differentiated between non-referred adolescents and adolescents who had been referred to the mental health service or had severe problems according to the parents. Boys had more externalizing problems than girls in the maladjustment group. Girls had more somatic symptoms in the maladjustment group than boys.

Dieting and weight concerns among Finnish adolescents

The aim of the study was to examine factors associated with dieting and weight concerns among Finnish adolescents. A school-survey included a 9-item screening scale for assessing attitudes and behaviors involving dieting and body image and a self-report measure of the Strengths and Difficulties Questionnaire assessing emotional and behavioral problems. Altogether 1458 questionnaires were analyzed, which accounted for about 89% of the target population including all the 7th and the 9th graders in two cities in Finland. According to the results, dieting and weight concerns were extremely common among Finnish adolescents. For all aspects of weight control and dieting concerns, the rates of occurrence were greater among girls. A high level of dieting concerns was associated with female sex, body mass, emotional, conduct, and hyperactivity symptoms, and alcohol use.

The Strengths and Difficulties Questionnaire among Finnish school-aged children and adolescents

The emotional and behavioural problems of 7- to 15-year-old Finnish children and adolescents (n = 735) were assessed in a community population by a brief screening instrument, the Strengths and Difficulties Questionnaire (SDQ). The parent-, teacher- and self-reports of the SDQ were obtained. The results show that for the total scores, the inter-rater agreement between the pairs of reports was 0.38-0.44. The internal consistency in all three questionnaires was 0.71. Functioning above the 90th percentile of the SDQ total difficulties scores in parent-, teacher- and self-reports was strongly associated with help-seeking variables and problematic behaviour according to parents. The correlation of the parental SDQ total scores and the Child Behaviour Checklist total scores was 0.75 and the correlation of the self-report SDQ total scores with the Youth Self Report total scores was 0.71. The differences in sex, grade and informants of the SDQ total difficulties scores are reported. The study gives further evidence of the usefulness of the SDQ as a promising screening instrument for epidemiological research and clinical purposes.

Persistence of bullying from childhood to adolescence--a longitudinal 8-year follow-up study

OBJECTIVE

To examine factors associated with bullying and victimization from age 8 to 16.

METHOD

An 8-year longitudinal study included questions about bullying and victimization at age 8 and 16. Children were evaluated with Rutter scales by parents and teachers and with the Child Depression Inventory filled in by the children at age 8. When the children were at the age of 16 parents filled in the CBCL and adolescents the YSR.

RESULTS

About 15% of boys and 7% of girls were bullied and 12% of girls and 13% of boys were victimized at age 16. Both bullying and victimization at age 16 were associated with a wide range of psychological problems at age 8 and 16, and with referral to child mental health services. Bullying at age 8 was associated with bullying at age 16, while victimization at age 8 was associated with victimization 8 years later.

CONCLUSIONS

Bullying and victimization are often persistent and associated with severe emotional and behavior problems. Preventive efforts should be focused, and targeted at those children who are characterized by both psychological disturbance and bullying.

Psychosocial factors and adequacy of services for children in children's homes

Risk and protective factors of psychosocial development in children in different residential care settings need to be further studied internationally, in order to develop working methods for social and health care services. Standardized methods of the CBCL, TRF, and CGAS, were used to evaluate psychosocial functioning of children in children's homes in Finland. Further, data on sociodemographic situations and traumatic events in their lives were assembled. The percentage of behavioural and emotional problems within clinical or borderline range in the different ratings was 55-80%. Combined traumatization, sexual abuse, school difficulties, male sex, older age (> 11 years) and older age at first and on-going placement (> 7 years), as well as difficulties in relationships with parents are likely to be associated with more severe behaviour problems and lower general functioning. The results of this study show that children and adolescents in social service residential settings are a highly vulnerable group and that these children have extensive mental health needs.

Parent-adolescent agreement on emotional and behavioral problems

BACKGROUND

The aim of the study is to report parent/youth self-report agreement on emotional and behavioral symptoms among 15- to 16-year-old adolescents.

METHODS

A completed Child Behavior Checklist and Youth Self-Report were obtained from 580 subjects.

RESULTS

Adolescents reported significantly more problem behaviors than their parents. Adolescent girls reported a significantly higher level of distress than boys in most symptom domains. The discrepancies between parent reports and youth self-reports were greater, especially for internalizing symptoms, for girls than for boys.

CONCLUSIONS

Many adolescents in need of psychiatric assessment do not receive appropriate help because their problems remain unnoticed by adults. Internalizing problems among girls seem especially likely to remain unrecognized by adults.

Widespread pain and neck pain in schoolchildren. A prospective one-year follow-up study

The aims of this study were to prospectively follow up population-based cohorts of children with widespread pain, children with neck pain and pain-free children, in order to evaluate 1-y changes in pain symptoms and to evaluate predictors for persistent widespread pain and for the change of neck pain to widespread pain. A structured pain questionnaire, the Children's Depression Inventory, and a sleep questionnaire were completed by the pre-adolescent cohorts, and clinical evaluation with tender point palpation and pain threshold measurements was carried out in both years. The Child Behavior Checklist, the Teacher's Report Form and a sociodemographic questionnaire were completed at baseline. More children in the 2 pain cohorts reported pain at follow-up than did controls (p < 0.0001). Children with persistent widespread pain had lower pain thresholds compared with those whose pain classification changed. In the neck pain group, 19 (20.4%) reported widespread pain at follow-up. Although depressive symptoms and sleep problems were associated with the change of neck pain to widespread pain, neither they nor other measured factors showed independent explanatory power in multiple logistic regression analysis. In conclusion, fluctuation of pain symptoms occurred mainly among pain cohorts. Depressive and sleep problems may have an effect on the spreading of regional neck pain to widespread pain. Pain threshold measurement and evaluation of depressive and sleep problems may be useful tools for secondary prevention of musculoskeletal pain in pre-adolescents.

Mood, latitude, and seasonality among adolescents

OBJECTIVE

To examine the effect of sex, latitude, and behavior problems on symptoms related to pediatric seasonal affective disorder among seventh and ninth graders.

METHOD

A school survey including a modified version of the Seasonal Pattern Assessment Questionnaire was carried out in 2 Finnish cities located in the 60th and 67th northern latitudes. Altogether 1,458 questionnaires were analyzed, representing 89% of the target population.

RESULTS

Seasonal changes in mood and behavior were commonly reported among seventh and ninth graders. A high Global Seasonality score (> 95th percentile) was associated with female gender and emotional and hyperactivity symptoms. During February and March, girls living in the 67th latitude reported more seasonal distress than girls living at the 60th latitude.

CONCLUSIONS

It is important to recognize pediatric seasonal affective disorder and related problems among adolescents. Seasonal alterations in child and adolescent behavior are not well understood and need to be investigated more thoroughly.

Psychiatric hospital care among children and adolescents in Finland: a nationwide register study

This register study includes all patients under 18 years in Finland discharged from psychiatric inpatient treatment in 1990 (n = 818) and 1993 (n = 958). The prevalence of children and adolescents in the population who had previously been treated was about 7-8 per 10,000. The incidence of new cases of children and adolescents who had previously been inpatients within the last year was about 5-6 per 10,000 in this age group. The prevalence was lowest in the preschool group (about 1:10,000) and highest in the adolescent group (about 12-14:10,000). About two-thirds of inpatients were boys. Adjustment disorders (DSM-III-R) were the most common diagnosis both in 1990 and 1993 (about 30%). Mood and anxiety disorders were the second most frequent (19-23%) and disruptive behaviour disorders the third most frequent (13-15%) diagnostic category. The diagnostic profiles differed largely according to sex and age.

Predictors of subjective quality of life in schizophrenic patients living in the community. A Nordic multicentre study

As part of a Nordic multi-centre study investigating the life and care situation of community samples of schizophrenic patients the aim of the present part of the study was to examine the relationship between global subjective quality of life and objective life conditions, clinical characteristics including psychopathology and number of needs for care, subjective factors such as satisfaction with different life domains, social network, and self-esteem. A sample of 418 persons with schizophrenia from 10 sites was used. The results of a final multiple regression analysis, explaining 52.3% of the variance, showed that five subjective factors were significantly associated with global subjective quality of life, together with one objective indicator, to have a close friend. No clinical characteristics were associated with global subjective quality of life. The largest part of the variance was explained by satisfaction with health, 36.3% of the variance, and self-esteem, 7.3% of the variance. It is concluded that the actual relationship between objective life conditions and subjectively experienced quality of life still remains unclear. Furthermore, it seems obvious that personality related factors such as self-esteem, mastery and sense of autonomy also play a role in the appraisal of subjective quality of life, which implies that factors like these are important to consider in clinical and social interventions for patients with schizophrenia in order to improve quality of life for these persons.

Three-year follow-up of child psychiatric inpatient treatment

Eighty child psychiatric inpatients with behavioral and emotional disorders were evaluated from multiple perspectives on admission and at 5-month and 3-year follow-ups. A majority of the patients showed a significant improvement in functioning during the 3-year follow-up. About half of the patients were functioning within clinical range at 3-year follow-up on parental (CBCL) and/or teacher (TRF) ratings. A less favorable outcome was predicted by disruptive behavioral disorder, severity of initial dysfunction, high antisocial and hyperkinetic symptoms, adoptive household and postdischarge institutional placement. Pure anxiety or affective disorder was associated with favorable outcome. Age, sex, place of treatment, and length of hospital treatment were not related to outcome variables.

Behavior problems and traumatic events of unaccompanied refugee minors

OBJECTIVE

The present study examined the traumatic events and behavior symptoms of 46 unaccompanied refugee minors waiting for placement in an asylum center in Finland.

METHOD

Using all the clinical information available information about the refugee children's experiences before and during their flight and after their arrival in Finland was gathered. Children were evaluated with the Child Behavior Checklist (CBCL).

RESULTS

The refugee children had experienced a number of losses, separations, persecution, and threats. About half of the minors were functioning within clinical or borderline range when evaluated with the CBCL. Young age (< 15 years) was associated with more severe psychiatric problems. There was a lack of rehabilitative services, the staff ratio was very low and the time spent in the asylum center waiting for the placement decision was relatively long for these minors.

CONCLUSIONS

Unaccompanied refugee minors are in a highly vulnerable situation. Younger refugee children are more vulnerable to emotional distress than older children. Current procedures for dealing with asylum-seekers may contribute to high level of stress and emotional symptoms in previously traumatized refugee children. A high level of social security and mental health care does not guarantee an appropriate level of care for unaccompanied refugee children.

Psychiatric symptoms in preadolescents with musculoskeletal pain and fibromyalgia

OBJECTIVES

To study the association of musculoskeletal pain with emotional and behavioral problems, especially depressive symptoms in Finnish preadolescents.

STUDY DESIGN

A structured pain questionnaire was completed by 1756 third- and fifth-grade schoolchildren for identifying children with widespread pain (WSP), children with neck pain (NP), and pain-free controls for the comparative study. There were 124 children with WSP (mean age, 10.7 years), 108 children with NP (mean age, 11.1 years), and 131 controls (mean age, 10.7 years) who completed the Children's Depression Inventory (CDI) and a sleep questionnaire. A blinded clinical examination was done to detect fibromyalgia. For parental evaluation, the Child Behavior Checklist and a sociodemographic questionnaire were used. For teacher evaluation the Teacher Report Form was used.

RESULTS

Children with WSP had significantly higher total emotional and behavioral scores than controls, according to child and parent evaluation. A significant difference in the mean total CDI scores was also found between the WSP and NP groups. Children with fibromyalgia had significantly higher CDI scores than the other children with WSP.

CONCLUSIONS

Musculoskeletal pain, especially fibromyalgia, and depressive symptoms had high comorbidity. Pain and depressive symptoms should be recognized to prevent a chronic pain problem.