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Sourander A, Ishikawa S, Ståhlberg T, Kishida K, Mori Y, Matsubara K, Zhang X, Hida N, Korpilahti-Leino T, Ristkari T, Torii S, Gilbert S, Hinkka-Yli-Salomäki S, Savolainen H, Närhi V. Cultural adaptation, content, and protocol of a feasibility study of school-based "Let's learn about emotions" intervention for Finnish primary school children. Front Psychiatry 2024; 14:1334282. [PMID: 38274431 PMCID: PMC10810134 DOI: 10.3389/fpsyt.2023.1334282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
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.
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Affiliation(s)
- A. Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
- Department for Child Psychiatry, Turku University Hospital, Turku, Finland
| | - S. Ishikawa
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - T. Ståhlberg
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
- Department for Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - K. Kishida
- School of Humanities, Kwansei Gakuin University, Nishinomiya, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Y. Mori
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - K. Matsubara
- Organization for Research Initiatives and Development, Doshisha University, Kyoto, Japan
| | - X. Zhang
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - N. Hida
- Center for Wing of Empirically Supported Treatments, Doshisha University, Kyoto, Japan
| | - T. Korpilahti-Leino
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - T. Ristkari
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - S. Torii
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - S. Gilbert
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - S. Hinkka-Yli-Salomäki
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - H. Savolainen
- School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland
| | - V. Närhi
- Department of Education, University of Jyväskylä, Jyväskylä, Finland
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Sourander S, Sourander A, Hinkka-Yli-Salomäki S, Ristkari T, Kurki M. An Internet-Based Parent Training With Telephone Coaching on Managing Disruptive Behavior in Children at Special Family Counseling Centers During the COVID-19 Pandemic: Feasibility Study. JMIR Pediatr Parent 2022; 5:e40614. [PMID: 36194895 PMCID: PMC9635457 DOI: 10.2196/40614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is growing concern about the short- and long-term impacts that the COVID-19 pandemic will have on the mental health and psychosocial well-being of children and families. There are no existing studies about feasibility and outcomes using internet-based parent training programs with telephone coaching for disruptive behavioral problems in childhood during the COVID-19 pandemic in clinical settings. OBJECTIVE This study explored how the Strongest Families Smart Website (SFSW) parent training program, with telephone coaching, provided support during the COVID-19 pandemic at specialist family counseling centers in Helsinki, Finland, when restrictions made face-to-face counseling impossible. This study followed the success of a randomized controlled trial (RCT) and its implementation study of the SFSW parent training program by primary care child health clinics. The aim was to improve parenting skills, so that parents could tackle disruptive behavior by developing positive parent-child relationships. It started in May 2020, when the COVID-19 pandemic was at its height in Finland. METHODS In total, 8 family counseling centers in Helsinki identified 50 referrals aged 3-8 years with high levels of parent-reported disruptive behavioral problems. Child psychopathology and functioning and parental skills and well-being were measured at baseline, posttreatment, and 6 months later using a range of tools. The data were extracted from questionnaires completed by the parents. RESULTS We found that 44 (88%) of the 50 families completed the whole 11-session parent training program. Most of the children (n=48, 96%) had definitive or severe behavioral problems when they were initially screened by the centers, but with those assessed at the 6-month follow-up (n=45, 90%), this dropped to 58% (n=26). There were significant changes from baseline to 6-month follow-up in most of the child psychopathology measures, including the Child Behavior Checklist-Parent Report Form (CBCL) total score (mean change 16.3, SE 3.0, 95% CI 10.2-22.3; P<.001) and externalizing score (mean change 7.0, SE 1.0, 95% CI 4.9-9.0; P<.001). When parenting skills were measured with the Parenting Scale (PS), they showed significant changes from baseline to 6-month follow-up in total scores (mean change 0.5, SE 0.1, 95% CI 0.4-0.7; P<.001). Parents showed significant change in the stress subscore (mean change 3.9, SE 0.8, 95% CI 2.2-5.6; P<.001). Of the parents who filled in the satisfaction questionnaire (n=45, 90%), 42 (93%) reported high satisfaction in the skills and 44 (98%) in the professionalism of the family coaches. CONCLUSIONS The program proved to be an effective method for improving parenting skills and child psychopathology and functioning. The parents were satisfied with the program, and the dropout rate was exceptionally low. The study shows that the training program could be implemented in specialist clinical settings and during crisis conditions, such as the COVID-19 pandemic.
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Affiliation(s)
- Saana Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Unit of Digital Education and Master Programmes, Laurea University of Applied Sciences, Vantaa, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,ITLA Children´s Foundation, Helsinki, Finland
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Korpilahti-Leino T, Luntamo T, Ristkari T, Hinkka-Yli-Salomäki S, Pulkki-Råback L, Waris O, Matinolli HM, Sinokki A, Mori Y, Fukaya M, Yamada Y, Sourander A. Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study. J Med Internet Res 2022; 24:e26438. [PMID: 35138265 PMCID: PMC9009379 DOI: 10.2196/26438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/19/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has had a major impact on families’ daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children’s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods The Let’s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program’s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children’s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. Conclusions The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery.
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Affiliation(s)
- Tarja Korpilahti-Leino
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Terhi Luntamo
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Laura Pulkki-Råback
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Otto Waris
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Hanna-Maria Matinolli
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Atte Sinokki
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Yuko Mori
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Mami Fukaya
- Department of Psychology and Human Developmental Sciences, Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Yuko Yamada
- Section of Medical Care and Consultation, Nagoya City Central Care Center for Disabled Children, Nagoya, Japan
| | - Andre Sourander
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Sourander A, Ristkari T, Kurki M, Gilbert S, Hinkka-Yli-Salomäki S, Kinnunen M, Pulkki-Råback L, McGrath PJ. Effectiveness of an Internet-Based and Telephone-Assisted Training for Parents of 4-Year-Old Children With Disruptive Behavior: Implementation Research. J Med Internet Res 2022; 24:e27900. [PMID: 35377332 PMCID: PMC9016503 DOI: 10.2196/27900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/31/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background There is a lack of effectiveness studies when digital parent training programs are implemented in real-world practice. The efficacy of the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention on the disruptive behavior of 4-year-old children was studied in a randomized controlled trial setting in Southwest Finland between 2011 and 2013. After that, the intervention was implemented nationwide in child health clinics from 2015 onwards. Objective The main aim of this study was to compare the treatment characteristics and effectiveness of the SFSW parent training intervention between the families who received the intervention when it was implemented as a normal practice in child health clinics and the families who received the same intervention during the randomized controlled trial. Methods The implementation group comprised 600 families who were recruited in the SFSW intervention between January 2015 and May 2017 in real-world implementation. The RCT intervention group comprised 232 families who were recruited between October 2011 and November 2013. The same demographic and child and parent measures were collected from both study groups and were compared using linear mixed-effect models for repeated measurements. The child psychopathology and functioning level were measured using the Child Behavior Checklist (CBCL) version 1.5-5 for preschool children, the Inventory of Callous-Unemotional Traits (ICU), and a modified version of the Barkley Home Situations Questionnaire. Parenting skills were measured using the 31-item Parenting Scale and the shorter 21-item Depression, Anxiety and Stress Scale (DASS-21). The estimated child and parent outcomes were adjusted for CBCL externalizing scores at baseline, maternal education, duration of the behavior problems, and paternal age. The baseline measurements of each outcome were used as covariates. Results The implementation group was more likely to complete the intervention than the RCT intervention group (514/600, 85.7% vs 176/232, 75.9%, respectively; P<.001). There were no significant differences between the implementation and RCT intervention groups with regard to child measures, including CBCL externalizing score (–0.2, 95% CI –1.3 to 1.6; P=.83), total score (–0.7, 95% CI –3.0 to 4.5; P=.70), internalizing score (–0.3, 95% CI –1.0 to 1.6; P=.64), and ICU total score (–0.4, 95% Cl –1.9 to 1.2; P=.64). No significant difference was detected in the Parenting Scale total score (0.0, 95% Cl –0.1 to 0.1; P=.50), while DASS-21 total score differed nearly significantly (2.5, 95% Cl 0.0-5.1; P=.05), indicating better improvement in the implementation group. Conclusions The internet-based and telephone-assisted SFSW parent training intervention was effectively implemented in real-world settings. These findings have implications for addressing the unmet needs of children with disruptive behavior problems. Our initiative could also provide a quick socially distanced solution for the considerable mental health impact of the COVID-19 pandemic. Trial Registration ClinicalTrials.gov NCT01750996; https://clinicaltrials.gov/ct2/show/NCT01750996 International Registered Report Identifier (IRRID) RR2-10.1186/1471-2458-13-985
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Affiliation(s)
- Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Finland INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Finland INVEST Research Flagship, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Finland INVEST Research Flagship, University of Turku, Turku, Finland.,ITLA Children's Foundation, Helsinki, Finland
| | - Sonja Gilbert
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Finland INVEST Research Flagship, University of Turku, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Finland INVEST Research Flagship, University of Turku, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Finland INVEST Research Flagship, University of Turku, Turku, Finland
| | - Laura Pulkki-Råback
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Finland INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada.,Faculty of Science, Dalhousie University, Halifax, NS, Canada.,Strongest Families Institute, Halifax, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Wan Mohd Yunus WMA, Matinolli HM, Waris O, Upadhyaya S, Vuori M, Korpilahti-Leino T, Ristkari T, Koffert T, Sourander A. Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review. J Med Internet Res 2022; 24:e33337. [PMID: 35195532 PMCID: PMC8908191 DOI: 10.2196/33337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/12/2021] [Accepted: 12/13/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy. This approach has become increasingly important in many clinical areas due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area. OBJECTIVE Our systematic review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy. METHODS A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS The review identified 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies. CONCLUSIONS Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. Digitalized CBT interventions can provide prompt, effective, evidence-based interventions for pregnant women. This review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159.
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Affiliation(s)
- Wan Mohd Azam Wan Mohd Yunus
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Psychology, School of Human Resource Development & Psychology, Faculty of Social Sciences & Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Hanna-Maria Matinolli
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Otto Waris
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | - Subina Upadhyaya
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Miika Vuori
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Teacher Education, Turku Institute for Advanced Studies, University of Turku, Turku, Finland
| | - Tarja Korpilahti-Leino
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Tarja Koffert
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Luntamo T, Korpilahti-Leino T, Ristkari T, Hinkka-Yli-Salomäki S, Kurki M, Sinokki A, Lamminen K, Saanakorpi K, Saarinen S, Maunuksela M, Sourander S, Toivonen K, Zadkova A, Suilamo M, Casagrande L, Palmroth J, Sourander A. Internet-assisted cognitive behavioural therapy with telephone coaching for anxious Finnish children aged 10-13 years: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e045474. [PMID: 34162641 PMCID: PMC8230974 DOI: 10.1136/bmjopen-2020-045474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Terhi Luntamo
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Tarja Korpilahti-Leino
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Sanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Kaisa Lamminen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Kristiina Saanakorpi
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Susanna Saarinen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Marjukka Maunuksela
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Saana Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Katja Toivonen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Anna Zadkova
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Miia Suilamo
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Linda Casagrande
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Johanna Palmroth
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - A Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
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Kronström K, Multimäki P, Ristkari T, Parkkola K, Sillanmäki L, Sourander A. Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study. Eur Child Adolesc Psychiatry 2021; 30:313-325. [PMID: 32232581 PMCID: PMC7932936 DOI: 10.1007/s00787-020-01517-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology.
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Affiliation(s)
- Kim Kronström
- Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Petteri Multimäki
- Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | | | - Lauri Sillanmäki
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.
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Kaajalaakso K, Lempinen L, Ristkari T, Huttunen J, Luntamo T, Sourander A. Psychometric properties of the screen for child anxiety related emotional disorders (SCARED) among elementary school children in Finland. Scand J Psychol 2020; 62:34-40. [PMID: 32776566 DOI: 10.1111/sjop.12677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/17/2020] [Indexed: 12/01/2022]
Abstract
Anxiety disorders are the most common mental disorders in children and youth. Effective screening methods are needed to identify children in need of treatment. The Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire is a widely used tool to assess childhood anxiety. We aim toevaluate the psychometric properties of the SCARED questionnaire, test the SCARED factor structure, and evaluate the prevalence of anxiety symptoms in a community sample of Finnish elementary school children, based on both a child and parent report. The sample included all pupils (n = 1,165) in grades 2 through 6 (ages 8-13) in four elementary schools in the city of Turku, Finland. Children completed a Finnish translation of the SCARED questionnaire at school, with one parent report questionnaire per child completed at home. In total, 663 child-parent dyads (56.9%) completed the questionnaire. Internal consistency was high for both child and parent reports on all subscales (0.71-0.92), except for school avoidance (0.57 child, 0.63 parent report). Inter-rater reliability ranged from poor to fair across subscales (intraclass correlation 0.27-0.47). Self-reported anxiety scores were higher than the parent reported scores. Females had significantly higher total scores than males based on the child reports (p = 0.003), but not the parent reports. In the confirmatory factor analysis, hypothesized models did not have a good fit with the data, and modification was needed. The Finnish SCARED questionnaire has good internal consistency. Low child-parent agreement calls for the importance of including both child and parental reports in the assessment of anxiety symptoms.
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Affiliation(s)
- Katri Kaajalaakso
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Lotta Lempinen
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Terja Ristkari
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Jukka Huttunen
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Terhi Luntamo
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Andre Sourander
- Child psychiatry, University of Turku and Turku University Hospital, Finland.,INVEST Research Flagship, University of Turku, Finland
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Ristkari T, Mishina K, Lehtola MM, Sourander A, Kurki M. Public health nurses' experiences of assessing disruptive behaviour in children and supporting the use of an Internet-based parent training programme. Scand J Caring Sci 2019; 34:420-427. [PMID: 31487074 PMCID: PMC7328683 DOI: 10.1111/scs.12744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/23/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In Finland, although families generally receive support from child health clinics, some need more help in dealing with their child's emotions, behaviour and psychosocial development. Public health nurses play a central role in providing vital psychosocial support for families, but they often lack the confidence and competence to tackle mental health problems. AIM To describe how public health nurses used and experienced a working model that combined a psychosocial tool (Strengths and Difficulties Questionnaire, SDQ) to identify disruptive behaviour in four-year-old children and an Internet-based parent training programme with telephone coaching. METHODS This is a descriptive, cross-sectional survey study. The sample consists of public health nurses (n = 138) who were working in child health clinics in Finland that had used the working model. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open-ended question were analysed using inductive content analysis. RESULTS The experiences about the working model were mainly positive. The public health nurses felt that the psychosocial tool, the SDQ, was easy and suitable to use in child health clinics. The availability of an Internet-based parent training programme provided greater support for parents by overcoming practical barriers. Overall, the working model helped nurses to develop their mental health competencies. CONCLUSION Within primary care, the need to tackle psychosocial problems is increasing, and for this, public health nurses need extra support and tools. It seems that the working model, including the SDQ and the online and telephone coaching programme, worked well in child health clinics. This working model can be used to provide parental support and improve nurses' mental health competencies.
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Affiliation(s)
- Terja Ristkari
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Kaisa Mishina
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, University of Turku, Turku, Finland
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Ristkari T, Kurki M, Suominen A, Gilbert S, Sinokki A, Kinnunen M, Huttunen J, McGrath P, Sourander A. Web-Based Parent Training Intervention With Telephone Coaching for Disruptive Behavior in 4-Year-Old Children in Real-World Practice: Implementation Study. J Med Internet Res 2019; 21:e11446. [PMID: 30973337 PMCID: PMC6482405 DOI: 10.2196/11446] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/09/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022] Open
Abstract
Background Parent training is the most effective approach to the psychosocial treatment of disruptive behavioral problems in childhood. However, no studies exist on how well Web-based training programs work when they make the transition from the research setting to implementation in primary health care. Objective The study aimed to examine how the randomized controlled trial (RCT) and implementation study groups of the Strongest Families Smart Website (SFSW) intervention differed in child psychopathology, family demographics and treatment-related factors, such as therapeutic alliance and parents’ satisfaction rates. The intervention was conducted in the pediatric primary health care in Finland. Methods The study focused on 232 parents who had taken part in the SFSW intervention, which formed part of a 2-arm RCT study, and 882 families that would participate in the subsequent SFSW implementation study group. Both groups comprised parents whose children displayed high levels of parent-reported disruptive behavioral problems when they were screened in child health clinics at 4 years of age. Parents in both groups were provided with the SFSW intervention, which consisted of a Web-based training program with 11 weekly themes and associated telephone sessions. Results Demographic factors or duration of behavioral problems did not differ statistically or clinically between the RCT and implementation groups. Overall, 42.0% (362/862) of children in the implementation group and 35.4% (80/226) in the RCT intervention group had suffered from behavioral difficulties more than 1 year before the screening phase (χ12=3.2; P=.07). The mean duration of telephone coaching calls was very similar in the implementation and RCT intervention groups, that is, 38 and 37 min per call, respectively (t279.5=0.26; P=.79). The total time spent on the website of the program was 451 min in the implementation group and 431 min in the RCT intervention group (t318.8=1.38; P=.17). In the RCT intervention group, 52 of the 232 participants (22.4%) discontinued the program before the tenth week, whereas in the implementation group, 109 of the 882 participants (12.4%; odds ratio 2.05, 95% CI 1.4-3.0; P<.001) discontinued. Parents in both the implementation (77.1% to 98.5%, 498/742 to 731/742, respectively) and the RCT (64.8% to 98.2%, N=105/162- to 159/162, respectively) groups reported qualitatively similar and high level of posttreatment satisfaction rates in improved parenting skills, expectations, and stress relief. Parents in both groups reported a high level of satisfaction in skills and professionalism of the telephone coaches. Conclusions The implementation of population-based screening of Web-based parent training intervention with telephone coaching resulted in good feasibility, fidelity, accessibility, and similar satisfaction level post treatment when compared with intervention in RCT research setting. The discontinuation of treatment in the implementation group was exceptionally low.
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Affiliation(s)
- Terja Ristkari
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Auli Suominen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Sonja Gilbert
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Patrick McGrath
- Centre for Research in Family Health, Izaak Walton Killam Health Centre, Halifax, NS, Canada.,Strongest Families Institute, Halifax, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
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Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Hinkka-Yli-Salomäki S, Kurki M, Lingley-Pottie P. Two-Year Follow-Up of Internet and Telephone Assisted Parent Training for Disruptive Behavior at Age 4. J Am Acad Child Adolesc Psychiatry 2018; 57:658-668.e1. [PMID: 30196869 DOI: 10.1016/j.jaac.2018.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine whether an internet-based and telephone-assisted parent training intervention, which used whole population screening and which comprehensively targeted symptomatic 4-year-old children, was effective 24 months after the start of treatment. No long-term follow-up studies using a randomized controlled trial (RCT) existed on this subject. METHOD Of the 4,656 children 4 years old who were screened in Southwest Finland, 730 met the criteria for high-level disruptive behavioral problems, and 464 parents agreed to be randomized to the 11-week Strongest Families Smart Website (SFSW) intervention (n = 232) or an educational control (EC) (n = 232). After 24 months, 163 SFSW parents (70%) and 165 EC parents (71%) were still participating. RESULTS When we compared the results at baseline and 24 months, the primary outcome of the Child Behavior Checklist (CBCL) externalizing score showed significantly higher improvements in the SFSW group (effect size 0.22; p < 0.001). This group also showed greater improvements in the secondary outcomes: the CBCL total and internalizing scales, 5 of the 7 CBCL symptom domains, 3 of the 5 DSM subscores, and self-reported parenting skills. Fewer SFSW children (17.5%) than EC children (28.0%) had been referred to child mental health services between baseline and 24 months (odds ratio = 1.8; 95% confidence interval = 1.1-3.1). CONCLUSION The SFSW internet-based and telephone-assisted parental training program was effective 24 months after initiation, underlining the value of identifying children at risk in the community early and providing evidence-based parent training for a large number of families. CLINICAL TRIAL REGISTRATION INFORMATION STRONGEST FAMILIES FINLAND CANADA: Family-based Prevention and Treatment Program of Early Childhood Disruptive Behavior (Fin-Can). http://www.clinicaltrials.gov; NCT01750996.
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Affiliation(s)
- Andre Sourander
- University of Turku, Finland; Turku University Hospital, Finland.
| | - Patrick J McGrath
- IWK Health Centre, Halifax, Nova Scotia, Dalhousie University, Halifax, Nova Scotia, and the Strongest Families Institute, Halifax, Nova Scotia, Canada
| | - Terja Ristkari
- University of Turku, Finland; Turku University Hospital, Finland
| | - Charles Cunningham
- DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Patricia Lingley-Pottie
- IWK Health Centre, Halifax, Nova Scotia, Dalhousie University, Halifax, Nova Scotia, and the Strongest Families Institute, Halifax, Nova Scotia, Canada; QEII Health Sciences Centre, Halifax, Nova Scotia
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Fossum S, Ristkari T, Cunningham C, McGrath PJ, Suominen A, Huttunen J, Lingley-Pottie P, Sourander A. Parental and child factors associated with participation in a randomised control trial of an Internet-assisted parent training programme. Child Adolesc Ment Health 2018; 23:71-77. [PMID: 32677336 DOI: 10.1111/camh.12193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Parental training is an effective way to treat and prevent children's conduct problems, but knowledge of who participates in such initiatives is limited. METHOD This study examined child and family factors associated with participation in an Internet-assisted parent training programme. The parents of 4-year-old children with high levels of disruptive behaviour in a region of Finland were offered the opportunity to participate in a randomised controlled trial of the Strongest Families Smart Website intervention (SFSW). The participants and nonparticipants were compared using the Strengths and Difficulties Questionnaire (SDQ), duration of child problems and information about family demographics, which were routinely collected prior to randomisation to the SFSW and control group. RESULTS We found that 464 (64.5%) of the 709 parents of children fulfilling the screening criteria, participated. In the multivariable analysis, nonparticipation was most strongly associated with a child only having minor difficulties [odds ratio (OR): 2.1; 95% confidence interval (CI): 1.5-3.0] and a shorter duration of problems, for less than 12 months (OR: 1.7, 95% CI: 1.2-2.5), after controlling for other child factors. Nonparticipation was significantly associated with mothers spending a shorter time in the education system (OR: 1.6, 95% CI: 1.2-2.3) after controlling for other parental factors. CONCLUSIONS A larger percentage of parents of children with longer lasting and more severe problems seemed to be motivated to participate in this remote parent training programme. Future studies on how to encourage parents with shorter duration of education to participate in early intervention programmes are warranted.
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Affiliation(s)
- Sturla Fossum
- UiT The Artic University of Norway, Faculty of Health Sciences, The Regional Centre for Child and Youth Mental Health and Child Welfare - North, Tromsø, Norway
| | - Terja Ristkari
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, University of Turku and Turku University Hospital, Lemminkäisenkatu 3/ Teutori 3. krs, 20014, Turku, Finland
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Science, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada.,Faculty of Science, Dalhousie University, Halifax, NS, Canada.,Strongest Families Institute, Lower Sackville, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Auli Suominen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, University of Turku and Turku University Hospital, Lemminkäisenkatu 3/ Teutori 3. krs, 20014, Turku, Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, University of Turku and Turku University Hospital, Lemminkäisenkatu 3/ Teutori 3. krs, 20014, Turku, Finland
| | - Patricia Lingley-Pottie
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada.,Strongest Families Institute, Lower Sackville, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, University of Turku and Turku University Hospital, Lemminkäisenkatu 3/ Teutori 3. krs, 20014, Turku, Finland
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Fossum S, Cunningham C, Ristkari T, McGrath PJ, Hinkka-Yli-Salomäki S, Sourander A. Does parental mental health moderate the effect of a telephone and internet-assisted remote parent training for disruptive 4-year-old children? Scand J Psychol 2018; 59:273-280. [PMID: 29480527 DOI: 10.1111/sjop.12430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/27/2017] [Indexed: 10/17/2022]
Abstract
This study explores the moderators affecting the success of an Internet-based and telephone assisted remote parent training intervention and compares them to an educational control group. We prospectively identified 464 parents who reported at a health check that their 4-year-old children showed elevated levels of externalizing behavior. The moderators explored included parental attention deficit and hyperactivity disorder (ADHD) and parental distress. The dependent variables were child externalization scores and self-reported parenting skills. The measures were completed at baseline, six and 12-months follow-up. The 232 families randomized to active treatment received 11 Internet-based training sessions with weekly phone calls from a coach. The other 232 families had access to a website that provided general positive parenting advice and one 45-minute phone-call from a coach. Using hierarchical linear models, we explored if the parental ADHD or parental distress modified the treatment effects on child externalizing behavior or parenting skills. The results showed that none of the independent variables moderated intervention effects on child externalizing behavior or parenting skills. The lack of significant moderator effects could have been due to the treatment's personalization, the format's flexibility and adaptability to when and how the parents wanted to complete the sessions or the relatively low levels of ADHD and parental distress among the participants.
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Affiliation(s)
- Sturla Fossum
- UiT The Artic University of Norway, the Regional Centre for Child and Youth Mental Health and Child Welfare - North, Tromsø, Norway
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terja Ristkari
- Department of Child Psychiatry, Clinical Sciences, University of Turku and Turku University Hospital, Turku, Finland
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada.,Faculty of Science, Dalhousie University, Halifax, Nova Scotia, Canada.,Strongest Families Institute, Lower Sackville, Nova Scotia, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, Clinical Sciences, University of Turku and Turku University Hospital, Turku, Finland
| | - Andre Sourander
- Department of Child Psychiatry, Clinical Sciences, University of Turku and Turku University Hospital, Turku, Finland
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14
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Sourander A, Ristkari T. Developing and implementing digital-assisted parent training intervention for disruptive behavior in primary health care. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundAccording 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.MethodsThe 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.ResultsDuring 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.ConclusionsTraining 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 interestThe authors have not supplied their declaration of competing interest.
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Joelsson P, Chudal R, Gyllenberg D, Kesti AK, Hinkka-Yli-Salomäki S, Virtanen JP, Huttunen J, Ristkari T, Parkkola K, Gissler M, Sourander A. Demographic Characteristics and Psychiatric Comorbidity of Children and Adolescents Diagnosed with ADHD in Specialized Healthcare. Child Psychiatry Hum Dev 2016; 47:574-82. [PMID: 26399420 DOI: 10.1007/s10578-015-0591-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Recent studies have shown an increasing incidence of attention-deficit/hyperactivity disorder (ADHD) among children diagnosed in specialized services. This study aims to describe children with ADHD in Finnish specialized healthcare by reporting the demographic characteristics, time trends in diagnosis, psychiatric comorbidity, and the validity of register-based diagnoses. All the singletons born in Finland between 1991 and 2005 and diagnosed with ADHD by 2011 were identified and their psychiatric comorbidity data was obtained from the Finnish Hospital Discharge Register (FHDR). Parents of 69 patients were interviewed via telephone for a diagnostic validation. A total of 10,409 children were identified with ADHD, with a male: female ratio of 5.3:1 and a psychiatric comorbidity rate of 76.7 %. Of the validation sample 88 % met the diagnostic criteria of ADHD for DSM-IV. There is an increasing trend of ADHD diagnosis among both males and females. Psychiatric comorbidity is common and includes a wide range of disorders among children with ADHD. There was an increase of ADHD diagnoses especially among boys. More attention is needed to detect ADHD among girls in health services. Diagnoses in the FHDR show diagnostic validity and their sociodemographic patterns are in line with previous studies.
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Affiliation(s)
- Petteri Joelsson
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.
| | - Roshan Chudal
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - David Gyllenberg
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Anna-Kaisa Kesti
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Juha-Pekka Virtanen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Kai Parkkola
- Navy Command Finland, Turku, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Nordic School of Public Health, Gothenburg, Sweden.,National Institute for Health and Welfare, Helsinki, Finland.,New York State Psychiatric Institute, New York, NY, USA
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Ilola AM, Lempinen L, Huttunen J, Ristkari T, Sourander A. Bullying and victimisation are common in four-year-old children and are associated with somatic symptoms and conduct and peer problems. Acta Paediatr 2016; 105:522-8. [PMID: 26741067 DOI: 10.1111/apa.13327] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 05/12/2015] [Accepted: 01/04/2016] [Indexed: 01/30/2023]
Abstract
AIM There are few population-based studies on bullying behaviour among preschool children. The aims of the study were to investigate the prevalence of bullying behaviour among four-year-old children, as reported by their parents, the prevalence of types of bullying behaviour and the associations between bullying behaviour and psychosocial factors. METHODS This study was based on a population-based study sample of 931 children who attended their check-up at a child health clinic at four years of age. Parents completed the questionnaire about their child's bullying behaviour and risk factors during the check-up. RESULTS Bullying behaviour, especially being both a bully and a victim, was a common phenomenon among four-year-old children. Being a bully or both a bully and victim were most strongly associated with conduct problems, while being a victim was associated with somatic symptoms and peer problems. CONCLUSION Bullying behaviour was frequently found in preschool children and associated with a wide range of other problems, which indicate that routine checking of bullying behaviour should be included in child health clinic check-ups. Bullying prevention programmes are usually targeted at school-aged children, but this study highlights the importance of focusing already on preschool children.
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Affiliation(s)
- Anna-Marja Ilola
- Department of Child Psychiatry; Faculty of Medicine; University of Turku and Turku University Hospital; Turku Finland
| | - Lotta Lempinen
- Department of Child Psychiatry; Faculty of Medicine; University of Turku and Turku University Hospital; Turku Finland
| | - Jukka Huttunen
- Department of Child Psychiatry; Faculty of Medicine; University of Turku and Turku University Hospital; Turku Finland
| | - Terja Ristkari
- Department of Child Psychiatry; Faculty of Medicine; University of Turku and Turku University Hospital; Turku Finland
| | - Andre Sourander
- Department of Child Psychiatry; Faculty of Medicine; University of Turku and Turku University Hospital; Turku Finland
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Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Lingley-Pottie P, Hinkka-Yli-Salomäki S, Kinnunen M, Vuorio J, Sinokki A, Fossum S, Unruh A. Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial. JAMA Psychiatry 2016; 73:378-87. [PMID: 26913614 DOI: 10.1001/jamapsychiatry.2015.3411] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems. OBJECTIVE To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment. DESIGN, SETTING, AND PARTICIPANTS This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n = 232) or an education control (EC) group (n = 232). INTERVENTIONS The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching. MAIN OUTCOMES AND MEASURES Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization. RESULTS Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.5-5 externalizing scale (effect size, 0.34; P < .001), internalizing scale (effect size, 0.35; P < .001), and total scores (effect size, 0.37; P < .001); 5 of 7 syndrome scales, including aggression (effect size, 0.36; P < .001), sleep (effect size, 0.24; P = .002), withdrawal (effect size, 0.25; P = .005), anxiety (effect size, 0.26; P = .003), and emotional problems (effect size, 0.31; P = .001); Inventory of Callous-Unemotional Traits callousness scores (effect size, 0.19; P = .03); and self-reported parenting skills (effect size, 0.53; P < .001). CONCLUSIONS AND RELEVANCE The study reveals the effectiveness and feasibility of an Internet-assisted parent training intervention offered for parents of preschool children with disruptive behavioral problems screened from the whole population. The strategy of population-based screening of children at an early age to offering parent training using digital technology and telephone coaching is a promising public health strategy for providing early intervention for a variety of child mental health problems. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01750996.
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Affiliation(s)
- Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland2Turku University Hospital, Turku, Finland
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada4Faculty of Science, Dalhousie University, Halifax, Nova Scotia, Canada5Strongest Families Institute, Halifax, Nova Scotia, Canada6Department of Psychiatry, Dalhousie Uni
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jukka Huttunen
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Patricia Lingley-Pottie
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada5Strongest Families Institute, Halifax, Nova Scotia, Canada6Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Malin Kinnunen
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Jenni Vuorio
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Sturla Fossum
- Center for Child and Adolescent Mental Health, North Norway, University of Tromsø, Breivika, Norway
| | - Anita Unruh
- Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
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Elonheimo H, Gyllenberg D, Huttunen J, Ristkari T, Sillanmäki L, Sourander A. Criminal offending among males and females between ages 15 and 30 in a population-based nationwide 1981 birth cohort: Results from the FinnCrime Study. J Adolesc 2014; 37:1269-79. [DOI: 10.1016/j.adolescence.2014.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/03/2014] [Accepted: 09/15/2014] [Indexed: 11/15/2022]
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19
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Chudal R, Sucksdorff D, Suominen A, Lehti V, Hinkka-Yli-Salomäki S, Huttunen J, Ristkari T, Gissler M, McKeague IW, Brown AS, Sourander A. Finnish Prenatal Study of Bipolar Disorders (FIPS-B): overview, design and description of the sample. Nord J Psychiatry 2014; 68:169-79. [PMID: 24627962 DOI: 10.3109/08039488.2013.789073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bipolar disorders (BPD) are chronic mental illnesses, the development of which involves genetic factors and environmental influences. AIMS The aim of this paper is to provide an overall description of the Finnish Prenatal Study of Bipolar Disorders (FIPS-B), including the study design, national registers and linkage of the registers. METHODS FIPS-B is a population-based prenatal epidemiological study of BPD with a nested case-control study design using several national registers. The registers used are: the Finnish Medical Birth Register (FMBR), the Finnish Hospital Discharge Register (FHDR), the Population Central Register and the Finnish Maternity Cohort (FMC), which are linked using the unique personal identity code (PIC). FIPS-B includes all children born from January 1, 1983 to December 31, 1998 and diagnosed with BPD in Finland by December 31, 2008. RESULTS The total number of cases included in the FIPS-B is 1887. The age at first diagnosis ranged from 4 to 25 years. Half (50.4%) of the cases utilized only outpatient services, 12.7% only inpatient services and the rest (36.9%) utilized both services. Offspring of mothers with the lowest educational level had an increased odds of BPD (OR = 1.46, 95% CI 1.13-1.88). The cumulative incidence of BPD in the population aged 25 years or younger was 11.6/10,000 in 2008. CONCLUSIONS FIPS-B has all the strengths of a register-based prenatal epidemiological study, along with the availability of maternal biomarkers, enabling it to examine several prenatal, perinatal and familial risk factors for BPD.
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Affiliation(s)
- Roshan Chudal
- Department of Child Psychiatry, University of Turku , Finland
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20
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McGrath PJ, Sourander A, Lingley-Pottie P, Ristkari T, Cunningham C, Huttunen J, Filbert K, Aromaa M, Corkum P, Hinkka-Yli-Salomäki S, Kinnunen M, Lampi K, Penttinen A, Sinokki A, Unruh A, Vuorio J, Watters C. Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada). BMC Public Health 2013; 13:985. [PMID: 24139323 PMCID: PMC4015286 DOI: 10.1186/1471-2458-13-985] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/08/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. METHODS/DESIGN This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. DISCUSSION The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. TRIAL REGISTRATION ClinicalTrials.gov # NCT01750996.
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Affiliation(s)
- Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
- Center for Child and Adolescent Mental Health, North Norway (RBUP), University of Tromsø, 9037, Breivika, Norway
| | - Patricia Lingley-Pottie
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
- Strongest Families Institute, 7105 Chebucto Road, Suite 355, Halifax, Nova Scotia B3L 4W8, Canada
| | - Terja Ristkari
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Science, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Jukka Huttunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katharine Filbert
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Minna Aromaa
- Outpatient Clinic for Children and Adolescents, Itäinen Pitkäkatu 30, 20700, Turku, Finland
- Department of Public Health, University on Turku, FI-20014, Turun Yliopisto, Finland
| | - Penny Corkum
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katja Lampi
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anne Penttinen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anita Unruh
- Dalhousie University, Faculty of Health Professions, Burbidge Building, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Jenni Vuorio
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Carolyn Watters
- Dalhousie University, Faculty of Computer Science, 6050 University Avenue, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
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Ristkari T, Sourander A, Ronning JA, Elonheimo H, Helenius H, Salokangas RKR. Sense of coherence and criminal offences among young males. Findings from the Finnish from a boy to a man study. Nordic Psychology 2012. [DOI: 10.1027/1901-2276.61.1.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sourander A, Brunstein Klomek A, Kumpulainen K, Puustjärvi A, Elonheimo H, Ristkari T, Tamminen T, Moilanen I, Piha J, Ronning JA. Bullying at age eight and criminality in adulthood: findings from the Finnish Nationwide 1981 Birth Cohort Study. Soc Psychiatry Psychiatr Epidemiol 2011; 46:1211-9. [PMID: 21120451 DOI: 10.1007/s00127-010-0292-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
Abstract
CONTEXT There are no prospective population-based studies examining predictive associations between childhood bullying behavior and adult criminality. OBJECTIVE To study predictive associations between bullying and victimization at age eight and adult criminal offenses. DESIGN Nationwide birth cohort study from age 8 to 26 years. PARTICIPANTS The sample consists of 5,351 Finnish children born in 1981 with information about bullying and victimization at age eight from parents, teachers, and the children themselves. MAIN OUTCOME MEASURES National police register information about criminal offenses at age 23-26 years. RESULTS When controlled for the parental education level and psychopathology score, bullying sometimes and frequently independently predicted violent (OR 3.9, 95% CI 1.9-7.9, p < 0.001; OR 2.5, 95% CI 1.6-4.1, p < 0.001, respectively), property (OR 2.3, 95% CI 1.2-4.7, p < 0.05; OR 1.7, 95% CI 1.1-2.7, p < 0.05), and traffic (OR 2.8, 95% CI 1.8-4.4, p < 0.001; OR 1.6, 95% CI 1.3-2.1, p < 0.001) offenses. The strongest predictive association was between bullying frequently and more than five crimes during the 4-year period (OR 6.6, 95% CI 2.8-15.3, p < 0.001) in adjusted analyses. When different informants were compared, teacher reports of bullying were the strongest predictor of adult criminality. In adjusted analyses, male victimization did not independently predict adult crime. Among girls, bullying or victimization at age eight were not associated with adult criminality. CONCLUSIONS Bullying among boys signals an elevated risk of adult criminality.
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Affiliation(s)
- Andre Sourander
- Department of Child Psychiatry, Turku University and Turku University Hospital, 20520 Turku, Finland.
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Lampi KM, Banerjee PN, Gissler M, Hinkka-Yli-Salomäki S, Huttunen J, Kulmala U, Lindroos J, Niemelä S, Rihko M, Ristkari T, Saanakorpi K, Sarlin T, Sillanmäki L, McKeague IW, Surcel HM, Helenius H, Brown AS, Sourander A. Finnish Prenatal Study of Autism and Autism Spectrum Disorders (FIPS-A): Overview and Design. J Autism Dev Disord 2010; 41:1090-6. [DOI: 10.1007/s10803-010-1132-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sourander A, Brunstein Klomek A, Ikonen M, Lindroos J, Luntamo T, Koskelainen M, Ristkari T, Helenius H. Psychosocial risk factors associated with cyberbullying among adolescents: a population-based study. ACTA ACUST UNITED AC 2010; 67:720-8. [PMID: 20603453 DOI: 10.1001/archgenpsychiatry.2010.79] [Citation(s) in RCA: 262] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT To our knowledge, no population study examining psychosocial and psychiatric risk factors associated with cyberbullying among adolescents exists. OBJECTIVE To study cross-sectional associations between cyberbullying and psychiatric and psychosomatic problems among adolescents. DESIGN Population-based cross-sectional study. SETTING Finland. PARTICIPANTS The sample consists of 2215 Finnish adolescents aged 13 to 16 years with complete information about cyberbullying and cybervictimization. MAIN OUTCOME MEASURES Self-reports of cyberbullying and cybervictimization during the past 6 months. RESULTS In the total sample, 4.8% were cybervictims only, 7.4% were cyberbullies only, and 5.4% were cyberbully-victims. Cybervictim-only status was associated with living in a family with other than 2 biological parents, perceived difficulties, emotional and peer problems, headache, recurrent abdominal pain, sleeping difficulties, and not feeling safe at school. Cyberbully-only status was associated with perceived difficulties, hyperactivity, conduct problems, low prosocial behavior, frequent smoking and drunkenness, headache, and not feeling safe at school. Cyberbully-victim status was associated with all of these risk factors. Among cybervictims, being cyberbullied by a same-sex or opposite-sex adult, by an unknown person, and by a group of people were associated with fear for safety, indicating possible trauma. CONCLUSIONS Both cyberbullying and cybervictimization are associated with psychiatric and psychosomatic problems. The most troubled are those who are both cyberbullies and cybervictims. This indicates the need for new strategies for cyberbullying prevention and intervention.
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Affiliation(s)
- Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, 20520 Turku, Finland.
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Ristkari T, Sourander A, Rønning JA, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F. Childhood psychopathology and sense of coherence at age 18: findings from the Finnish from a boy to a man study. Soc Psychiatry Psychiatr Epidemiol 2009; 44:1097-105. [PMID: 19333530 DOI: 10.1007/s00127-009-0032-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 03/06/2009] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine associations between childhood psychopathology and family factors at age 8, and sense of coherence (SOC) at age 18. METHODS The sample includes 2,314 Finnish boys born 1981 with information about psychopathology from parents and teachers using Rutter scales, and self-reports of depressive symptoms using Child Depression Inventory (CDI), and self-reports of SOC at age 18. RESULTS Low parental education level and living in other than two biological parent family at age 8 were associated with low SOC 10 years later. Boys with internalizing symptoms based on parent/teacher reports, and depressive symptoms based on self-reports at age 8 were at risk for lower SOC at follow-up. Comorbidity of internalizing and conduct problems had the strongest association with low SOC. CONCLUSION The study shows that internalizing symptoms, comorbid conduct and emotional problems, low parental education level and nonintact family at age 8 predict low SOC at age 18. Future research whether universal, selective or indicated early interventions targeted on risk factors of childhood mental health problems may result in promotion of well-being (including good SOC) in early adulthood is warranted.
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Affiliation(s)
- Terja Ristkari
- Deapartment of Psychiatry, Turku University, Turku, Finland.
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Sourander A, Ronning J, Brunstein-Klomek A, Gyllenberg D, Kumpulainen K, Niemelä S, Helenius H, Sillanmäki L, Ristkari T, Tamminen T, Moilanen I, Piha J, Almqvist F. Childhood Bullying Behavior and Later Psychiatric Hospital and Psychopharmacologic Treatment. ACTA ACUST UNITED AC 2009; 66:1005-12. [DOI: 10.1001/archgenpsychiatry.2009.122] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sourander A, Klomek AB, Niemelä S, Haavisto A, Gyllenberg D, Helenius H, Sillanmäki L, Ristkari T, Kumpulainen K, Tamminen T, Moilanen I, Piha J, Almqvist F, Gould MS. Childhood Predictors of Completed and Severe Suicide Attempts. ACTA ACUST UNITED AC 2009; 66:398-406. [DOI: 10.1001/archgenpsychiatry.2009.21] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Elonheimo H, Sourander A, Niemelä S, Nuutila AM, Helenius H, Sillanmäki L, Ristkari T, Parkkola K. Psychosocial correlates of police-registered youth crime. A Finnish population-based study. Nord J Psychiatry 2009; 63:292-300. [PMID: 19229735 DOI: 10.1080/08039480902727058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study is focused on psychosocial correlates of youth crime in a sample of 2330 Finnish boys born in 1981. Two kinds of data were combined: questionnaires completed by the boys at call-up in 1999 and crime registered in the Finnish National Police Register between 1998 and 2001. One-fifth of the boys were registered to offending during the 4-year period in late adolescence; 14% were registered for one or two offences, 4% for three to five offences, and 3% for more than five offences. Crime accumulated heavily in those with more than five offences, as they accounted for 68% of all crime. Independent correlates of crime were living in a small community, parents' low educational level and divorce, having a regular relationship, self-reported delinquency, daily smoking, and weekly drunkenness, whereas anxious-depressiveness was reversely associated with crime. Most psychosocial problems covaried linearly with offending frequency, being particularly manifested by multiple recidivists. However, recidivists had very rarely used mental health services. The results indicate that offending and various psychosocial problems accumulate in a small minority of boys not reached by mental health services.
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Ristkari T, Sourander A, Rønning JA, Nikolakaros G, Helenius H. Life events, self-reported psychopathology and sense of coherence among young men--a population-based study. Nord J Psychiatry 2008; 62:464-71. [PMID: 18846443 DOI: 10.1080/08039480801984313] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- T Ristkari
- Department of Psychiatry, University of Turku, Turku, Finland.
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Huttunen J, Heinimaa M, Svirskis T, Nyman M, Kajander J, Forsback S, Solin O, Ilonen T, Korkeila J, Ristkari T, McGlashan T, Salokangas RKR, Hietala J. Striatal dopamine synthesis in first-degree relatives of patients with schizophrenia. Biol Psychiatry 2008; 63:114-7. [PMID: 17655830 DOI: 10.1016/j.biopsych.2007.04.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 04/03/2007] [Accepted: 04/13/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND First degree relatives (FDR) of patients with schizophrenia have higher risk of developing schizophrenia than the general population. Previous positron emission tomography (PET) studies have shown that striatal presynaptic dopamine synthesis capacity is increased in schizophrenia. We investigated whether this same phenomenon is shared by individuals with increased genetic risk for schizophrenia. METHODS We used 6-[18F]-fluorodopa (FDOPA) PET imaging to measure striatal dopamine synthesis capacity. We studied 17 nonpsychotic subjects with an FDR with schizophrenia. This group was compared to 17 healthy subjects with no FDRs with schizophrenia. RESULTS A conventional region of interest (ROI)-analysis indicated that FDOPA uptake (K(i)) in the caudate-putamen was statistically significantly higher in the FDR group than in the control group. A voxel-level analysis confirmed these results. CONCLUSIONS These results suggest that the changes of striatal presynaptic dopamine synthesis seen previously in neuroleptic-naive schizophrenic patients is also present in FDRs of patients with schizophrenia. These findings have implications for the early detection of psychosis as well as for pharmacological interventions in individuals at risk for psychosis.
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Affiliation(s)
- Jukka Huttunen
- Department of Psychiatry, University of Turku, Turku, Finland
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Sourander A, Jensen P, Davies M, Niemelä S, Elonheimo H, Ristkari T, Helenius H, Sillanmäki L, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F. Who is at greatest risk of adverse long-term outcomes? The Finnish From a Boy to a Man study. J Am Acad Child Adolesc Psychiatry 2007; 46:1148-1161. [PMID: 17712238 DOI: 10.1097/chi.0b013e31809861e9] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study associations between comorbid psychopathology and long-term outcomes in a large birth cohort sample from age 8 to early adulthood. METHOD The sample included long-term outcome data on 2,556 Finnish boys born in 1981. The aim was to study the impact of early childhood psychopathology types (externalizing versus internalizing versus both) and informant sources (self-report versus parent/teacher reports) on young adult outcomes, based on data from a military registry of psychiatric diagnosis, a police registry on criminal and drug offenses, and self-reported problems in late adolescence and early adulthood. RESULTS Children with combined conduct and internalizing problems at age 8 had the worst outcomes and highest risk of subsequent psychiatric disorders, criminal offenses, and self-reported problems at follow-up, with 62% of these boys manifesting psychiatric disorders, committing criminal offenses, or both at follow-up. Although these children included only 4% of the sample, they were responsible for 26% of all criminal offenses at follow-up. In contrast, children with conduct problems without internalizing problems and those with attention problems had much less severe but nonetheless elevated levels of risk of antisocial personality disorder and criminal offenses. Long-term outcomes for these two groups were substantially better than for children with combined conduct and internalizing problems. Children with "pure" emotional problems had an elevated risk only of similar emotional problems at follow-up. CONCLUSIONS The subjective suffering and long-term burden to society is especially high among children with comorbid conduct and internalizing problems in childhood. A major challenge for child and adolescent psychiatric, education, and social services is to develop effective intervention strategies focusing on these children. Additional longitudinal epidemiological studies of this comorbidity group are needed, and, if replicated, such findings will have important implications for future diagnostic classification systems (DSM-V).
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Affiliation(s)
- Andre Sourander
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital..
| | - Peter Jensen
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Mark Davies
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Solja Niemelä
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Henrik Elonheimo
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Terja Ristkari
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Hans Helenius
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Lauri Sillanmäki
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Jorma Piha
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Kirsti Kumpulainen
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Tuula Tamminen
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Irma Moilanen
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
| | - Fredrik Almqvist
- Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital
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Korkeila JA, Svirkis T, Heinimaa M, Ristkari T, Huttunen J, Ilonen T, McGlashan TH, Salokangas RKR. Physical ill health and risk of psychosis. Psychiatry Res 2007; 150:255-63. [PMID: 17331590 DOI: 10.1016/j.psychres.2006.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 01/16/2006] [Accepted: 03/01/2006] [Indexed: 11/26/2022]
Abstract
Patients with psychosis have been found to suffer from physical illnesses more commonly than the general population. In this report, self-reported physical ill health and its correlates among subjects with and without vulnerability to psychosis in a sample of first-degree relatives, help-seekers and controls were investigated. Perceived physical health was statistically significantly poorer among subjects with minor symptoms on the Structured Interview for Prodromal Symptoms and those vulnerable to psychosis than among those without symptoms measured by 13 somatoform symptom sum scores of the Symptom Checklist-90. Those at current risk of psychosis had a significantly higher mean sum score on the 13 somatic items (mean=21.1) than others (mean=9.6). Having physical symptoms or a self-reported physician-diagnosed illness was significantly associated with vulnerability to psychosis (odds ratio=3.05). The subjects with a mood disorder (odds ratio=4.33) had significantly more commonly physician-diagnosed illnesses than those who had no diagnosis or any other diagnosis. Physical ill health seems to be common among those vulnerable to psychosis.
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Affiliation(s)
- Jyrki A Korkeila
- Department of Psychiatry, University of Turku, 20700 Turku, Finland.
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Svirskis T, Korkeila J, Heinimaa M, Huttunen J, Ilonen T, Ristkari T, Hietala J, Syvälahti E, McGlashan T, Vahlberg T, Salokangas RKR. Quality of life and functioning ability in subjects vulnerable to psychosis. Compr Psychiatry 2007; 48:155-60. [PMID: 17292706 DOI: 10.1016/j.comppsych.2006.10.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 10/23/2006] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is well established that quality of life (QOL) and functioning ability are impaired in psychosis, especially schizophrenia. Little is known about QOL and functioning in subjects vulnerable to psychosis (VTP). METHOD Three samples of nonpsychotic subjects (first-degree relatives of psychotic or severely ill patients, treatment-seeking patients, and a random community sample, in all 133 subjects) were assessed by the Structured Interview for Prodromal Symptoms and their vulnerability to psychosis was defined by severity of lifetime psychotic-like positive symptoms (nonsymptomatic, symptomatic, VTP). Quality of life was assessed by the Heinrichs' Quality of Life Scale and the Global Assessment of Functioning Ability (GAF) was used to measure functioning. Variance of QOL and GAF was explained by vulnerability status and psychiatric symptoms. RESULTS Quality of life and functioning ability decreased linearly as positive symptom intensity increased and was lowest in the VTP subjects when background factors were controlled for. In multivariate analysis, negative symptoms predicted low QOL/GAF scores in addition to vulnerability status that was based on positive symptoms. CONCLUSION Vulnerability to psychosis is associated with decreased QOL and impaired functioning ability. Although current diagnostic evaluation of patients at high risk of psychosis relies heavily on the occurrence of positive symptoms, negative symptoms seem to be strongly associated with QOL and functioning ability in VTP subjects. This should be taken into account when assessing putatively vulnerable patients and planning treatment interventions for them.
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Affiliation(s)
- Tanja Svirskis
- Department of Psychiatry, University of Turku, 20700 Turku, Finland.
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Ristkari T, Sourander A, Ronning J, Helenius H. Self-reported psychopathology, adaptive functioning and sense of coherence, and psychiatric diagnosis among young men--a population-based study. Soc Psychiatry Psychiatr Epidemiol 2006; 41:523-31. [PMID: 16568249 DOI: 10.1007/s00127-006-0059-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the associations between psychiatric disorders and self-perceived problems among adolescent boys. METHOD The study population consisted of 2348 Finnish boys born during 1981 attending obligatory military call-up (79.7% of the original sample). At military call-up in 1999, the boys filled in the Young Adult Self-Report (YASR) and Orientation of Life Questionnaire (SOC-13). Information about psychiatric disorders was obtained from the national military register during the years 1999-2004. RESULTS Most of the psychopathology, adaptive functioning and SOC scales were associated with a variety of psychiatric disorders at follow-up. However, when the effects of scales were controlled in multivariate analysis, only YASR somatic problems and SOC-13 showed an independent association with a wide range of psychiatric disorders at follow-up. Poor SOC-13 predicted anxiety, depression, antisocial personality and substance use disorders. The YASR somatic problems scale predicted anxiety, depression, substance use, psychotic, and adjustment disorders. Self-reported delinquency and poor competence at school predicted substance use and antisocial personality disorders. CONCLUSIONS Self-reports of poor sense of coherence and somatic complaints have a non-specific association with a wide range of psychiatric disorders. Clinical and theoretical implications of these findings are discussed.
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Affiliation(s)
- Terja Ristkari
- Dept. of Psychiatry, University of Turku, Kunnallissairaalantie 20, rak. 9, 20700, Turku, Finland
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Korkeila JA, Svirskis T, Heinimaa M, Ristkari T, Huttunen J, Ilonen T, McGlashan T, Salokangas RKR. Substance abuse and related diagnoses in early psychosis. Compr Psychiatry 2005; 46:447-52. [PMID: 16275212 DOI: 10.1016/j.comppsych.2005.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Accepted: 03/30/2005] [Indexed: 11/23/2022] Open
Abstract
Substance abuse seems to be common among those with early signs of evolving psychosis. This article seeks to determine the prevalence of substance abuse and substance use disorders (SUDs) and the association of abuse and SUD with vulnerability psychosis among a sample of first-degree relatives of schizophrenic patients (n = 70), help-seekers (n = 29), and control subjects (n = 34). The Structured Interview for Prodromal Symptoms (SIPS) 1.0 was used to define the vulnerability status and the Structured Clinical Interview for DSM-IV Axis I to diagnose the subjects. Data on various other measures, including premorbid adjustment, personality disorder symptoms, psychological distress, and abuse of substances, were collected. Those who were identified as vulnerable to psychosis reported significantly more lifetime alcohol abuse and had more commonly an SUD than controls. Substance use disorder, as well as alcohol and drug abuse, correlated significantly with personality disorder symptoms and current positive SIPS score and both types of abuse also with disorganization SIPS score. The odds ratio for having an SUD among those vulnerable to psychosis was 6.33 (95% confidence interval, 1.77-22.73). Early psychosis and substance abuse frequently occur together.
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Affiliation(s)
- Jyrki A Korkeila
- Department of Psychiatry, Turku City Hospital and Turku University Central Hospital, University of Turku, Finland.
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Sourander A, Multimäki P, Nikolakaros G, Haavisto A, Ristkari T, Helenius H, Parkkola K, Piha J, Tamminen T, Moilanen I, Kumpulainen K, Almqvist F. Childhood predictors of psychiatric disorders among boys: a prospective community-based follow-up study from age 8 years to early adulthood. J Am Acad Child Adolesc Psychiatry 2005; 44:756-67. [PMID: 16034277 DOI: 10.1097/01.chi.0000164878.79986.2f] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study early childhood predictors for early adulthood psychiatric disorders. METHOD The sample included 2,712 Finnish boys born in 1981. Information about the 8-year-old boys' problem behavior was obtained from parents, teachers, and children. The 10-15-year follow-up information about psychiatric disorders in early adulthood was based on the national military register between the years 1999 and 2004. RESULTS According to the military register, 10.4% of men had a psychiatric disorder. All informant sources, parents, teachers, and the children themselves predicted early adulthood psychiatric disorders. Conduct symptoms at age 8 independently predicted substance abuse, antisocial personality, and psychotic disorders in early adulthood. Self-reported depressive symptoms, poor school performance, and living in a nonintact family had an independent predictive association with antisocial personality and depressive disorders. Parent-reported emotional symptoms and self-reported psychosomatic symptoms independently predicted anxiety disorders. About one third of those who had used services at age 8 had a psychiatric disorder in early adulthood. Among service users, conduct and hyperkinetic symptoms predicted psychiatric disorders in early adulthood. CONCLUSIONS Efforts to prevent early adult psychiatric disturbance already present in childhood are emphasized. Active screening to detect children in need of early interventions in childhood to prevent negative development in early adulthood is justified.
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Affiliation(s)
- Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Finland.
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Svirskis T, Korkeila J, Heinimaa M, Huttunen J, Ilonen T, Ristkari T, McGlashan T, Salokangas RKR. Axis-I disorders and vulnerability to psychosis. Schizophr Res 2005; 75:439-46. [PMID: 15885535 DOI: 10.1016/j.schres.2004.11.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 10/27/2004] [Accepted: 11/03/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The psychopathology that manifests during the prodromal phase of first-episode psychosis is varied. Little is known about the clinical diagnoses of subjects with so-called prodromal or psychotic-like symptoms. METHOD Samples of psychotic patients, first-degree relatives (FDRs) of psychotic, or severely ill patients, treatment-seeking patients, and a random community sample (in all 157 subjects) were assessed by the Structured Interview for Prodromal Symptoms (SIPS) and the SCID-I. Vulnerability to psychosis (VTP) was defined by severity of positive symptoms reported in the SIPS interview and associated with lifetime SCID-I diagnoses. RESULTS The number of lifetime diagnoses received increased linearly as the SIPS symptoms approached more psychotic-like phenomena. All VTP subjects received on average 2.5, and currently prodromal subjects 2.9 lifetime SCID-I diagnoses, while the corresponding figure for non-VTP subjects was 0.7 (p<0.0001). Mood disorders and comorbid anxiety disorders were particularly common. CONCLUSION Vulnerability to psychosis seems to be associated with a high number of lifetime Axis-I diagnoses. Occurrence of anxiety disorders is remarkable, and most VTP subjects can be diagnosed with a lifetime mood disorder. VTP subjects require careful assessment of mood and anxiety symptoms and adequate treatment for their multiple disorders.
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Affiliation(s)
- Tanja Svirskis
- University of Turku, Department of Psychiatry, Kunnallissairaalantie 20 rak., 9 20700 Turku, Finland.
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Ristkari T, Sourander A, Helenius H, Nikolakaros G, Salanterä S, Multimäki P, Parkkola K. Sense of coherence among Finnish young men--a cross-sectional study at military call-up. Nord J Psychiatry 2005; 59:473-80. [PMID: 16316900 DOI: 10.1080/08039480500360898] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to study associations between sense of coherence (based on Antonovsky's theory), and mental health problems, the use of mental health services, substance use, predisposition to suicide and possible psychiatric diagnosis among Finnish young men. The study included 2314 18-year-old young men who attended military call-up in autumn 1999 and completed the 13-item Orientation to Life Questionnaire (SOC-13) questionnaire (89.1% of the study sample attending military call-up). Furthermore, all young men had a medical examination at military call-up, including evaluation of possible psychiatric disorder. Suicidality, perceived mental health problems, psychiatric diagnosis at military call-up medical examination, use of mental health services, excessive alcohol consumption and use of illicit drugs were identified as independent factors associated with sense of coherence. Sense of coherence is a valuable construction in psychiatric evaluation of adolescents. SOC-13 can be used both in clinical practice and in epidemiological research to evaluate the adolescent's health resources. Future research on its applications in clinical practice is warranted.
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Affiliation(s)
- Terja Ristkari
- Department of Psychiatry, University of Turku, Turku, Finland.
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Heinimaa M, Salokangas RKR, Ristkari T, Plathin M, Huttunen J, Ilonen T, Suomela T, Korkeila J, McGlashan TH. PROD-screen--a screen for prodromal symptoms of psychosis. Int J Methods Psychiatr Res 2003; 12:92-104. [PMID: 12830303 PMCID: PMC6878465 DOI: 10.1002/mpr.146] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to describe the PROD-screen, an instrument for screening prodromal symptoms indicating risk for psychotic conversion in the near future. PROD-screen consists of 29 questions assessing performance and symptoms. Clinical construct validity was tested by comparing scores from the unselected general population (GP, n = 64) with those of general psychiatric patients from a community mental health centre (CMHC, n = 107). The concordant validity of PROD-screen for prodromal symptoms of psychosis was assessed in a large epidemiologically mixed sample of research subjects (n = 132) by comparing PROD-screen scores with the prodromal diagnosis made by Structured Interview for Prodromal Symptoms as a gold standard. Using the cut-off point of 2/12 specific symptoms, PROD-screen gave correct classification of prodromal status in 77% of cases, distinguishing prodromal from non-prodromal subjects with reasonable sensitivity (80%) and specificity (75%) in the epidemiologically mixed sample. According to subsample analysis PROD-screen functions well with first-degree relatives of schizophrenic patients and probably also with general population samples, but not with psychiatric outpatients. In conclusion, PROD-screen is a useful tool for screening prodromal symptoms of psychosis and selecting subjects for more extensive research interviews.
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Affiliation(s)
- M Heinimaa
- Department of Psychiatry, University of Turku, Finland.
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Suomela T, Heinimaa M, Ilonen T, Korkeila J, Huttunen J, Ristkari T, Salokangas R. Self-reported prodromal symptoms of adolescents attending psychiatric care. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
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.
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Affiliation(s)
- A Sourander
- Department of Child Psychiatry, Turku University Hospital, Finland
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