Child and adolescent mental health service use in Finland

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL IMPLICATIONS

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

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

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

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

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

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Parent-adolescent agreement on emotional and behavioral problems

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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