Gerasimos Kolaitis

Elevated morning serum interleukin (IL)-6 or evening salivary cortisol concentrations predict posttraumatic stress disorder in children and adolescents six months after a motor vehicle accident.

BACKGROUND This study examined prospectively the activity of the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system and inflammatory factors in children shortly after a motor vehicle accident (MVA) in relation to later posttraumatic stress disorder (PTSD) development. PATIENTS AND METHODS Fifty six children, aged 7-18, were studied after an MVA and 1 and 6 months later; 40 subjects served as controls. Morning serum cortisol and interleukin (IL)-6 and plasma catecholamine concentrations were measured within 24h after the event. Salivary cortisol was measured 5 times at defined time points during the same day. PTSD diagnoses 1 and 6 months later were based on K-SADS interview. RESULTS Morning serum IL-6 concentrations, measured within the first 24h after the accident, were higher in children that developed PTSD 6 months later than those who did not and those of the control group. Longitudinal IL-6 measurements revealed normalization of IL-6 in the PTSD group, while no differences between the three groups were detected 1 and 6 months later. Evening salivary cortisol and morning serum IL-6 after the accident were positively inter-related (r=0.54, p<0.001) and in separate regression analyses both predicted PTSD development 6 months later. In contrast, morning serum IL-6 did nor correlate with morning serum or salivary cortisol concentrations. CONCLUSIONS Immediate posttraumatic alterations in neuroendocrine or inflammatory factors-increased evening salivary cortisol and/or increased morning serum IL-6 concentrations-are involved in subsequent PTSD development in children and adolescents.

Posttraumatic stress reactions among children following the Athens earthquake of September 1999

Abstract.The objective of the present study was to assess symptoms of posttraumatic stress disorder (PTSD), depression and anxiety among children 6 months after they had been exposed to an earthquake (EQ) affecting the northwestern suburbs of Athens in September 1999. A total of 115 children attending two elementary schools located at the epicentre of the EQ were assessed. A group of 48 children not affected by the EQ attending a school not affected by the EQ were used as controls. The children and their parents completed a number of questionnaires. Overall, there was a high rate (78%) of severe to mild PTSD symptoms in the EQ exposed group. Additionally, a substantial proportion of these children scored above criteria (32%) for depression compared to the control group (12.5%). Severe or moderate symptoms of PTSD were associated with high scores of depression (p = 0.002). The relationship between PTSD symptoms and anxiety was limited to the “avoidance” factor of the anxiety questionnaire (p = 0.029). Those who were most likely to be affected were children alone at the time of the EQ, and children who sustained injuries. In summary, countries where EQs are frequent should be prepared to offer psychological support to a substantial proportion of children presenting with PTSD and depressive symptoms and should educate and prepare children to cope with these events.

The natural history of neuroendocrine changes in pediatric posttraumatic stress disorder (PTSD) after motor vehicle accidents: progressive divergence of noradrenaline and cortisol concentrations over time.

BACKGROUND The hypothalamic-pituitary-adrenal axis and the catecholaminergic system are involved in the pathophysiology of post-traumatic stress disorder (PTSD). This was a prospective and longitudinal study of neuroendocrine physiology in children with PTSD following a motor vehicle accident (MVA). METHODS Sixty children aged 7-18 were studied immediately after an MVA and 1 and 6 months later. Fasting morning plasma catecholamine and serum cortisol concentrations were measured. Salivary cortisol concentrations were measured serially five times daily to examine circadian variation in all three assessments. Values were compared between those who did (PTSD) or did not develop PTSD (non-PTSD) after the trauma and a control group at months 1 and 6. RESULTS Twenty-three of the children had PTSD at the 1-month and 9 children at the 6-month evaluations. 1) Plasma noradrenaline concentrations were higher in the PTSD group than in the other two groups at both months 1 and 6 (p = .001 and p = .001, respectively). Additionally, the PTSD patients presented with significantly higher salivary cortisol concentrations at 18.00 (p = .03) and 21.00 (p = .04) at month 1.2) Eight children suffering from PTSD at both months 1 and 6 had significantly elevated plasma noradrenaline concentrations at month 6 compared with those at month 1 and at baseline and to the other two groups (within subjects: p < .001; between subjects: p = .005). The initially elevated evening salivary cortisol concentrations in this group normalized at month 6. CONCLUSIONS This progressive divergence of noradrenaline and cortisol concentrations over time might underlie the natural history and pathophysiology of PTSD.

Psychiatric services and training for children and adolescents in Europe: Results of a country survey

Abstract Mental health budgets, services and programs are seldom commensurate with mental health needs in the countries, particularly of population groups whose voice in advocacy is weak. In this inquiry we explored the adequacy of mental health care resources available for the young in Europe. To achieve this objective this survey investigated a few variables (e. g., number of services, degree of coverage, trained personnel) that were used as gross indicators of the discrimination suffered by this health sector. We sent a short postal questionnaire to the mental health focal points of the 51 countries included in the World Health Organization European Region. Thirty six countries (70.5 %) responded. The results showed that the degree of coverage and quality of services for the young were generally worse in comparison with those for adults, including for serious disorders. A lack of both specialized and in-training personnel was identified. The exposure of general practitioners and pediatricians to psychiatry for the young was limited. Generally, the lower the income level of the country the worse the situation. Our mapping confirmed findings of previous inquiries. European child psychiatry leaders had raised a set of recommendations to improve the current situation; their implementation can now benefit from novel strategies adopted by the World Health Organization to advance mental health worldwide.

Prevalence of recurrent complaints of pain among Greek schoolchildren and associated factors: A population-based study

Aim: To determine the prevalence of recurrent complaints of pain (RCP) in Greek children, and to examine associations with socio‐demographic characteristics and psychosocial factors. Methods: Cross‐sectional study comprising a nationally representative population of 8130 7‐y‐old Greek schoolchildren. Data were collected by mailed questionnaires (response rate 89%). RCP was defined as present if at least one of the complaints of headache, abdominal pain or limb pain occurred at least once a week. Results: The RCP prevalence rate was 7.2%, with significant gender differences (8.8% of girls, 5.7% of boys; p<0.001). RCP was significantly positively associated with a chronic health problem among the children, frequent change of residence, poor school performance, often watching TV and rarely playing with other children. There were no statistically significant associations of RCP with family structure and socio‐economic status.

Psychosocial adaptation of immigrant Greek children from the former Soviet Union

Abstract.Background: The objective of this study was to assess psychiatric disorders in, and the psychosocial adaptation and academic performance of, children of immigrant families of Greek origin from countries of the former Soviet Union. Method: At a preliminary stage, all immigrant children (276) aged 8–12 years attending 22 schools in a working-class suburb of Athens were assessed by their teachers in terms of behaviour and academic performance. They and their families had migrated to Greece within the previous three years. A matching control group of native children (251) attending the same schools and classes was also assessed. For an in-depth assessment of psychopathology and social adaptation, 65 immigrant and 41 native children were randomly selected from the two larger groups and were further assessed. Results: No statistically significant differences were observed between the immigrant and native children in terms of psychopathology and social adaptation, although a few differences were observed in subscales. However, there were significant differences between the groups in academic performance, that of the immigrant group being poorer, particularly in language-related areas (p < 0.01). In the light of these results, language enrichment classes are suggested for immigrant children who need them.

Parental stress affects the emotions and behaviour of children up to adolescence: a Greek prospective, longitudinal study.

Systematic research about the continuity of mental health problems from childhood to adolescence is limited, but necessary to design effective prevention and intervention strategies. We used a population-based representative sample of Greek adolescents, followed-up from birth to the age of 18 years, to assess early influences on and the persistence of mental health problems in youth. We examined the role of peripartum, early development and parental characteristics in predicting mental health problems in childhood and adolescence. Results suggest a strong relationship between behavioural problems in childhood and adolescence for both genders, while emotional problems were more likely to persist in boys. Age and sex-specific models revealed significant positive associations between higher scores on the behavioural and emotional problems scales and higher frequency of accidents in preschool years, physical punishment in early childhood, lack of parental interest in childs school and activities, and perceived maternal stress in all children. Perceived paternal stress was associated with higher scores on the Total and Internalizing problems scales in the total population. Our results suggest that early interventions are necessary as mental health problems strongly persist from childhood to late adolescence. The adverse effects of parental stress and poor care-giving practices on childs psychopathology need to be recognised and improved.

Care Staff Awareness Training on Mental Health Needs of Adults with Learning Disabilities Results from a Greek sample

The mental health needs of adults with learning disabilities have not been adequately addressed in many European countries. Although carers can play a significant role in identification and referral, they usually lack the expertise necessary to identify signs of mental disorders. This study evaluated a care staff training programme aiming at improving awareness on issues of dual diagnosis in a group of 36 care staff from residential and community centres in Greece. Training was based on the British Mental Health in Learning Disabilities Training Pack and the PAS–ADD Checklist. The overwhelming majority of staff were very satisfied with training. Staff from institutional work settings, with no previous training on dual diagnosis and with a lower level of education, benefited to a significant degree. Changes occurred mostly in their knowledge and attitudes rather than practice. Supervised practical training is vital to transfer, strengthen and maintain positive changes at work.

Predicting pediatric posttraumatic stress disorder after road traffic accidents: The role of parental psychopathology

This study examined prospectively the role of parental psychopathology among other predictors in the development and persistence of posttraumatic stress disorder (PTSD) in 57 hospitalized youths aged 7-18 years immediately after a road traffic accident and 1 and 6 months later. Self report questionnaires and semistructured diagnostic interviews were used in all 3 assessments. Neuroendocrine evaluation was performed at the initial assessment. Maternal PTSD symptomatology predicted the development of childrens PTSD 1 month after the event, OR = 6.99, 95% CI [1.049, 45.725]; the persistence of PTSD 6 months later was predicted by the childs increased evening salivary cortisol concentrations within 24 hours of the accident, OR = 1.006, 95% CI [1.001, 1.011]. Evaluation of both biological and psychosocial predictors that increase the risk for later development and maintenance of PTSD is important for appropriate early prevention and treatment.

Greek financial crisis and child mental health

During the past few years, the percentage of Greek children living in poverty or social exclusion has been on the rise as a result of the fi nancial crisis. Although several reports showed that depression and suicide rates have increased in adults in Greece, no relevant studies exist in child and adolescent populations. It is well known that poverty is a distal risk factor for children’s mental health and development. The psychological stress associated with poverty has proximal eff ects, such as harsh parenting, and distal ones, such as children’s antisocial behaviour and other mental health problems. In everyday clinical practice, we encounter an ever-increasing number of families with complicated psychosocial adversities, both in outpatient and inpatient treatment settings. A striking example is that the recorded number of abused or neglected children admitted for child protection to the largest Greek paediatric hospital has risen from 81 cases in 2011 to 170 cases in 2014. As the need for psychosocial interventions is substantially increasing, child and adolescent mental health services and supportive policies have started to undergo budget cuts. Public funding cuts (almost 50% in 2014 compared with public funding in 2007) led to some services not being fully operational, whereas others are on the verge of being suspended. At the same time, many non-profi t child and adolescent mental health community centres, psychosocial rehabilitation units, and highly specialised establishments have closed during the past 3 years. Moreover, many parents have cut back or discontinued their children’s treatment, even for debilitating disorders such as autism, because of their inability to cover the out-of-pocket expenses of the treatment. Although the eff ect of the fi nancial crisis on the mental health of young people is still unknown, the fi nancial crisis is expected to produce a child and adolescent mental health crisis. Evidence-based and targeted promotive and preventive interventions should be urgently implemented to strengthen parenting in the most vulnerable families (eg, impoverished families and parents struggling with mental health disorders). Investment in children and support to their families is one of the most important investments Greece could make in these diffi cult times because it will not only enhance children’s wellbeing and right to a life in dignity but also help our society prepare for an improved future.