Jari Sinkkonen

Mortality in children registered in the Finnish child welfare registry: population based study

Studies have shown inverse associations between childhood social class and mortality,1 and others have shown higher mortality in children in care. 2 3 However, to our knowledge, only one study has investigated mortality in children in care with results specific to sex and cause of death.3 Mortality in that study was higher than expected among boys, although mortality related to age at the time of death was not reported.3 In Finland, children are cared for within the child protection system up to the age of 18. Our specific interest lies in whether mortality before age 18 in children in care is higher than expected on the basis of figures for the general population, reflecting failure in the child protection system, or whether mortality is increased from age 18, reflecting difficulties in adapting to independent living. The basic data source was the Finnish …

Prenatal Expectations in Transition to Parenthood: Former Infertility and Family Dynamic Considerations

Prenatal expectations are important for the future parent-child relationship. The authors examined how maternal and paternal prenatal expectations of the relationship with the child predicted 1st-year parenting stress and whether these expectations were violated over the transition to parenthood. They further examined how former infertility affected these associations. The participants were 745 Finnish couples, 367 having undergone a successful assisted reproductive treatment and 378 conceiving spontaneously. Couples completed a questionnaire of family representations during pregnancy and when the child was 2 and 12 months old and Abidins Parenting Stress Index at 2 and 12 months postpartum. The hypothesis of moderately high expectations predicting the lowest level of parenting stress was substantiated only concerning paternal expectations of own autonomy with the child. Generally, however, negative expectations of own and spouses relationship with the child were linearly associated with higher parenting stress. Postnatal representations were more positive or equal to expectations, except for negative violation occurring in maternal expectation of the father-child relationship, especially among normative mothers. The results are discussed in relation to family dynamic considerations and special features of formerly infertile couples.

Ante- and perinatal factors and child characteristics predicting parenting experience among formerly infertile couples during the child's first year: a controlled study.

In this prospective controlled study, the authors examined (a) parenting experiences among couples with successful assisted reproduction treatment (ART; n = 367) and fertile spontaneously conceiving controls (n = 371) and (b) the impact of ante- and perinatal factors and child characteristics on parenting experiences. The results show that positive mothering experiences increased more during the 1st year of parenting and were generally higher among ART mothers than control mothers. No differences were found between ART fathers and controls in their fathering experience. Unpleasant birth experiences, low birth weight, and difficulty soothing the child were associated with high levels of parental stress in the control group, but this was not so among the ART parents. Psychosocial interventions in maternal care should take into account the various meanings that couples give to the history of infertility and conception and ante- and perinatal experiences.

Experiences of School Bullying Among Internationally Adopted Children: Results from the Finnish Adoption (FINADO) Study

This study investigated the prevalence of and factors associated with school bullying and victimization among Finnish international adoptees. The Olweus bully/victim questionnaire was sent to all 9–15-year-old children adopted in Finland between 1985 and 2007 through the mediating organizations officially approved by the Ministry of Social Affairs and Health. The children were identified through official adoption organizations. The response rate in the target sample was 49.4%: the study sample consisted of 364 children (190 girls, 52.2%). The children’s background factors and symptoms of reactive attachment disorder (RAD) were evaluated using a FINADO questionnaire. Their learning difficulties and social and language skills were assessed using a standardized parental questionnaire (Five to Fifteen). Of the participants, 19.8% reported victimization by peers while 8% had bullied others. Both victimization and bullying were associated with severe symptoms of RAD at the time of adoption (RR 2.68, 95%CI 1.50–4.77 and RR 2.08, 95%CI 1.17–3.69 for victimization and bullying, respectively). Lack of social skills was associated with victimization (RR 1.74, 95%CI 1.06–2.85) but not independently with being a bully (RR 1.50, 95%CI 0.91–2.45). In a multivariate analysis the child’s learning difficulties and language difficulties were not associated with either bullying others or victimization.

Substance abusing mothers in residential treatment with their babies: Postnatal psychiatric symptomatology and its association with mother - child relationship and later need for child protection actions

Background: A residential treatment model has been developed in Finland, which is specifically designed for substance abusing pregnant and parenting women, and has its focus on supporting both maternal abstinence from substances and mother–baby relationship. Aims: Among mother–baby pairs in this residential treatment, to explore amount and type of maternal postnatal psychiatric symptoms, relationship with the baby, and their association with later need for child substitution care placements. Methods: Participants were 34 mother–baby pairs from three units during pre- to postnatal period. Methods included self-report questionnaires for substance abuse and background data (pregnancy and perinatal period), experienced difficulties with the baby (1 month postnatally); maternal psychiatric symptoms (Brief Symptom Inventory, Edinburgh Pre–postnatal Depression Screen, Inventory of Interpersonal Problems; (pregnancy and 3 months) postnatally; videotaped mother–child interaction measure (Care Index for infants and toddlers) and standardized test of child development (Bayley Scales of Infant Development) (4 months postnatally); questionnaire for follow-up information (2 years of childs age). Results: Mothers showed high levels of different types of psychiatric symptomatology. Maternal interaction with the baby was on average weak, as 53% were within the high-risk range regarding sensitivity. Experiencing more difficulties in early care-giving of the baby was associated with higher amount of postnatal psychiatric symptomatology. Specific psychiatric symptoms were associated with later need for child substitution care. Conclusions: In designing treatment and follow-up of these mother–baby pairs, careful attention should be paid to pre- and perinatal identification and type of maternal psychiatric symptoms, and mothers’ expressions of subjectively experienced difficulties in early care-giving of the baby.

Maternal Pre- and Postnatal Mental Health Trajectories and Child Mental Health and Development: Prospective Study in a Normative and Formerly Infertile Sample.

Pregnancy and early motherhood involve uncertainty and change, which can evoke mental health problems. We identified maternal mental health trajectories in pre- and postnatal period, and examined their association with later child mental health and development. Finnish mothers reported psychological distress (General Health Questionnaire [GHQ-36]) and depressive (Beck Depression Inventory [BDI-13]) symptoms in pregnancy (T1; N = 788) and two months (T2; N = 657) and 12 months (T3; N = 545) postpartum. Both parents accounted their child’s mental health (Behavior Assessment System for Children [BASC]) and social (Social Skills Rating System [SSRS], Child Behavior Scale [CBS]) and cognitive development (Five to Fifteen [FTF]) when the child was 7–8 years old (T4; N = 485). We identified five trajectories depicting unique timing and course of maternal mental health from pregnancy into 1 year of mothering: Stable low levels of mental health symptoms (75%) and prenatal (6%), early postpartum (9%) and late postpartum (6%) mental health problems. The fifth trajectory, heterogeneous high levels of mental health problems (4%) was an unclassified post hoc class, combining mothers with chronic high or highly variable mental health profiles. Results show some trajectory-related timing effects on children’s mental health and cognitive development. The trajectories of early postpartum and heterogeneous high levels of mental health problems predicted higher level of internalizing symptoms as compared to stable low-levels trajectory. The heterogeneous high-levels trajectory predicted higher levels of problems in executive functions than the stable low and late postpartum trajectories, and in memory tasks than children in other trajectories. We discuss the timing and course of maternal mental health from the viewpoint of infant and child development.

Impact of infertility characteristics and treatment modalities on singleton pregnancies after assisted reproduction

Obstetric and neonatal outcomes of assisted reproduction and control singletons were evaluated after taking into account treatment characteristics and infertility background. The elective single embryo transfer (eSET) group (n = 45) was compared with the compulsory single embryo transfer (cSET; n = 52), double embryo transfer (DET; n = 227) and control (n = 304) groups. Infertility-related prognostic factors for neonatal outcomes were also analysed. Data were collected with structured questionnaires at gestational week 20 and 8 weeks after delivery. Spontaneous onset of delivery was more typical of the eSET group than of cSET and DET groups (68.9 versus 52.0%, P = 0.02). Mean (+/-SD) gestation at birth (39.3 +/- 1.6 weeks) and mean birth weight (3,470 +/- 505 g) of eSET singletons were comparable with other assisted reproduction groups, but gestational duration was lower than in the eSET group than in the control group (39.9 +/- 1.4; P < 0.05). However, numbers of preterm births and low birth weight infants were similar between groups. History of induced abortion increased risk of preterm birth (OR 4.5 and 95% CI 1.2-17.1) in assisted reproduction singletons. A small though clinically unimportant difference in gestational age at birth and birth weight between assisted reproduction and control singletons was found regardless of the number of embryos transferred.

The satisfaction of Finnish adoptive parents with statutory pre-adoption counselling in inter-country adoptions

We examined how satisfied Finnish adoptive parents were with statutory pre-adoption counselling in inter-country adoptions. The data were collected through the Finnish Adoption Study using a retrospective survey measuring satisfaction with received pre-adoption counselling. All adoptive parents with a child under the age of 18, adopted from abroad between the years 1990 and 2007, were included. The sample of the study comprised parents of 1451 children and a total response rate of 55.7% was achieved. The data consisted of self-scored reports of satisfaction as well as open answer questions. Parent satisfaction and associated variables were analysed using chi-square and multiple logistic regression. Of the respondents, 81.7% reported satisfaction with the pre-adoption counselling they had received. The level of satisfaction was stable over time and did not differ according to service provider, whereas family type and sending country were associated with satisfaction. However the explanations for satisfaction were different for those services provided in units specialized in adoption and for those provided by municipal child protection services. The components found to explain satisfaction and dissatisfaction were experience, adoption knowledge, and attitude of the social worker, service accessibility and availability issues, as well as the content of the pre-adoption counselling offered.