Jocelyne Clench-Aas

Self-reported strengths and difficulties in a large Norwegian population 10-19 years : age and gender specific results of the extended SDQ-questionnaire.

This study reports young people’s assessment of own problems and strengths from a Norwegian survey (n=29,631, age range 10–19), based on the self-report version of the Strengths and Difficulties Questionnaire (response rate 84.3%). Differences according to the age and gender are illuminated. Girls reported most emotional problems and boys most conduct and peer problems. Compared to other countries, Norwegian adolescents reported more hyperactive behaviour. Total problem scores were highest in early-adolescence for boys (Mean=10.8, SD=6.1), and for girls it is in late adolescence (Mean 11.3, SD=5.2). One third of the subjects reported at least minor perceived difficulties. All symptom scales were strongly associated with perceived difficulties, impact and burden to others (P<0.001) with significant gender and age effects. Impact scores were included in the estimate of possible caseness. Combining symptom scores and impact scores, 3.7% of the sample was defined as a high risk group, while 8.8% needed special attention from mental health services. The results also suggested that SDQ could be a valuable screening instrument for older adolescents.

Construct validity of the five-factor Strengths and Difficulties Questionnaire (SDQ) in pre-, early, and late adolescence.

BACKGROUND The Strengths and Difficulties Questionnaire (SDQ) is designed to measure psychological adjustment in children and adolescents. Psychometric evaluations of the instrument have shown satisfactory convergent and discriminant validity, while factor analysis studies have shown mixed results across countries. In the present study, the construct validity of the five-factor SDQ is evaluated in a large community sample of Norwegian pre-, early, and late adolescents. METHODS The sample consisted of 26,269 children and adolescents (10-19 years) with valid answers on all 25 items of the SDQ self-report. Complete parent/proxy data of respective pre-adolescent children was available for 6,645 cases. A Lisrel approach to Confirmatory Factor Analysis (CFA) was used to evaluate the five-factor model and the presence of a positive construal factor. In the sample of pre-adolescents and their parents/proxies, convergent and discriminant validity was evaluated by a CFA approach to multitrait-multimethods (MTMM). RESULTS Fit statistics for the hypothesized five-factor model were satisfactory, but introducing correlated error terms for some of the items led to significant model improvement in all age groups. All factor loadings were higher than .30, except for item 11 (good friend). The loadings differed across age groups and differed markedly between the parent/proxy and self-report measures. The MTMM showed that the source of ratings made a difference on the validity of all subscale ratings, with self-reports discriminating more on ratings of emotional and peer problems, and parents/proxies discriminating more on hyperactivity symptoms. A positive construal factor was identified but had a modest effect compared with the original five traits. Results suggested an unclear construct and meaning of the Prosocial behaviour subscale. CONCLUSION The results of the present study indicated support for the proposed five-factor structure of the SDQ (Goodman, 2001) across a wide age range (10-19years), including older adolescents and different informants. However, some improvements should be considered to improve internal reliability and conceptual clarity.

Psychiatric symptoms in Norwegian children with epilepsy aged 8-13 years: effects of age and gender?

Purpose:  In this population‐based study we wanted to assess the prevalence and impact of psychiatric symptoms in children with epilepsy compared to controls, and investigate possible age and gender differences.

Psychiatric symptoms in adolescents with epilepsy in junior high school in Norway: A population survey

The aims of this study were to assess the frequency and impact of psychiatric symptoms among adolescents with epilepsy in a general population, and compare the findings with those for adolescents without epilepsy. The data were collected through the Health Profiles for Children and Youth in Akershus Study. The data were cross-sectional and based on self-reports from adolescents (13-16 years of age). To assess psychiatric symptoms, we used the Strengths and Difficulties Questionnaire-Self Report (SDQ-S). A total of 11,021 pupils were invited to participate, and 9424 responded to the questionnaire (response rate=86%). We found that adolescents with epilepsy (124) from an unselected group obtained a significantly higher symptom score on the SDQ-S than those without epilepsy, indicating a higher incidence of psychiatric symptoms. The adolescents with epilepsy also reported a greater impact of their perceived difficulties on their daily life than did adolescents without epilepsy. The study illustrates the need for developing better strategies to detect and prevent psychiatric problems in adolescents with epilepsy.

Comparing hospital mortality – how to count does matter for patients hospitalized for acute myocardial infarction (AMI), stroke and hip fracture

BackgroundMortality is a widely used, but often criticised, quality indicator for hospitals. In many countries, mortality is calculated from in-hospital deaths, due to limited access to follow-up data on patients transferred between hospitals and on discharged patients. The objectives were to: i) summarize time, place and cause of death for first time acute myocardial infarction (AMI), stroke and hip fracture, ii) compare case-mix adjusted 30-day mortality measures based on in-hospital deaths and in-and-out-of hospital deaths, with and without patients transferred to other hospitals.MethodsNorwegian hospital data within a 5-year period were merged with information from official registers. Mortality based on in-and-out-of-hospital deaths, weighted according to length of stay at each hospital for transferred patients (W30D), was compared to a) mortality based on in-and-out-of-hospital deaths excluding patients treated at two or more hospitals (S30D), and b) mortality based on in-hospital deaths (IH30D). Adjusted mortalities were estimated by logistic regression which, in addition to hospital, included age, sex and stage of disease. The hospitals were assigned outlier status according to the Z-values for hospitals in the models; low mortality: Z-values below the 5-percentile, high mortality: Z-values above the 95-percentile, medium mortality: remaining hospitals.ResultsThe data included 48 048 AMI patients, 47 854 stroke patients and 40 142 hip fracture patients from 55, 59 and 58 hospitals, respectively. The overall relative frequencies of deaths within 30 days were 19.1% (AMI), 17.6% (stroke) and 7.8% (hip fracture). The cause of death diagnoses included the referral diagnosis for 73.8-89.6% of the deaths within 30 days. When comparing S30D versus W30D outlier status changed for 14.6% (AMI), 15.3% (stroke) and 36.2% (hip fracture) of the hospitals. For IH30D compared to W30D outlier status changed for 18.2% (AMI), 25.4% (stroke) and 27.6% (hip fracture) of the hospitals.ConclusionsMortality measures based on in-hospital deaths alone, or measures excluding admissions for transferred patients, can be misleading as indicators of hospital performance. We propose to attribute the outcome to all hospitals by fraction of time spent in each hospital for patients transferred between hospitals to reduce bias due to double counting or exclusion of hospital stays.

Gender differences in risk-taking behaviour in youth with epilepsy: a Norwegian population-based study.

Alfstad KÅ, Clench‐Aas J, Van Roy B, Mowinckel P, Gjerstad L, Lossius MI. Gender differences in risk‐taking behaviour in youth with epilepsy: a Norwegian population‐based study.
Acta Neurol Scand: 2011: 124 (Suppl. 191): 12–17.
© 2011 John Wiley & Sons A/S.

Erratum to: The relationship between negative life events, psychological distress and life satisfaction: a population-based study

Purpose Negative life events may increase psychological distress and reduce life satisfaction (LS). This study investigates associations between negative life events and both positive and negative indicators of mental health and explores the extent to which these associations are buffered by sense of mastery and perceived social support.

Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction?

OBJECTIVES Psychopathology in children and youth with epilepsy has previously been related to executive dysfunction, but the nature of the association is uncertain. We sought to explore risk factors for psychiatric disorders in children and youth with epilepsy, with emphasis on executive dysfunction, along with seizure-related and psychosocial factors. METHODS The cohort consisted of one hundred and one consecutive patients aged 10-19 years with focal (n=52) or genetic generalized (n=49) epilepsy. All were screened for psychiatric symptoms, using part of an extensive questionnaire, the Strengths and Difficulties Questionnaire (SDQ) for both patients and their parents. Participants scoring in the borderline or abnormal range on the SDQ received a psychiatric interview (Kiddie-SADS-PL). All participants underwent a neuropsychological examination, and those with general cognitive abilities (IQ)<70 were excluded. RESULTS Forty-seven of 101 participants (46.5%) had a SDQ score in the borderline or abnormal range and underwent a psychiatric evaluation. Of these, 44 (93.6%) met the criteria for a psychiatric diagnosis, the most common being ADHD and anxiety. An executive deficit was identified in 26.8% of the participants with a psychiatric diagnosis, but in only 5.4% of those without such a diagnosis (p=0.003). Multivariate logistic regression analysis showed that executive dysfunction was an independent risk factor for having a psychiatric disorder (OR 8.2, CI 1.8-37.2, p=0.006), along with male gender (OR 2.9, CI 1.2-7.3, p=0.02), and early seizure onset (0.86-that is one year older equals risk of psychiatric disorder reduced by 14%-CI 0.77-0.96, p=0.01). Other epilepsy-related or psychosocial factors were not significantly associated with psychiatric disorders. CONCLUSIONS Multiple factors are associated with psychiatric problems in children and youth with epilepsy. In this study, executive dysfunction, male gender, and early epilepsy onset were independent risk factors for having a psychiatric disorder. An evaluation of psychiatric and cognitive problems is important to enable a positive long-term outcome in childhood epilepsy.

ADHD With Co-Occurring Depression/Anxiety in Children: The Relationship With Somatic Complaints and Parental Socio-Economic Position

Attention-Deficit/Hyperactivity Disorder (ADHD) and depression/anxiety are often comorbid in children, and consequences of ADHD are more detrimental in lower socioeconomic levels. The aim of this study was to compare co-occurrence of ADHD and depression/anxiety with ADHD alone and depression/anxiety alone when the outcome measure is somatic complaints. Additionally, we examined whether low parental Socio- Economic Position (SEP) were related to occurrence of ADHD alone, depression/anxiety alone, and co-occurrence. The sample consisted of 12,900 parents who participated in a cross-sectional health survey that included Strengths and Difficulties Questionnaire (SDQ) and impact supplement. Socio-economic factors were dichotomized into low versus average/high parental socio-economic position (SEP), abdominal pain, neck pain and headache were categorized as somatic complaints. Parents described 58 % of the children with ADHD as comorbid with depression/anxiety. Children with ADHD only report somatic complaints when thedisorder is co-occurring with depression/anxiety. The prevalence of ADHD, depression/ anxiety, or a combination of the two disorders in children, is higher when parents have a low socio-economic position. Increased awareness of the heterotypic nature of ADHD is needed, especially when interpreting somatic complaints. There is a pattern of an inverse relationship between mental health and socio-economic position in children when measured by ADHD and depression/anxiety.

Children are reliable reporters of common symptoms: results from a self-reported symptom diary for primary school children

Background:  Collecting information on subjective symptoms in children by parental reports or physician’s interview is indirect and not suited for prospective data collection over extended time periods.