Jorma Piha

Bullying and psychiatric symptoms among elementary school-age children.

OBJECTIVE The aim of this study was to assess bullying and psychological disturbance among 5,813 elementary school-aged children. METHOD The data consisted of information given by the parents, teachers, and children themselves (Rutter A2 Scale, Rutter B2 Scale and Childrens Depression Inventory). Children involved in bullying (as bullies, bully-victims, and victims) were compared to other children. RESULTS More boys than girls were found to be involved in bullying. Bully-victims scored highest in externalizing behaviour and hyperactivity, and they themselves reported feelings of ineffectiveness and interpersonal problems. Victims scored highest in internalizing behavior and also psychosomatic symptoms, and they themselves reported anhedonia. Some gender differences in psychiatric symptomatology were also found. Children involved in bullying, especially children who both bullied and were bullied themselves, were psychologically disturbed. More children involved in bullying than others were referred for psychiatric consultation. The probability of being referred was highest among bully-victims (6.5 fold for males and 9.9 for females when compared to children not involved in bullying). CONCLUSIONS The findings indicate that bullying is a common phenomenon among children who are psychologically disturbed. Bullying also elevates the probability of being referred for psychiatric consultation.

What is the early adulthood outcome of boys who bully or are bullied in childhood? The Finnish "From a Boy to a Man" study.

OBJECTIVE. Our goal was to study predictive associations between bullying and victimization at age 8 years and psychiatric disorders in early adulthood. METHODS. The sample comprised 2540 boys born in 1981. Information about bullying and victimization was gathered in 1989 when the boys were 8 years old from parents, teachers, and children. Information about psychiatric disorders was based on military call-up examination and army registry when the subjects were 18 to 23 years old. RESULTS. In univariate logistic regression analysis, frequent bullying-only status predicted antisocial personality, substance abuse, and depressive and anxiety disorders; frequent victimization-only status predicted anxiety disorder, whereas frequent bully-victim status predicted antisocial personality and anxiety disorder. When controlled against the effects of parental education level and parent and teacher reports of emotional and behavioral symptoms by using Rutter scales, frequent victimization-only status predicted anxiety disorders, and frequent bullying-only predicted antisocial personality disorder, whereas frequent bully-victimization predicted both anxiety and antisocial personality disorder. Information about frequent bullying and victimization as primary screening for children at risk identified ∼28% of those with a psychiatric disorder 10 to 15 years later. CONCLUSIONS. Both bullying and victimization during early school years are public health signs that identify boys who are at risk of suffering psychiatric disorders in early adulthood. The school health and educational system has a central role to play in detecting these boys at risk.

Childhood Bullying Behaviors as a Risk for Suicide Attempts and Completed Suicides: A Population-Based Birth Cohort Study

OBJECTIVE There are no previous studies about the association of childhood bullying behavior with later suicide attempts and completed suicides among both sexes. The aim was to study associations between childhood bullying behaviors at age 8 years and suicide attempts and completed suicides up to age 25 years in a large representative population-based birth cohort. METHOD The sample includes 5,302 Finnish children born in 1981. Information about bullying was gathered at age 8 years from self-report, as well as parent and teacher reports. Information about suicide attempts requiring hospital admission and completed suicides was gathered from three different Finnish registries until the study participants were 25 years old. Regression analyses were conducted to determine whether children who experience childhood bullying behaviors are at risk for later suicide attempts and completed suicides after controlling for baseline conduct and depression symptoms. RESULTS The association between bullying behavior at age 8 years and later suicide attempts and completed suicides varies by sex. Among boys, frequent bullying and victimization are associated with later suicide attempts and completed suicides but not after controlling for conduct and depression symptoms; frequent victimization among girls is associated with later suicide attempts and completed suicides, even after controlling for conduct and depression symptoms. CONCLUSIONS When examining childhood bullying behavior as a risk factor for later suicide attempts and completed suicides, each sex has a different risk profile.

Antenatal depression, substance dependency and social support

BACKGROUND The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women. METHOD 391 women who were 14-37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2). RESULTS 7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression. LIMITATION The caseness was defined with a self-report instrument. CONCLUSION Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.

Childhood bullying as a risk for later depression and suicidal ideation among Finnish males

BACKGROUND Little is known about the predictive association between childhood bullying behavior with depression and suicidal ideation at age 18. METHODS The sample included 2348 boys born in 1981. Information about bullying was gathered at the age of 8 from self, parent and teachers reports. Depression and suicidal ideation were assessed during the Finnish military call-up examination. RESULTS Based on regression models, boys who were bullies frequently, but not merely sometimes, were more likely to be severely depressed and to report suicidal ideation compared to boys who were not bullies. When controlling for depression at age 8 the association between frequent bullying and severe depression was maintained but the association with suicidal ideation became non-significant. Boys who were only victimized were not more likely to be depressed or to report suicidal ideation at age 18. Boys who were frequently both bullies and victims were found to be at risk for later depression. LIMITATIONS Our finding can only be generalized to boys who were involved in bullying at elementary school age. Data at age 18 was based only on self-reports and the bullying/victimization questions were very general. CONCLUSIONS Childhood bullying behavior is a risk factor for later depression. Screening and intervention for bullying behavior in the early school years is recommended to avoid subsequent internalizing problem in late adolescence.

Sleep problems of school‐aged children: a complementary view

The aim of this population‐based multicentre study was to evaluate the prevalence rates of sleep problems among 8‐9‐y‐old children. The sample consisted of 5813 Finnish children, making up 10% of the age cohort. Both parents and children provided information. Disturbed sleep was reported by 21.7% of parents. Most of the problems were mild; only 0.3% were serious. Dyssomnias were frequent: 11.1% had difficulties with sleep onset, 7.1% with night waking and 2.3% with waking too early. Multiple sleep problems were present in 9.1% of the children. 17.8% of children reported disturbed sleep, 12.7% had problems many nights and 5.1% every night. In 32.0% of cases, either the parent or the child reported disturbed sleep; 7.4% of these reports came from both the parent and the child, 14.1% from the parent only and 10.3% from the child only. The correspondence between informants was poor (κ= 0.224). Sleeping problems were associated with somatic and psychiatric problems. It is concluded that by restricting questioning to parents only, one‐third of all potential cases of sleep problems may go unnoticed. In order to increase the sensitivity of screening childrens sleep problems, both parents and children should provide information in epidemiological settings as well as in clinical work.

Childhood Bullying Behavior and Later Psychiatric Hospital and Psychopharmacologic Treatment Findings From the Finnish 1981 Birth Cohort Study

CONTEXT No prospective population-based study examining predictive associations between childhood bullying behavior and long-term mental health outcomes in both males and females exists. OBJECTIVE To study predictive associations between bullying and victimization in childhood and later psychiatric hospital and psychopharmacologic treatment. DESIGN Nationwide birth cohort study from age 8 to 24 years. PARTICIPANTS Five thousand thirty-eight Finnish children born in 1981 with complete information about bullying and victimization at age 8 years from parents, teachers, and self-reports. MAIN OUTCOME MEASURES National register-based lifetime information about psychiatric hospital treatments and psychopharmacologic medication prescriptions. RESULTS When controlled for psychopathology score, frequent victim status at age 8 years among females independently predicted psychiatric hospital treatment and use of antipsychotic, antidepressant, and anxiolytic drugs. Among males, frequent bully-victim and bully-only statuses predicted use of antidepressant and anxiolytic drugs. Frequent bully-victim status among males also predicted psychiatric hospital treatment and use of antipsychotics. However, when the analysis was controlled with total psychopathology score at age 8 years, frequent bully, victim, or bully-victim status did not predict any psychiatric outcomes among males. CONCLUSIONS Boys and girls who display frequent bullying behavior should be evaluated for possible psychiatric problems, as bullying behaviors in concert with psychiatric symptoms are early markers of risk of psychiatric outcome. Among females, frequent childhood victimization predicts later psychiatric problems irrespective of psychiatric problems at baseline.

Psychiatric symptoms in children with intellectual disability.

In a sample of almost 6000 8-year-old children, we found that 1.5% attended special schools for the educationally subnormal, or training schools. Psychiatric symptoms were studied by means of three screening instruments: the Rutter Parent Questionnaire (RA2) for the parents, the Rutter Teacher Questionnaire (RB2) for the teachers, and the Children’s Depression Inventory (CDI) for the children. The prevalence rate of children identified as possibly suffering from a psychiatric disturbance was 32.2% according to the RA2. The corresponding prevalence rate for the RB2 was 34.2%. According to the CDI 11.0% had depressive disturbance. All types of disturbances were more frequent among the intellectually disabled children as compared to the nondisabled children. The differences were statistically significant for emotional and mixed types of disturbance on the RA2, and for emotional and conduct types of disturbance on the RB2.

Childhood Predictors of Completed and Severe Suicide Attempts: Findings From the Finnish 1981 Birth Cohort Study

CONTEXT To our knowledge, no prospective, population-based study in existence examines predictive associations between early or middle childhood psychopathologic disorders and later completed suicides. OBJECTIVE To study predictive associations between childhood psychopathologic disorders at the age of 8 years and later completed suicides and severe suicide attempts. DESIGN Birth cohort study of individuals 8 to 24 years old. SETTING Finland. PARTICIPANTS The sample includes 5302 Finnish people born in 1981 who were examined at the age of 8 years to gather information about psychopathologic conditions, school performance, and family demographics from parents, teachers, and children. MAIN OUTCOME MEASURES National register-based lifetime information about completed suicides and suicide attempts that prompted hospital admission. RESULTS Of all 24 deaths among males between 8 and 24 years of age, 13 were suicides, whereas of 16 deaths among females, only 2 were suicides. Fifty-four males and females (1%) had either completed suicide or made a serious suicide attempt, defined as a suicide attempt that prompted hospital admission. Of 27 males with completed or serious suicide attempts, 78% screened positive on parent or teacher Rutter scales at the age of 8 years, whereas of 27 females only 11% screened positive. Among males, completed or serious suicide attempt outcome was predicted at the age of 8 years by living in a nonintact family; psychological problems as reported by the primary teacher; or conduct, hyperkinetic, and emotional problems. However, self-reports of depressive symptoms at the age of 8 years did not predict suicide outcome. No predictive associations between the study variables measured at the age of 8 years and suicide outcome were found among females. Male suicide outcome was predicted most strongly by comorbid conduct and internalizing problems. CONCLUSIONS Most males who completed suicide and/or made serious suicide attempts in adolescence or early adulthood had psychiatric problems by the age of 8 years, indicating a trajectory that persists throughout their lives. However, female severe suicidality is not predicted by psychopathologic disorders at the age of 8 years. The results give additional support to the importance of early detection and treatment of psychiatric problems in males.

Design and subjects of a Finnish epidemiological study on psychiatric disorders in childhood

In an epidemiological multi-centre study, parents filled in the Rutter Parent Questionnaire (RA2) and teachers filled in the Rutter Teacher Questionnaire (RB2) for almost 6000 children. The children filled in the Children’s Depression Inventory (CDI). The subjects well represented the entire population of 8–9-year-old children in Finland. The material and design of the study as well as the basic demographic characteristics are presented.