Pälvi Kaukonen

Longitudinal study of maternal depressive symptoms and child well-being

OBJECTIVE To investigate whether prenatal, postnatal, and/or current maternal depressive symptoms are associated with low level of psychosocial functioning or high level of emotional/behavioral problems in school-age children. METHOD As part of a prospective longitudinal study, maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, and when the children were 8 to 9 years old. The original sample of 349 mothers was collected in 1989-1990 in Tampere, Finland. Of the 270 mother-child pairs at the latest stage of the study in 1997-1998, 188 mother-child pairs participated and 147 were included. The associations between maternal depressive symptoms at different points in time and the level of childrens psychosocial functioning and problems reported on the Child Behavior Checklist and Teachers Report Form were examined. RESULTS Childrens low social competence and low adaptive functioning were associated with concurrent maternal depressive symptoms. Maternal postnatal depressive symptoms predicted low social competence. The presence of prenatal depressive symptoms in the mother was a strong predictor of childs high externalizing and total problem levels (odds ratio 3.1, 95% confidence interval 1.1-8.9 and odds ratio 8.5, 95% confidence interval 2.7-26.5). Prenatal as well as recurrent maternal depressive symptoms were associated with the least favorable child outcome. CONCLUSIONS Maternal depressive symptomatology at any time, especially prenatally, is a risk factor for the childs well-being. This should be noted already in prenatal care. The timing and the recurrence of maternal depressive symptoms affect the outcome for the child.

A Longitudinal Study of Maternal Depressive Symptoms, Negative Expectations and Perceptions of Child Problems

The aim of this longitudinal study was to examine the associations between maternal depressive symptoms and perceptions of children’s problems. One hundred and nineteen mother–child dyads were followed from the third trimester of pregnancy for almost 10 years. Depressive symptoms and background factors of the mothers and the anticipated/perceived problems of their firstborn were assessed prenatally, postnatally, and when the child was 4–5 years and 8–9 years old. The simultaneous and long-term associations between maternal depressive symptoms and childs problems were examined. Maternal prenatal depressive symptoms, the continuity of negative expectations to postnatal problem perceptions, and high problem level at 4–5 years of childs age predicted high problem level in 8–9-year-olds.

Psychosomatic Symptoms in Preadolescent Children

As part of a Finnish national epidemiological study on child psychiatric disorders, psychosomatic symptoms were studied in a sample (n = 1,100) of 8-year-old children on the basis of self-report questionnaires by the children, their parents and teachers. Psychosomatic symptoms were common, although constant symptoms were rare. There were no sex differences in the occurrence of symptoms, but interesting differences were observed in associations between symptoms and other factors. Psychosomatic symptoms were strongly associated with depression scores and school performance.

Reliability of the Strengths and Difficulties Questionnaire among Finnish 4–9-year-old children

Background: Early recognition of childrens mental health problems calls for structured methods in front line services. The Strengths and Difficulties Questionnaire (SDQ) is a commonly used short questionnaire in screening childs mental difficulties. Aim: To test the reliability and descriptive properties of the SDQ in a community sample of Finnish 4–9-year-old children (n = 4178). Methods: Both parents, two teachers in day-care or a teacher at school completed the SDQ. To control for possible bias, public health nurses rated their concern about every childs mental health, including non-participants. Results: The internal consistencies of the SDQ total score in all informants’ reports were satisfactory to good. Agreement (Spearman rho) in total scores between parents was 0.65, between parent and teacher 0.43 and between two teachers in day-care 0.81. The stability in parents reports over 12 weeks was good. The distributions of the informant-rated scores indicated significant and clinically important gender differences, and the 80th and 90th percentiles were generally below the international cut-off points. Public health nurses reported emotional or behavioural difficulties more commonly in non-participants (12%) than in participants (7%; p < 0.001). Conclusions: The results supported earlier findings of good internal consistency, inter-rater and cross-informant agreements and test–retest of the method. However, the gender and age of the child, the number of informants and cultural differences in reporting styles affected the results and thus confirmed the need to re-evaluate the SDQ in the culture and population in question.

Finnish norms for young children on the Strengths and Difficulties Questionnaire

Abstract Background: Early recognition of childrens mental health problems is crucial. Although the Strengths and Difficulties Questionnaire (SDQ) is a commonly used screening method, further research is needed on its validity and norms for young children. Aims: The aims of the study were to confirm the adjusted lower (normal/borderline) and upper (borderline/abnormal) cut-offs for the SDQ in a Finnish community sample of 4–9-year-old children, and to explore the SDQs ability to identify the children with mental health problems. Methods: Parents and teachers completed the SDQs (n = 2666). The Development and Well-Being Assessment (DAWBA) was administered to parents and teachers of 646 children. Results: The overall participation rate was 57%. The suggested cut-offs for the SDQ total difficulties scale rated by parents and teachers were 2–5 points lower than the corresponding published British norms. The sensitivity for the total score normal/borderline cut-off (9/10) was 76% in the parent and 66% in the teacher reports and for the borderline/abnormal cut-off (11/12) 90% and 70% respectively. The respective specificity values were 69%, 63%, 74% and 66%. The area under curve (AUC) values of the higher cut-offs were good for parent (0.87) and satisfactory for teacher rated (0.76) total scores. The presence of a DAWBA-rater assigned diagnosis in the abnormal group compared with the normal group was sixfold in the parent and threefold in the teacher reported SDQs. Conclusions: The suggested cut-offs were clearly lower than the British norms. Yet the properties of the methods discriminative validity were acceptable. Population specific norms, taking into account both the culture and childrens age, seem necessary for screening and for international comparisons of the methods validity properties.

Feasibility of the Strengths and Difficulties Questionnaire in assessing children's mental health in primary care: Finnish parents’, teachers’ and public health nurses’ experiences with the SDQ

Background The aim of the study was to evaluate the feasibility of the Strengths and Difficulties Questionnaire (SDQ). Method Following the administration of the SDQ in medical check-ups of 4–9 year-old children (n = 2 682) the involved parents, teachers and public health nurses were asked to complete a feedback questionnaire of the SDQ. Results Parents took a maximum of 10–15 minutes to complete the SDQ, and only the public health nurses reported that its use was rather burdensome. The SDQ was an age-appropriate method and it was helpful in increasing information and agreement about the childs mental health and need for support. Using the SDQ was a positive experience for parents, but they expected more dialogue with the professionals about the childs situation. The respondents criticised the questionnaire somewhat for being difficult to interpret and complete. Conclusions The SDQ was found to be a feasible method for screening childrens mental health in primary health care together with parents, teachers and public health nurses. Using the SDQ was a positive experience for parents. However, they reminded the professionals of the importance of sensitive dialogue when assessing the mental health of the child.

The psychiatric infant—family ward at Tampere University Hospital

This article describes a new integrated evaluation and intervention program for infants, small children and their families, a child psychiatric infant–family ward treatment model at Tampere University Hospital. A centerpiece of the model is a 3-week treatment period for the whole family at the infant–family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are used as tools, including a reflective working model and sharing concrete interaction with the family. Theoretically, the treatment is based on an integrative model where psychoanalytical and systems theories as well as a behavioral approach are applied in defining the strengths and problems of the family and of the infant and in choosing the best intervention techniques. The fact that the whole family is present at the ward creates a strong therapeutic holding relationship context and an open therapeutic reflection, which are the cornerstones of this new and encouraging treatment model.

Child psychiatry in the Finnish health care reform: National criteria for treatment access

OBJECTIVES As a part of the Finnish National Health Care Project, to develop and validate nationwide standardised criteria for assessing the need for non-urgent child psychiatric specialised medical care (SMC). METHODS The Finnish criteria tool, a cutpoint measure indicating access to SMC, was developed on the basis of the Western Canada Waiting List Criteria Tool. The Finnish criteria were widely discussed at national level and finally confirmed by a national child psychiatric consensus meeting. The testing data included 949 new cases, aged 5-18 years, from SMC, family guidance clinics, primary health care and child protection. RESULTS The Finnish Child Psychiatric Criteria Tool covers the entire case-mix of child psychiatric disorders. Danger to self or others and psychotic symptoms have been combined into a threshold item. This alone suffices to indicate access to SMC. Sensitivity of the tool was 82% and specificity 74% with cutoff point 16/75. CONCLUSIONS Child psychiatric non-urgent SMC is provided in accordance with national criteria, publicly accessible in the Internet. The criteria development process evoked multisectoral discussion on organising child mental health services and, by determining the need of treatment requiring SMC, defined health policy.