Sari Fröjd

The association of parental monitoring and family structure with diverse maladjustment outcomes in middle adolescent boys and girls.

The aim of this study was to study the associations between family structure, parental monitoring and maladjustment outcomes among middle adolescent girls and boys. Data was collected through a school-based survey of a nationally representative sample of 17,643 Finnish adolescents aged 14–16 years. The less the parents knew the adolescents’ friends and whereabouts, the more common were all the maladjustment outcomes studied. Non-intact family structure was associated with maladjustment and had associations independent of parental monitoring. We conclude that parental involvement with adolescents is conducive to healthy development, and that adolescents need the protection provided by parental supervision. Knowing the adolescents whereabouts and friends is a concrete and easily measurable way of assessing parents’ involvement in the adolescents life.

Correlation between bullying and clinical depression in adolescent patients

A literature review of the associations between involvement in bullying and depression is presented. Many studies have demonstrated a concurrent association between involvement in bullying and depression in adolescent population samples. Not only victims but also bullies display increased risk of depression, although not all studies have confirmed this for the bullies. Retrospective studies among adults support the notion that victimization is followed by depression. Prospective follow-up studies have suggested both that victimization from bullying may be a risk factor for depression and that depression may predispose adolescents to bullying. Research among clinically referred adolescents is scarce but suggests that correlations between victimization from bullying and depression are likely to be similar in clinical and population samples. Adolescents who bully present with elevated numbers of psychiatric symptoms and psychiatric and social welfare treatment contacts.

How Low Is Low? Low Self-Esteem as an Indicator of Internalizing Psychopathology in Adolescence:

Schools are among the most important setting for preventive interventions among adolescents. There are evidence-based intervention programs for adolescents at risk for and with early signs of mental health problems but one demanding task is to detect the ones who are in need of an intervention. The aim of the present study was to analyze associations between self-esteem, depressive symptoms, and social anxiety in order to determine clinically relevant cut-points for male and female adolescents’ self-esteem as measured with the Rosenberg Self-Esteem Scale (RSES). The participants of the present prospective study, started in 2002-2003, were 2070 adolescents aged 15 years (1,167 girls and 903 boys) at two study sites in Finland who participated at both baseline and 2-year follow-up. Self-esteem was related to depressive symptoms and social anxiety, and the RSES was able to discriminate between cases of depression and social phobia. The present study suggests a cutoff of 25 points to classify low self-esteem in both girls and boys. Low self-esteem may function as an indicator of various forms of internalizing psychopathology. The RSES is worth further examination as a potential screening tool for adolescents in risk of psychopathology.

Adverse childhood experiences as risk factors for serious mental disorders and inpatient hospitalization among adolescents

Psychiatric hospitalization is an intense and powerful intervention for patients and is highly expensive for society. espite the individual and social costs of hospitalization, it is a common practice in the Finnish adolescent mental health are system (Fredriksson & Pelanteri, 2012). Hospitalized adolescents typically suffer from severe psychiatric disorders, ave faced several traumatic life events and experience psychosocial difficulties with their families and peer groups Gyllenberg et al., 2010; Sourander, Helenius, & Piha, 1995). Thus, it is important to identify the most prevalent and owerful childhood psychosocial risk factors for severe mental health disorders among high-risk adolescents to diminsh personal agony, prevent the aggravation of psychiatric problems and reduce hospitalization and high health care osts. Adolescence is a unique period of cognitive, emotional, social, and physical development. Adolescents are particularly ulnerable to the negative effects of exposure to adverse childhood experiences (ACEs, De Bellis, 2005), and many psychitrically hospitalized adolescents have a history of several ACEs. The most frequently examined ACEs are emotional, physical nd sexual abuse, neglect, being bullied and household dysfunction, including parental mental illness, alcohol or drug abuse, ivorce, death and criminality. In a recent Finnish study of 508 adolescent psychiatric inpatients, 34.6% of patients (29.3% ales and 38.3% females) reported being bullying victims (Mustanoja et al., 2011). The same research group reported that pproximately 25% of hospitalized adolescents had been exposed to physical abuse, approximately 23% of girls and 3% of oys had been exposed to sexual abuse and 31% of girls and 28% of boys had witnessed intimate partner violence. For

Does problem behaviour affect attrition from a cohort study on adolescent mental health

BACKGROUND Most surveys are plagued by significant numbers of non-respondents. In psychiatric epidemiology, differences in levels of psychopathology are often assumed between respondents and non-respondents. However, studies on attrition are rare, especially in child and adolescent populations. The present study sought to estimate the association of depression, anti-social behaviour with attrition from a cohort study among adolescents. METHODS The adolescent mental health cohort study (AMHC) is a prospective follow-up study on prevalence and determinants of mental health problems and risk behaviour among Finnish adolescents at two study sites. Subjects of the final baseline sample (n = 3278) were reached for a 2-year follow-up. Differences in data collecting methods between the study sites yielded different response rates (78% vs. 51%). Chi-square statistics and logistic regression models were computed to estimate the effect of two types of problem behaviour on attrition. RESULTS Depression at baseline was associated with higher probability of attrition at follow-up. School performance was a stronger predictor of attrition than problem behaviour. The models predicted non-response in the study site with mainly school-based surveys but not in the study site with mainly postal surveys. CONCLUSION Internalizing problem behaviour may be underrepresented in adolescent mental health surveys. School performance is strongly associated with attrition. Hence, special attention should be paid to designing questionnaires targeting adolescents.

Relationship between social phobia and depression differs between boys and girls in mid-adolescence.

BACKGROUND Earlier studies suggest that social phobia (SP) and depression (DEP) often have their onset in adolescence, and are highly comorbid, with SP mainly preceding depression. There is a lack of population-based prospective studies among adolescents vulnerable to both disorders, taking into account possible gender differences in the relationship between the two. METHODS This study is part of a prospective Adolescent Mental Health Cohort (AMHC) study. Subjects are 9th grade pupils (mean age 15.5 years (sd 0.39)) responding to a survey conducted 2002-2003 (T1) and a 2-year follow-up 2004-2005 (T2) (N=2038). Social phobia was measured by the Social Phobia Inventory (SPIN) and depression by the 13-item Beck Depression Inventory (BDI-13). RESULTS Risk for depression at T2 by SP at T1 was elevated only among boys (OR 3.6, 95% C.I. 1.507-8.579, p=0.004), whereas among girls, risk for SP at T2 by DEP at T1 was elevated (OR 7.8, 95% CI 4.529-13.391, p<0.001). The course of both disorders was unstable and recovery was common. LIMITATIONS Lack of diagnostic interviews and fairly high drop-out rate (36.9%) in follow-up. CONCLUSIONS The relationship between SP and depression in adolescence seems different for boys and girls. Further studies are needed to explore factors explaining the different course of these disorders among boys and girls. Clinicians need to be alert to comorbidity when examining an adolescent with SP or depression.

Overweight, perceived overweight and involvement in bullying in middle adolescence.

Overweight is reportedly a risk factor for being bullied, and body image may mediate this association. Research on associations between overweight and bullying has so far only focused on children and early adolescents. We explored associations between actual and perceived overweight at age 15 and involvement in bullying at ages 15 and 17. A total of 2070 Finnish adolescents responded to a survey at ages 15 and 17. Self-reported weight and height, perceived weight and involvement in bullying were elicited. Being overweight at age 15 was not associated with being bullied or with being a bully at age 15 or 17. Perceived overweight among girls was associated with subsequent involvement in bullying as a bully and in feeling shunned. Weight related bullying may decrease from pre- and early adolescence to middle adolescence. The associations between perceived overweight and self-identification as a bully, and those between perceived overweight and feeling isolated may be explained by the phenomena representing psychological dysfunction.

Is pubertal timing associated with involvement in bullying in middle adolescence

Off-time pubertal maturation is associated with mental disorders, presumably due to stress caused by deviation from peers that could also attract negative attention and result in being bullied. Stress related to off-time maturation could be acted out by involving oneself in bullying behavior. The associations between pubertal timing and involvement in bullying have so far not been a focus of research. The objective is to explore associations between off-time pubertal maturation and involvement in bullying. Cross-sectional and longitudinal associations between self-reported pubertal timing and involvement in bullying as victims and perpetrators were studied in a sample of 2070 Finnish adolescents aged 15–17 who participated in the Adolescent Mental Health Cohort Study. Internalizing (depression) and externalizing (conduct disorder) symptoms were controlled for. The adolescents were recruited to response the baseline survey in 2002–2003 (T1) and follow-up two years later (T2). In T1, response rate was 94.4% of all eligible students. The 2070 participants in T2 comprised 63.1% of the T1 participants. Early maturation among boys was cross-sectionally associated with being a bully, and late maturation with exclusion from peer group. After two years, the associations had disappeared. Among girls, no associations were detected between pubertal timing and involvement in bullying. Off-time pubertal maturation places boys at risk for involvement in bullying. The influence is transient and supports the stressful change hypothesis of pubertal timing.

The effect of adolescent- and parent-induced family transitions in middle adolescence

In a longitudinal school-based survey of Finnish adolescents aged 15–16 years at baseline, we examined associations of parent-induced family transitions (parental separation, divorce, remarriage) and adolescent-induced family transitions (moving away from the parental home) with adolescent maladjustment (substance abuse and internalizing symptoms). The findings revealed that externalizing problems were associated with moving away from the parental home, whereas the risk of internalizing problems was associated with a change in the caretaking parent through parental marital transition or being taken into custody.

Transparent criteria for specialist level adolescent psychiatric care

BackgroundRising health care costs and long waiting lists pose a challenge to public specialist level health services. In Finland, the Ministry of Social Affairs and Health required all medical specialities to create a priority-rating tool for elective patients, preferably giving a numerical rating ranging 0–100, with 50 as an entry threshold.ObjectiveTo create and test the psychometric properties of a point-count measure for prioritising entry to public specialist level adolescent psychiatric services.MethodAround 710 referred adolescents were given ratings on 17 items focusing on symptom severity, problem behaviours, functioning, progress of adolescent development and prognosis. The structured ratings were compared to an overall assessment of need for treatment on a VAS scale. In order to ensure that the tool was not inappropriately sensitive to confounding by non-disturbance related factors, the associations between the structured priority rating and sex, age, referring agent, study site and diagnosis were analysed.ResultsOf the 17 items, 15 were included in the final priority-rating tool. The requirement than threshold score for entry to services being set at 50 points necessitated scoring factors rather than individual items. Four blocks of items were formed: symptoms and risks; impaired functioning; other relevant issues, and prognosis without specialist level treatment. Most of the referred adolescents scored over the threshold of 50. When diagnosis was controlled for, scoring over 50 was largely independent of age, sex, referring agent or study site.ConclusionThe structured priority ratings corresponded well with clinical global rating of need for care. The tool was not inappropriately sensitive to age, sex, referring agent or study site. In the future, follow-up studies will be needed to evaluate the predictive value of priority ratings.