Sijmen A. Reijneveld

Higher prevalence of mental disorders in socioeconomically deprived urban areas in The Netherlands: community or personal disadvantage?

OBJECTIVE: Major mental disorders occur more frequently in deprived urban areas. This study examines whether this occurs for all mental disorders, including less serious ones. It further assesses whether such a concentration can be explained by the socioeconomic status (SES) of the residents concerned or that a cumulation of problems in deprived areas reinforces their occurrence. DESIGN: Mental disorders were assessed by means of the General Health Questionnaire (GHQ) among 4892 residents. Additional data were obtained on area deprivation, and on individual SES. Multilevel logistic regression models were used to take the hierarchical structure of the data into account, residents being nested in boroughs. SETTING: General population of the city of Amsterdam, the Netherlands. MAIN OUTCOME MEASURE: Prevalence of an increased (> or = 2) score on the GHQ, 12 item version. RESULTS: Mental disorders occur more frequently in deprived areas but this can be explained by the lower SES of the residents concerned. CONCLUSIONS: The cumulation of mental disorders in deprived urban areas is mainly a result of a concentration of low SES people in these areas. Contextual factors of deprived urban areas give hardly any additional risk above that resulting from a low individual SES.

Family factors and life events as risk factors for behavioural and emotional problems in children

Abstract. The aim of this study was to identify groups of children at increased risk of behavioural or emotional problems on the basis of socio-demographic characteristics, family characteristics, and recent life events with a focus on unemployment and divorce or separation. We obtained data on the Child Behavior Checklist (CBCL) from a community-based national sample of 4480 parents of school-aged children and interviewed them about their demographic and family characteristics and about the childs recent life events. Results showed that family characteristics and recent life events were more strongly associated with childrens risks of behavioural and emotional problems as measured by the CBCL than other demographic characteristics. Risks were somewhat higher for children who had experienced parental unemployment and divorce or separation recently, as compared to those who had experienced these events in the more distant past. We conclude that children with recent experience of parental unemployment or parental divorce or separation are at a relatively high risk of behavioural and emotional problems as reported by parents. Although relatively high, the risks that were found do not justify restriction of screening for behavioural and emotional problems to these children.

Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener

OBJECTIVE To investigate the psychometric properties of the Dutch version of the 48 months Ages and Stages Questionnaire (D_ASQ_48). DESIGN Prospective cohort study of a community-based sample of children born in 2002 and 2003 whose parents filled out the D_ASQ_48 and a questionnaire on school status at 60 months. The ASQ was translated into Dutch and back-translated into English by three independent translators. SETTING Well Child Centers covering 25% of the Netherlands. PARTICIPANTS Parents of 1510 preterm and 562 term children born in 2002-2003 attending routine Well Child visits at age 45-50 months. MAIN OUTCOME MEASURES Reliability, validity and mean population scores for D_ASQ_48 compared to other countries. RESULTS Mean population scores for the D_ASQ_48 were mostly similar to those in the USA, Norway and Korea. Exceptions (effect sizes of difference >0.5) were problem solving (USA) and fine motor (Korea). Reliability was good for the total score (Cronbach alpha 0.79) and acceptable for all domains (0.61-0.74). As expected, infants born at gestational age <32 weeks, children from low income families, of low educated mothers, and boys were more likely to fail on several domains (odds ratios, OR ranging from 1.5 to 4.9). The only unexpected association concerned children from one-parent families. Sensitivity to predict special education at five years of age was 89% and specificity 80%. CONCLUSIONS The good psychometric properties of the Dutch ASQ_48 and the small differences when compared to other countries support its usefulness in the early detection of developmental problems amongst children worldwide.

Self-esteem and resilience: The connection with risky behavior among adolescents

The aim was to explore the association of self-esteem and resilience with smoking and cannabis use among adolescents, separately for gender. A sample of 3694 adolescents (mean age 14.3 years) from elementary schools in Slovakia filled out the Rosenberg Self-esteem scale, the Resiliency scale and answered questions about cigarette and cannabis use. Logistic regression models showed associations between negative self-esteem and risky behavior, but only among boys. Regarding resilience, structured style and family cohesion were associated with a lower probability of smoking and cannabis use among both boys and girls. In contrast, social competence increased the probability of smoking and cannabis use among both groups. Negative self-esteem seems to play an important role regarding smoking and cannabis use among boys. Resilience seems to have mixed effects, some aspects being protective while other aspects increase the likelihood of smoking and use of cannabis. These results imply that the prevention of substance use should target not only specific individual characteristics, but also the possible risk or protective influences of the social environment, i.e. the family and social network.

The cross-cultural validity of self-reported use of health care. A comparison of survey and registration data

Surveys are often used to obtain data on ethnic differences in health care utilization. This study examines the cross-cultural validity of such data. Survey data were linked to an insurance register, for 3054 residents of Amsterdam, the Netherlands. Concordance was estimated using Cohens kappa statistics (agreement adjusted for chance agreement) and loglinear analyses regarding hospitalization, ambulatory physiotherapy, and prescription drugs. Self-reports yield higher utilization rates than registration, but irrespective of ethnicity and without statistical significance. Concordance between self-report and registration is fair [kappas (95% confidence interval): 0.77 (0.72-0.82), 0.71 (0.66-0.75), and 0. 58 (0.54-0.63) for hospitalization, physiotherapy, and prescription drugs]. Concordance is lower, though mostly without statistical significance, for immigrants, especially from Morocco and Turkey. Health care utilization is somewhat overestimated on the basis of self-report. This has no systematic impact on estimates of ethnic differences in health care utilization but adds measurement error to such comparisons.

Effects of case management for frail older people or those with chronic illness - a systematic review

Background:Financial constraints and quality requirements demand that interventions selected are most effective. A previous systematic review of the effectiveness of the patient advocacy case management model was not found. Objective:The objective of this study was to evaluate the effects of patient advocacy case management on service use and healthcare costs for impaired older people or adults with a chronic somatic disease living in the community. Methods:A literature search was conducted in Medline, CINAHL, and Cochrane databases. Included were English-language randomized controlled trials evaluating service use and costs of the patient advocacy case management model for people with a chronic somatic disease or for impaired older people living in the community. Results:Eight relevant studies were identified and included after evaluation of methodological quality. All studies concerned frail or impaired older people, and one study also included people with a somatic chronic disease. In none of the studies was evidence found for clinically relevant increase of service use and costs, whereas in two studies, it was reported that patient advocacy case management led to decreased service use and to savings in costs. Discussion:Patient advocacy case management does not increase service use and costs and was effective in decreasing service use and costs in two studies. These conclusions are an indication for quality improvement through the combination of its organizational benefits. Therefore, there should be more priority given to further implementation of patient advocacy case management for those with chronic illness and impaired older people. Nursing can play an important role in this development.

Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review

BACKGROUND Prenatal healthcare is likely to prevent adverse outcomes, but an adequate review of utilization and its determinants is lacking. OBJECTIVE To review systematically the evidence for the determinants of prenatal healthcare utilization in high-income countries. METHOD Search of publications in EMBASE, CINAHL and PubMed (1992-2010). Studies that attempted to study determinants of prenatal healthcare utilization in high-income countries were included. Two reviewers independently assessed the eligibility and methodological quality of the studies. Only high-quality studies were included. Data on inadequate use (i.e. late initiation, low-use, inadequate use or non-use) were categorized as individual, contextual and health behaviour-related determinants. Due to the heterogeneity of the studies, a quantitative meta-analysis was not possible. RESULTS Ultimately eight high-quality studies were included. Low maternal age, low educational level, non-marital status, ethnic minority, planned pattern of prenatal care, hospital type, unplanned place of delivery, uninsured status, high parity, no previous premature birth and late recognition of pregnancy were identified as individual determinants of inadequate use. Contextual determinants included living in distressed neighbourhoods. Living in neighbourhoods with higher rates of unemployment, single parent families, medium-average family incomes, low-educated residents, and women reporting Canadian Aboriginal status were associated with inadequate use or entering care after 6 months. Regarding health behaviour, inadequate use was more likely among women who smoked during pregnancy. CONCLUSION Evidence for determinants of prenatal care utilization is limited. More studies are needed to ensure adequate prenatal care for pregnant women at risk.

Prevalence of Chronic Health Conditions in Children With Intellectual Disability: A Systematic Literature Review

A systematic review of the prevalence rates of chronic health conditions in populations of children with intellectual disability was provided. We identified 2,994 relevant studies by searching Medline, Cinahl, and PsycINFO databases from 1996 to 2008. We included the 31 studies that had sufficient methodological quality. The 6 most prevalent chronic health conditions in children with intellectual disability were epilepsy (22.0/100), cerebral palsy (19.8/100), any anxiety disorder (17.1/100), oppositional defiant disorder (12.4/100), Down syndrome (11.0/100), and autistic disorder (10.1/100). The reported prevalence rates of chronic health conditions in this population was much higher than in the general population. However, both the number of studies that were included and the number of chronic health conditions they reported about were limited. There is an urgent need for better evidence on the prevalence of chronic health conditions among children with intellectual disability.

A comparison of four scoring methods based on the parent-rated Strengths and Difficulties Questionnaire as used in the Dutch preventive child health care system

BackgroundValidated questionnaires can support the identification of psychosocial problems by the Preventive Child Health Care (PCH) system. This study assesses the validity and added value of four scoring methods used with the Strengths and Difficulties Questionnaire (SDQ) for the identification of psychosocial problems among children aged 7–12 by the PCH.MethodsWe included 711 (of 814) children (response: 87%) aged 7–12 undergoing routine health assessments in nine PCH services across the Netherlands. Child health professionals interviewed and examined children and parents. Prior to the interview, parents completed the SDQ and the Child Behaviour Checklist (CBCL), which were not shown to the professionals. The CBCL and data about the childs current treatment status were used as criteria for the validity of the SDQ. We used four SDQ scoring approaches: an elevated SDQ Total Difficulties Score (TDS), parent-defined difficulties, an elevated score for emotional symptoms, conduct problems or hyperactivity in combination with a high impairment score, and a combined score: an elevated score for any of these three methods.ResultsThe Cohens Kappa ranged from 0.33 to 0.64 for the four scoring methods with the CBCL scores and treatment status, generally indicating a moderate to good agreement. All four methods added significantly to the identification of problems by the PCH. Classification based on the TDS yielded results similar to more complicated methods.ConclusionThe SDQ is a valid tool for the identification of psychosocial problems by PCH. As a first step, the use of a simple classification based on the SDQ TDS is recommended.

Psychosocial problems among immigrant and non-immigrant children - Ethnicity plays a role in their occurrence and identification

BackgroundThis study aims to examine a) the prevalence of psychosocial problems and b) the association between parent-reported problems and the identification by doctors and nurses (child health professionals, CHP) working in preventive child health care, among immigrant and non-immigrant children.MethodsCHPs examined 4,098 children aged 5 through 15 years (response: 90.1%) and interviewed parents and children during their routine health assessments in 19 Child Healthcare Services across the Netherlands, serving nearly all school-aged children routinely. The Child Behavior Checklist (CBCL) was completed by the parents. We compared five ethnic groups: indigenous Dutch, economic immigrants, immigrants from (former) Dutch colonies, from other non-industrialised, and from other industrialised countries.ResultsThe prevalence of parent-reported problems on the CBCL is higher among children from former Dutch colonies and economic immigrant children than among indigenous children, especially regarding internalising problems (odds ratios (OR); 95% confidence interval: 1.84; 1.03 to 3.29, and 2.52; 1.46 to 4.34). CHPs identified more problems among economic immigrant children (OR: 1.62; 1.01 to 2.60). Regarding associations, rates of CHP-identified problems were higher among indigenous children with clinical compared with normal CBCL Total Problems scores (OR: 6.90; 5.27 to 9.03), but not among economic immigrant children (OR: 0.73; 0.16 to 3.21).ConclusionsPsychosocial problems occur more frequently among some immigrant groups. CHP identification of psychosocial problems is poorly associated with parent report regarding economic immigrant children. This needs to be improved in order to provide better care.