Tord Ivarsson

Bullying in adolescence: Psychiatric problems in victims and bullies as measured by the youth self report (YSR) and the depression self-rating scale (DSRS).

Adolescents in junior high school (n=237), completed a questionnaire on bullying as it relates to victim and to perpetrator status, suicidality and biographical data. Psychological symptoms were assessed by the Youth Self Report (YSR) and the Depression Self-Rating Scale (DSRS) supplemented by school health officers blind assessments. Bullying was common: bully only (18%), victim only (10%) and victim and bully (9%). Bullies had mainly externalizing symptoms (delinquency and aggression) and those of the victim and bully group both externalizing and internalizing symptoms as well as high levels of suicidality. Adolescents in the bully only group were more likely to be boys and to have attention problems. Moreover, a substantial proportion of the adolescents in the victim only group were judged by school health officer to have psychiatric symptoms and to function socially less well.

Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive-compulsive disorder

The aims of the present study were to examine OCD-related impairments in clinical cases of childhood OCD and to replicate and extend previous research on OCD-related impairments.MethodSixty-eight patients aged 8–17 years recruited from four child psychiatric outpatient clinics in Norway and Sweden with a confirmed DSM-IV diagnosis of OCD were included in the study. All patients and their parents were interviewed for diagnosis and comorbidity (KSADS),OCD symptoms and severity (CY-BOCS), and global impairment (CGAS). OCD-specific impairments were assessed by means of the Child OCD Impact Scale (COIS), a 58 item questionnaire with parallel parent and child versions.ResultsOverall, the majority of patients suffered from substantial impairments. The impact of OCD symptoms was found to be most severe at home, but impairments were also prominent in situations related to school and social settings.ConclusionsOur study supports findings of previous research suggesting multiple impacts of OCD symptoms on children’s psychosocial functioning. We conclude that impairment issues should be further addressed in future research to establish a better empirical basis for the understanding of different aspects of OCD-related impairment.

Examining Relations among Attachment, Religiosity, and New Age Spirituality Using the Adult Attachment Interview.

This study was the first to examine relations between attachment and religion-spirituality in adults using a developmentally validated attachment assessment, the Adult Attachment Interview. Security of attachment was expected to be linked to a religiosity-spirituality that is socially based on the parental relationships and reflects extrapolation of attachment experiences with sensitive parents to perceived relationships with a loving God. Insecurity of attachment was expected to be related to religiosity- spirituality via emotional compensation for states of insecurity. Participants (N=84; 40% men; mean age=29 years) were drawn from religious-spiritual groups. Religiousness-spirituality was assessed with questionnaires. Results generally supported the hypotheses (ps<.05). Estimates of parental loving were linked to socially based religiosity, loving God images, and gradual religious changes occurring at early ages and in life contexts indicating a positive influence of close relationships. Estimates of parental rejection and role reversal were related to New Age spirituality and sudden-intense religious changes occurring in life contexts of turmoil. Current attachment state of mind was generally unrelated to traditional religiosity, but current preoccupation, unresolved- disorganized, and cannot classify states were associated with New Age spirituality.

Diurnal cortisol levels and cortisol response in youths with obsessive-compulsive disorder.

Background/Aims: Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects. Methods: Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240–336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined. Results: Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters. Conclusion: These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.

The Children's Depression Inventory (CDI) as measure of depression in Swedish adolescents. A normative study

Self-rating scales are an economical and practical aid in the diagnostic work-up. However, normative data from the general population are needed to interpret scores. Four hundred and five adolescents selected to be fairly representative of the general population (both ethnical Swedes and born abroad) filled in a questionnaire containing the Childrens Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC) and background data (including socio-economic status (SES). The CDI was reliable in terms of internal consistency (0.86) with a mean inter-item correlation of 0.18 and item-total score correlations ranging from 0.26 to 0.57. The CDI sub-scales (Negative Mood, Ineffectiveness, Anhedonia and Negative Self-esteem had good internal consistency values slightly above 0.60, except for sub-scale Interpersonal Problems with poor internal consistency (0.36). The 90th and 95th percentiles respectively were defined by scores 15 and 18 and above for boys and by scores 20 and 23 and above for girls. Common correlates of high scores were female gender, broken family but not SES, nor ethnicity. Also, some estimates of the convergent validity of the CDI were found in a Pearson correlation of 0.40 with the MASC total score and in the capacity of the CDI (predictive validity); OR = 1.1 in predicting suicidal ideation. The CDI has some, but as of yet not sufficient indications of being a valid and reliable measure of depression in adolescence and scores can be used to indicate, though not prove the absence or presence of, depression.

The Birleson Depression Self-Rating Scale (DSRS). Clinical evaluation in an adolescent inpatient population

The Birleson DSRS, a depression self-rating scale for children, was evaluated in a group of adolescent psychiatric inpatients and a community-based group of adolescents. The DSRS was a valid measure of depression but slightly less powerful with these patients than with children. The DSRS might be a useful tool for screening of depressive symptoms, at least in clinical settings.

Clinical characteristics of adolescent psychiatric inpatients who have attempted suicide

Abstract The clinical characteristics of 191 adolescent inpatients were examined in relation to frequency of previous suicide attempts, predictors of suicide attempts prior to hospitalization, and lifetime suicide attempts. Overall, more than 50% of the adolescent inpatients had attempted suicide during their lifetime, and of these more than half (58%) had made more than one attempt. Approximately half of the suicide attempters had made a serious attempt prior to hospitalization. Girls reported higher levels of depressive symptoms and suicidal ideation than boys, in addition to having attempted suicide prior to hospitalization (33%) or during lifetime (37%) more often than the boys (13% and 26%, respectively). Although about two thirds of the adolescent inpatients reported that they had received some help after a suicide attempt, approximately half of the repeaters had not received any help. The results of multivariate analyses showed that suicide attempts made prior to hospitalization were predicted by depressive symptom levels and a clinical diagnosis of depressive disorder, whereas frequency of lifetime suicide attempts was predicted by suicidal ideation levels and having a family member or a friend who had attempted (or committed) suicide. The high prevalence of lifetime and repeated suicide attempts among the psychiatric inpatients underscores the importance of identifying risk factors in the clinical evaluation of adolescent suicide attempters.

Normative data for the Multidimensional Anxiety Scale for Children (MASC) in Swedish adolescents

The Swedish translation of a new scale developed for childhood and adolescent anxiety, the Multidimensional Anxiety Scale for Children (MASC), was studied regarding reliability and convergent validity and to obtain norms in a general population. Four hundred and five adolescents, reasonably representative of Swedish adolescents, were asked to rate their anxiety symptoms on the MASC. In order to study the convergent validity, they also rated their depressive symptoms on the Childrens Depression Inventory (CDI), their attitude to their body on the Body Esteem Scale for Adolescents and Adults (BESAA) and filled in demographical data on themselves. The MASC showed adequate internal consistency both for the whole scale (alpha = 0.87) and for subscales (range 0.64–0.84). The scale showed convergent validity through a moderate correlation with the CDI (r=0.400, P=0.0001) and the BESAA (r= − 0.29, P=0001). Girls scored higher (mean = 38.9) than boys (mean = 31.9) on the MASC total score (t(385) = 5.14, P=0.0001) and on the subscales, except Harm avoidance. Using the MASC as a general screen for anxiety, scores of 48 for boys and 56 for girls using MASC total scores, or scores of 15 for boys and 17 for girls using the Anxiety Disorders Index could be employed (both representing the 90th percentiles). The MASC appears to be a reliable and valid scale both on the global and on the subscale level.

A 2-4 year follow up of depressive symptoms, suicidal ideation, and suicide attempts among adolescent psychiatric inpatients.

Abstract One hundred eleven (58%) of 191 adolescent inpatients previously admitted to the emergency wards at the Child and Adolescent Psychiatric Clinics in the cities of Uppsala and Göteborg participated in a 2–4 year follow-up evaluation. The prevalence, incidence, and stability of depressive symptoms, suicidal ideation, and suicide attempts among the adolescents, and predictors of follow-up functioning were examined. Although a majority of the patients substantially reduced their depressive symptoms over the 2–4 year period, a smaller group (13%), mainly girls (94%), continued reporting high symptom levels at follow-up, and one out of five adolescents had moderate-severe levels of suicidal ideation. The accumulated frequency of suicide attempts among the patients shortly prior to hospitalization and during the follow-up was 59% including two patients who committed suicide. Significant predictors of depressive symptom severity at follow-up were depressive symptom scores and V-diagnoses at inpatient assessment. Previous suicide attempts before hospitalization, high levels of self-reported depressive symptoms and nonintact family status at inpatient assessment predicted suicide attempts during the follow-up period. The high prevalence of attempted and completed suicide in this clinical group underscores the importance of developing effective treatments for suicidal adolescents.

The Nordic long-term OCD treatment study (NordLOTS): rationale, design, and methods

BackgroundThis paper describes and discusses the methodology of the Nordic long-term OCD-treatment study (NordLOTS). The purpose of this effectiveness study was to study treatment outcome of CBT, to identify CBT non- or partial responders and to investigate whether an increased number of CBT-sessions or sertraline treatment gives the best outcome; to identify treatment refractory patients and to investigate the outcome of aripiprazole augmentation; to study the outcome over a three year period for each responder including the risk of relapse, and finally to study predictors, moderators and mediators of treatment response.MethodsStep 1 was an open and uncontrolled clinical trial with CBT, step 2 was a controlled, randomised non-blinded study of CBT non-responders from step 1. Patients were randomized to receive either sertraline plus CBT-support or continued and modified CBT. In step 3 patients who did not respond to either CBT or sertraline were treated with aripiprazole augmentation to sertraline.ConclusionsThis multicenter trial covering three Scandinavian countries is going to be the largest CBT-study for paediatric OCD to date. It is not funded by industry and tries in the short and long-term to answer the question whether further CBT or SSRI is better in CBT non-responders.