Tormod Rimehaug

Prevalence and comorbidity of mental disorders among adolescents living in residential youth care

Most adolescents are placed in residential youth care (RYC) because of severe psychosocial strains and child maltreatment, which represent risk factors for developing mental disorders. To plan RYC units and ensure that residents receive evidence-based psychiatric interventions, it is necessary to obtain reliable and valid prevalence estimates of mental disorders in this population. However, there is a lacuna of research on diagnoses derived from standardized clinical interviews. The aim of this study was to assess the prevalence and comorbidity of mental disorders applying diagnostic interviews in an entire population of adolescents living in RYC in Norway. All young people in RYC were invited to participate in the study. Eighty-six RYC institutions with 601 eligible adolescents were included and 400 adolescents, 12–20xa0years old, participated in the study, yielding a response rate of 67xa0%. Anonymous Child Behaviour Checklist scores for 141 (70xa0%) of the declining residents were also available, allowing diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) for 541 youths to be estimated. Diagnoses were assessed by trained interviewers with the Child and Adolescent Psychiatric Assessment interview (CAPA). Seventy-six point two per cent (71.5–80.8 CI 95xa0%) of adolescents received at least one 3-month DSM-IV diagnosis. Prevalence rates for internalizing psychiatric disorders were higher than for behavioural disorders. Comorbidity was high between these two groups. Mental disorders were prevalent among children and youth in RYC. Our results create major concerns and challenge the existing organization of the RYC system.

Psychogenic muscle tension: the significance of motivation and negative affect in perceptual-cognitive task performance

Nineteen subjects volunteered to represent a stratified recruitment of serious-minded (goal-directed) and playful (impulsive) individuals balanced for gender. They all performed a perceptual-cognitive task under a neutral condition and with the contingency of monetary reward for good performance (counterbalanced order). Integrated electromyographic (IEMG) recordings were made from the biceps and triceps muscles of both upper arms, and from prebaseline, task performance and postbaseline periods. Verbal reports on motivational state during task performance (serious-minded/playful) and hedonic tone were also recorded. Results verified and extended earlier findings that IEMG activity increases over the course of task performance when a task is performed in the serious-minded state and even more so when a negative hedonic tone coincides with this motivational state. The increased IEMG occurred in all 4 recording sites under both incentive contingencies, although it was particularly marked in the right triceps muscle. These findings should be viewed in the light of the fact that both arms were allowed to remain in a passive resting condition during performance periods.

Competence and emotional/behavioural problems in 7–16-year-old Norwegian school children as reported by parents

Background: Previous studies from Nordic countries suggest that parent ratings of childrens emotional and behavioural problems using the Child Behavior Checklist (CBCL) are among the lowest in the world. However, there has been no Norwegian population study with acceptable response rates to provide valid Norwegian reference data. Aims: Firstly, to compare CBCL Internalizing, Externalizing, Total Problems and Competence scores of Norwegian children and adolescents with those from 1) previous Norwegian studies, 2) other Nordic countries, and 3) international data. Secondly, to present Norwegian reference data in order to perform these comparisons. Thirdly, to investigate the effects of age, gender, socio-economic and urban/rural status on the CBCL. Methods: A stratified cluster sample of 2582 school children (1302 girls and 1280 boys) was identified from the general Norwegian population and their parents were asked to complete the CBCL. Results: The response rate was 65.5%. The mean Total Problems score for the whole sample was 14.2 (standard deviation, s = 14.1). Girls were rated as having greater Competence and fewer Total Problems than boys. Younger children had more Total Problems than adolescents. Parents with low education reported more child Total Problems and lower Competence than those with high education. All effect sizes were small, except for the effect of parental education on child Competence, which was moderate. Conclusions: Total Problems scores were lower than in other societies. The data from this study obtained from one county in central Norway provide an important reference for clinical practice and treatment outcome research.

Anxiety and depressive symptoms related to parenthood in a large Norwegian community sample: the HUNT2 study

IntroductionThe study compared anxiety and depression prevalence between parents and non-parents in a society with family- and parenthood-friendly social politics, controlling for family status and family history, age, gender, education and social class.MethodsAll participants aged 30–49 (Nxa0=xa024,040) in the large, non-sampled Norwegian HUNT2 community health study completed the Hospital Anxiety and Depression Scales.ResultsThe slightly elevated anxiety and depression among non-parents compared to parents in the complete sample was not confirmed as statistically significant within any subgroups. Married parents and (previously unmarried) cohabiting parents did not differ in portraying low anxiety and depression prevalence. Anxiety was associated with single parenthood, living alone or being divorced, while elevated depression was found only among those living alone.DiscussionBurdening selection and cultural/political context are suggested as interpretative perspectives on the contextual and personal influences on the complex relationship between parenthood and mental health.

Group and individual stability of three parenting dimensions

BackgroundThe Parental Bonding Instrument, present self-report version, (PBI-PCh) includes three scales, Warmth, Protectiveness and Authoritarianism, which describe three dimensions of current parenting. The purposes of this study were to (1) evaluate the true and observed stability of these parenting dimensions related to older children, (2) explore the distribution of individual-level change across nine months and (3) test potential parental predictors of parenting instability.MethodsQuestionnaires were distributed to school-based samples of community parents of both genders (n = 150) twice, nine months apart. These questionnaires measured parenting, parental personality and emotional symptoms.ResultsBased on 1) stability correlations, 2) true stability estimates from structural equation modeling (SEM) and 3) distribution of individual-level change, Warmth appeared rather stable, although not as stable as personality traits. Protectiveness was moderately stable, whereas Authoritarianism was the least stable parenting dimension among community parents. The differences in stability between the three dimensions were consistent in both estimated true stability and observed stability. Most of the instability in Warmth originated from a minority of parents with personality, childhood care characteristics and lower current parenting warmth. For the Protectiveness dimension, instability was associated with higher Protectiveness scores.ConclusionsTrue instability with all three self-reported parenting dimensions can occur across nine months in a community sample related to older children (7-15), but it may occur with varying degrees among dimensions and subpopulations. The highest stability was found for the Warmth parenting dimension, but a subgroup of unstably cold parents could be identified. Stability needs to be taken into account when interpreting longitudinal research on parenting and when planning and evaluating parenting interventions in research and clinical practice.

Change in self-reported emotional distress and parenting among parents referred to inpatient child psychiatric family treatment

Aims: Our aim was to examine changes in distress symptoms and parenting dimensions among parents in child psychiatry services (clinic parents) (n = 102). Parents were followed from referral and admission to 3-month and 12-month follow-ups of “treatment-as-usual” at inpatient family clinics. These measurements were compared with a sample of community parent (n = 439) standards. Methods: Standardized questionnaires measuring the childs problems, parental anxiety and depression symptoms (distress), and warmth protectiveness and authoritarianism (parenting dimensions), were distributed to parents four times (T0–T1–T2–T3). The family clinics received families whose children had long-term problems and unsatisfactory previous treatment outcomes. Results: Clinic mothers, but not fathers, showed an improvement in distress symptoms at the 3-month (T2) and 12-month (T3) follow-ups relative to at admission (T1). Nevertheless, clinic mothers displayed distress symptoms at all measurement points compared with community parents. Parents of children with learning/developmental problems and attention disorders showed significantly higher warmth scores at the 3-month and 12-month follow-up compared with at admission, although the levels remained lower than those of community parents. In contrast, parents of children with emotional problems showed the same level of warmth as community parents and lower levels of protectiveness, but no change in these parenting dimensions T1–T2. Implications: Parental emotional distress symptoms and parenting characteristics should be addressed systematically in child psychiatry to inform evaluations of the context of the childs problems and the familys treatment needs. Systematic and effective treatment components related to parenting should be implemented.

P300 and quality of performance in a forewarned go-NoGo reaction time task: the significance of goal-directed lifestyle and impulsivity

Abstract Eighteen undergraduate subjects were recruited from a larger sample to represent a stratified distribution of goal-directed lifestyle. They all performed a forewarned reaction time task where S1 signalled ‘Go’ or ‘NoGo’ (random alternation) in response to S2; 1000-Hz and 2000-Hz tones being counterbalanced across subjects as ‘Go’ or ‘NoGo’ signals. P300 was measured on-line from the Cz position, and P300 amplitude was averaged in relation to S1 across 16 ‘Go’ and 16 ‘NoGo’ trials respectively. Subjects dominated by a goal-directed lifestyle showed (1) high P300 power scores in response to both ‘Go’ and ‘NoGo’ S1, (2) few errors (sum of errors of commission and omission at S2), and (3) high numbers of ‘Go’ responses to S2 that were within a preset reaction time (RT) window. The RT criterion proved unrelated to scores on goal-directed lifestyle. The results indicate that goal-directed lifestyle may reduce the inverse relationship between RT and quality of performance. The association of P300 and goal-directed lifestyle in the present findings may open up a new approach to the psychological significance of individual differences in P300.

The Ecology of Sustainable Implementation Reflection on a 10-Year Case History Illustration

The primary aim of this paper is to illustrate the strategic and ecological nature of implementation. The ultimate aim of implementation is not dissemination but sustainability beyond the implementation effort. A case study is utilized to illustrate these broad and long-term perspectives of sustainable implementation based on qualitative analyses of a 10-year implementation effort. The purveyors aimed to develop selective community prevention services for children in families burdened by parental psychiatric or addictive problems. Services were gradually disseminated to 23 sites serving 40 municipalities by 2013. Up to 2013, only one site terminated services after initial implementation. Although many sites suspended services for shorter periods, services are still offered at 22 sites. This case analysis is based on project reports, user evaluations, practitioner interviews, and service statistics. The paper focuses on the analyses and strategies utilized to cope with quality decay and setbacks as well as progress and success in disseminating and sustaining the services and their quality. Low-cost multilevel strategies to implement services at the community level were organized by a prevention unit in child psychiatry, supervised by a university department (purveyors). The purveyors were also involved in national and international collaboration and development. Multilevel strategies included manualized intervention, in-practice training methods, organizational responsibility, media strategies, service evaluation, staff motivation maintenance, quality assurance, and proposals for new law regulations. These case history aspects will be discussed in relation to the implementation literature, focusing on possible applicability across settings.

Change in mental health symptoms in families with nonresponding children referred to inpatient family units

Aims: To examine changes in child mental health symptoms following inpatient family unit treatment after long-term unsuccessful treatment in community and child psychiatry outpatient services. Follow-up from referral and admission to 3 and 12u2009months. Methods: Standardized questionnaires measuring the child mental health symptoms and parental anxiety and depression converted to standardized scores and compared to each child’s clinical diagnosis. Results: Significant group mean improvement on almost all problem scales at the 3-month follow-up (T2) remaining through 12-month follow-up (T3) relative to admission (T1). Aggression showed the highest levels and largest improvements. Statistically significant improvements were widespread, whereas clinically significant improvements were found for some diagnostic groups on diagnosis-related problems and secondary problems. Improvement in child symptoms were partly correlated with improvement in parental anxiety symptoms. Implications: Even previously nonresponding children may benefit from broad tailored interventions including parents and the wider system. Development of systematic component approaches is needed.

Refining the COPES to Measure Social Climate in Therapeutic Residential Youth Care

BackgroundPrevious studies have shown that social climate in therapeutic residential youth care (TRC) is important to the welfare of residents, staff, and assessing treatment outcomes. The most influential theory on social climate in residential settings is the theory of Moos. The measurement of the concepts and aspects of this theory using the Community Oriented Programs Environment Scale (COPES) has repeatedly been criticized regarding usability, validity, and reliability, especially for TRC.ObjectiveTo improve the usability and psychometric quality of the COPES by shortening and refining the original subscale structure for usage in TRC.MethodsFour-hundred adolescents living in Norwegian TRC participated. We supplemented confirmatory factor analysis (CFA) with item response theory (IRT) to evaluate model fit, investigate factor loadings, and shorten scales to improve their psychometric qualities and usability in describing social climate in TRC.ResultsThe original subscales were not acceptable as evaluated by the criteria for CFA and IRT. By removing psychometrically weak items, the instrument was shortened to 40 items within the original ten subscales. This short version showed acceptable psychometric qualities based on both CFA and IRT criteria and the instrument retained its content validity. Finally, the original three higher-order dimensions was not supported.ConclusionsCompared to the original instrument, the refined 40-item version of the COPES represents a more usable instrument for measuring social climate in TRC. Future studies are needed to confirm the multifaceted refined short version in comparable samples of youth and staff to further investigate predictive value and construct validity.