Tytti Solantaus

Children's mental health in times of economic recession: replication and extension of the family economic stress model in Finland

This study evaluated the applicability of the family economic stress model (FESM) in understanding the influences of economic hardship on child mental health during a nationwide economic recession in Finland. The information was gathered from 527 triads of 12-year-olds and their mothers and fathers from a population sample. The structural equation models showed that the FESM fit the data well, indicating its generalizability in Finnish society. The results confirmed that a reduction in disposable family income constitutes a risk for child mental health through increased economic pressure and negative changes in parental mental health, marital interaction, and parenting quality. Controlling the childrens prerecession mental health substantiated that economic hardship can lead to deterioration in childrens mental health. Alternative models based on fully recursive analyses revealed reciprocal influences between parents and their children over time: Childrens prerecession mental health problems predicted compromised parenting, which in turn contributed to childrens internalizing and externalizing symptoms during the recession.

Social support and the quality of parenting under economic pressure and workload in Finland: the role of family structure and parental gender.

This study focused on how factors outside the home affect the quality of mothering and fathering. Economic pressure and workload were evaluated along with the compensating role of social support on parenting. Information was gathered from 842 mothers and 573 fathers including 139 single-mother and 21 single-father families. The results showed that the nature of the strains, together with parental gender and family structure, influenced their effects on parenting. The results further revealed some gender- and strain-specific protective functions of social support on parenting. For example, economic pressure was related to increased punitive parenting, which was compensated by instrumental and emotional support among the mothers. Workload was related to less authoritative single fathering, which was compensated by instrumental support.

The specific mediating paths between economic hardship and the quality of parenting

Finland, one of the welfare states of northern Europe, faced an exceptionally deep economic recession at the beginning of the 1990s. Based on the Family Stress Model (Conger & Elder, 1994) we studied specific mediating paths between economic hardship and the different domains of parenting in 527 mother-father-child triads. The results show that economic hardship created economic pressures for both parents. For fathers, both the general and specific pressures were further associated with symptoms of anxiety and social dysfunction, whereas for mothers, only the specific economic pressures were negatively reflected in mental health by increasing depressing mood and anxiety symptoms. Paternal anxiety was then associated with hostile marital interaction, perceived by the wife, and maternal anxiety with low marital support, perceived by the husband. The negative marital interaction finally was associated with poor parenting, especially among the fathers. Fathers’ anxiety was also directly related to their punitive and noninvolved fathering, and social dysfunction to noninvolved fathering. Depressive symptoms in mothers were negatively reflected in authoritative mothering. Finally, the results revealed that supportive and nonhostile marital interaction was able to moderate the negative impact of economic hardship on parenting. The findings suggest that mothers and fathers fulfil gendered roles in dealing with the family economy and relationships.

Four-year follow-up study of sleep and psychiatric symptoms in preadolescents: relationship of persistent and temporary sleep problems to psychiatric symptoms.

ABSTRACT. The course of sleep disturbances in preadolescents was assessed during a 4-year follow-up, and psychiatric problems associated with persistent and temporary sleep problems were investigated in an epidemiological setting. A representative random sample of 1,290 children, their parents, and school teachers filled out various questionnaires when the children were aged 8 and 12 years. Response rates to the relevant items varied between 66.8% and 81.2%. Parental reports of sleep problems decreased from 23.4% to 9.1% during the 4-year period, whereas childrens reports remained steady at 18%. Persistent sleep disturbances were found in 12% of children, and 33.3% of sleep problems reported at age 8 were continued. Both current and persistent sleep disturbances were associated with the broad range of mental health problems reported by teachers. However, multivariate modeling suggested that especially current sleep problems were associated with an increased risk for psychiatric problems (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.20–4.99), particularly emotional problems (OR 2.92; 95% CI 1.58–5.38).

The Effective Family Programme: Preventative Services for the Children of Mentally Ill Parents in Finland

The Effective Family Programme was initiated in Finland in 2001 to provide methods for health and social services to support families and children of mentally ill parents. The methods are implemented and clinicians are trained in psychiatric services and primary health care. The methods include the Beardslee Preventive Family Intervention, a parent-focused Let’s Talk about Children Discussion and the Network Meeting. The Effective Family Programme represents large-scale implementation of a promotive and preventative child-centred approach in adult psychiatry. The first five years have been successful. Two thirds of health districts have initiated training. However, big challenges lie ahead. While the work was initiated in psychiatric services, it needs to be extended to primary health care and social services as well. Institutionalisation of the methods is still in progress, as well as incorporation of the work into the basic training of all mental health professionals.

The Effective Family Programme II: Clinicians’ Experiences of Training in Promotive and Preventative Child Mental Health Methods

Mental health clinicians were trained to master interventions and to become trainers for promotion of development and prevention of mental health problems in children with mentally ill parents, as part of the Effective Family Programme. The trainees’ experiences of the impact of the training on their professional skills and work satisfaction, on one hand, and implementation of the methods, on the other, were examined. The data was collected by a questionnaire. The 30 respondents (response rate 83%) reported an increase in their professional skills as well as in work-related joy and motivation. Most of them had trained others, and implementation of the new working methods had started. The success factors of the Effective Family training for first phase of the implementation are discussed.

Four-year course of teacher-reported internalising, externalising and comorbid syndromes in preadolescent children

The aim of this study was to elucidate the nature of comorbidity between internalising and externalising syndromes and its meaning in the course of these syndromes from 8 to 12 years of age in a school setting. The children in the cohort (N=1320) were born in 1981. They were first surveyed in second grade (N=1284) and followed up in sixth grade (N=906). Teachers were the informants, and the study was carried out by means of a questionnaire. Data from both points of time were available on 861 subjects. The Rutter Teacher Questionnaire (RB2) measured behavioural and emotional symptoms at Time 1, and the Teacher Report Form (TRF) at Time 2. Comorbidity was more prevalent in boys than girls. Childhood comorbidity predicted externalising syndrome and comorbidity, but not internalising syndrome in early adolescence. It changed the course of boys’ internalising syndromes to an externalising direction over time. The data suggest a gender difference in the pattern of comorbidity. When comorbidity was partialled out, it was very rare for internalising and externalising syndromes to develop into contrasting syndromes over time. The recovery rate for childhood comorbidity was poor. Special attention should be paid to making schools recognise and help these children.

“Together at school” - a school-based intervention program to promote socio-emotional skills and mental health in children: study protocol for a cluster randomized controlled trial

BackgroundSchools provide a natural context to promote children’s mental health. However, there is a need for more evidence-based, high quality school intervention programs combined with an accurate evaluation of their general effectiveness and effectiveness of specific intervention methods. The aim of this paper is to present a study protocol of a cluster randomized controlled trial evaluating the “Together at School” intervention program. The intervention program is designed to promote social-emotional skills and mental health by utilizing whole-school approach and focuses on classroom curriculum, work environment of school staff, and parent-teacher collaboration methods.Methods/DesignThe evaluation study examines the effects of the intervention on children’s socio-emotional skills and mental health in a cluster randomized controlled trial design with 1) an intervention group and 2) an active control group. Altogether 79 primary school participated at baseline. A multi-informant setting involves the children themselves, their parents, and teachers. The primary outcomes are measured using parent and teacher ratings of children’s socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire and the Multisource Assessment of Social Competence Scale. Secondary outcomes for the children include emotional understanding, altruistic behavior, and executive functions (e.g. working memory, planning, and inhibition). Secondary outcomes for the teachers include ratings of e.g. school environment, teaching style and well-being. Secondary outcomes for both teachers and parents include e.g. emotional self-efficacy, child rearing practices, and teacher-parent collaboration. The data was collected at baseline (autumn 2013), 6 months after baseline, and will be collected also 18 months after baseline from the same participants.DiscussionThis study protocol outlines a trial which aims to add to the current state of intervention programs by presenting and studying a contextually developed and carefully tested intervention program which is tailored to fit a national school system. Identification of effective intervention elements to promote children’s mental health in early school years is crucial for optimal later development.Trial registrationClinicalTrials.gov register: NCT02178332.

Translation gone awry: differences between commonsense and science

Abstract A general assumption is that science is just organised commonsense. It is noted that translation involves a two-way pathway between basic laboratory science and patient care, and that some scientific findings have implications for prevention rather than treatment. A succinct critique follows on the key features that differentiate science and commonsense. The main part of the paper discusses six rather different examples of translation that went awry because people treated science and commonsense as equivalent. Examples based on empirical evidence of translation going awry include (i) the claim that only early intervention can bring lasting benefits; (ii) the claim that the main policy goal for children should be the elimination of all stresses; (iii) the claim that exposure in utero to maternal smoking causes ADHD and conduct disturbance; (iv) the claim that tax benefits should be used to encourage couples to marry; (v) the effects of profound institutional deprivation are similar to those of any adversity; and (vi) environmental effects are largely independent of genetic influences. Much of science is ‘unnatural’ in the sense that technical tools (such as imaging or DNA) are employed, or because animal models are used, or because unusual comparisons are made. Science cannot be based solely on an inductive process; rather, there must be some form of experiment and the testing of two or more alternative explanations. Translation needs to be based on top quality science and an appreciation that even the best science needs to take account of multiple strategies and multiple evaluations.

Together at school - a school-based intervention program to promote socio-emotional skills and mental health in children: study protocol for a cluster randomized controlled trial

BackgroundSchools provide a natural context to promote children’s mental health. However, there is a need for more evidence-based, high quality school intervention programs combined with an accurate evaluation of their general effectiveness and effectiveness of specific intervention methods. The aim of this paper is to present a study protocol of a cluster randomized controlled trial evaluating the “Together at School” intervention program. The intervention program is designed to promote social-emotional skills and mental health by utilizing whole-school approach and focuses on classroom curriculum, work environment of school staff, and parent-teacher collaboration methods.Methods/DesignThe evaluation study examines the effects of the intervention on children’s socio-emotional skills and mental health in a cluster randomized controlled trial design with 1) an intervention group and 2) an active control group. Altogether 79 primary school participated at baseline. A multi-informant setting involves the children themselves, their parents, and teachers. The primary outcomes are measured using parent and teacher ratings of children’s socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire and the Multisource Assessment of Social Competence Scale. Secondary outcomes for the children include emotional understanding, altruistic behavior, and executive functions (e.g. working memory, planning, and inhibition). Secondary outcomes for the teachers include ratings of e.g. school environment, teaching style and well-being. Secondary outcomes for both teachers and parents include e.g. emotional self-efficacy, child rearing practices, and teacher-parent collaboration. The data was collected at baseline (autumn 2013), 6 months after baseline, and will be collected also 18 months after baseline from the same participants.DiscussionThis study protocol outlines a trial which aims to add to the current state of intervention programs by presenting and studying a contextually developed and carefully tested intervention program which is tailored to fit a national school system. Identification of effective intervention elements to promote children’s mental health in early school years is crucial for optimal later development.Trial registrationClinicalTrials.gov register: NCT02178332.