Scandinavian Journal of Child and Adolescent Psychiatry and Psychology最新文献

Background: The number of immigrants has been increasing. Immigrant adolescents experience an acculturation process that affects particularly their ethnic identity, perceived discrimination, and relationships with their peers, which would have significant impact on their mental health. The ethnic composition of social environments might affect this relationship. Objective: The main purpose of the current research is to examine the effect of peer attachment, social support, ethnic identity, and perceived discrimination on immigrant adolescents' mental health. Method: The sample included 226 Syrian immigrants (X^¯ _age = 13.31, SD=1.67, 70.8 % girls). Adolescents live in a homogenous social environment where proportion of Syrian is higher. Two hierarchical regression models were used to predict depression and emotional problems. In both models, the predictive roles of social and psychological factors were examined in separate steps. Results: The regression analysis results for depression emphasized peer attachment, social support, and ethnic identity did not affect the depression after controlling the effect of emotional problems. Similarly, regression analysis results for emotional problems showed that peer attachment, social support, and ethnic identity did not affect depression after controlling the effect of emotional problems. The results also revealed that perceived discrimination was a risk factor for both depression and emotional problems. Conclusions: The results underlined the importance of psychological variables on immigrant adolescents' depression. Past research emphasized that ethnic identity and peer support had a buffering effect on mental health. The current study participants were living in a different area where they attended schools for only immigrants. The social environment was totally different from the host culture. These reasons may account for why social support from ethnic peers and ethnic identity development did not emerge as a protective factor in the present study. The results will further be discussed in terms of the importance of interaction between ethnic and host culture.

Background: Sexuality is a major facet of development during adolescence. Apace with normal sexual development, sexual experiences become more common and intimate. Recent research reports mixed results as to whether this is the case among transgender identifying adolescents. Recent research also suggests that trans youth experience negative sexual experiences (such as dating violence and sexual harassment) more often than their cisgender identifying peers. However, most studies have had clinical or selected samples.

Objective: The aim of this study is to compare the normative as well as negative sexual experiences of trans youth with their cisgender peers in the general population.

Method: Our study included 1386 pupils of the ninth year of comprehensive school in Finland, mean age (SD) 15.59 (0.41) years. We compared sexual experiences, sexual harassment and dating violence among trans youth and their cisgender identifying peers. Distributions of the outcome variables were calculated among the whole sample and by sex. Next, multivariate associations were studied using logistic regression adjusting for age, sex, honesty of responding and depression. Odds Ratios (OR) with 95% confidence intervals (CI) are given.

Results: After adjusting for age, sex, honesty of responding and ultimately for depression, normative sexual experiences of trans youth did not differ systematically from those of the mainstream, cisgender identifying youth. After adjusting for sex, age and honesty, transgender youth had increased Odds Ratios for experiences of sexual coercion and dating violence perpetration. In the final models however, no statistically significant differences were detected in the negative sexual experiences between transgender and cisgender youth.

Conclusions: Transgender identifying adolescents presented neither with delayed nor with excessively advanced sexual experiences. However, transgender youth seem to be more susceptible to subjection to sexual coercion and, unexpectedly, dating violence perpetration than their cisgender peers. However, these associations may in fact relate more closely to depression, a prevalent phenomenon among trans youth, than transgender identity itself.

Background: Little is known about the scope of problems driving referrals to child and adolescent psychiatry services. Identifying the full range of mental disorders affecting a particular child can help triage the child to a clinician with the appropriate level of expertise. The Child Behavior Checklist (CBCL) is an easy-to-use assessment tool that may provide invaluable information regarding the severity of the presenting complaints and also aid in the referral process.

Objective: To assess the utility of the CBCL to gain insights into the type of clinical problems driving referrals of youth to an outpatient pediatric psychiatry clinic.

Method: The sample consisted of 418 newly referred youth 4-18 years of age of both sexes. Parents completed the CBCL assessing psychopathology and competence. Rates of patients with elevated T-scores on each scale were calculated for the whole group and stratified by sex and age (≤12 versus >12).

Results: The CBCL identified high rates of psychopathology affecting referred youth. It also provided information on the type of suspected disorders affecting a particular child as well as their severity, critical information to guide likely differing clinical needs and therapeutic approaches. It also helped identify a high number of youth affected with multiple psychopathological conditions, likely to require a high level of clinical attention. Overall, males were significantly more impaired than females but there were no major differences between children and adolescents.

Conclusions: The CBCL can aid in the identification of individual and comorbid mental disorders affecting youth seeking mental health services by providing specific information about the presence and the severity of specific suspected disorder. These findings have implications for prioritizing scarce resources in child mental health and for improved consideration of the complexity of clinical presentations to pediatric psychiatry programs of any type.

Background: The Brief Child and Family Phone Interview (BCFPI) is a standardized intake and follow-up interview used in child and adolescent mental health services (CAMHS). Although it has shown good validity compared with other measures using parent reports, it has not yet been compared with diagnoses derived from a Longitudinal Expert All Data (LEAD) procedure, which includes information from separate diagnostic interviews with parent(s) and child. The aim was to compare the BCFPI evaluation in an outpatient child and adolescent psychiatry setting with an evaluation derived from a LEAD procedure.

Methods: At four Swedish outpatient CAMHS, 267 patients were interviewed at intake with the BCFPI. Within six weeks, patients and parents were interviewed separately with the 2009 version of the semi-structured Kiddie Schedule for Affective Disorders and Schizophrenia for School-age Children, Present and Lifetime Version (K-SADS-PL) and parents completed the Child Behavior Checklist (CBCL). LEAD diagnoses were subsequently determined by two senior clinicians based on 1.2 years of clinical records including the K-SADS-PL and ensuing information from further assessments, psychological tests, information from teachers and other informants as well as treatment outcome. The Diagnostic and Statistical Manual of Mental Disorders subscales from the CBCL and the subscales from the BCFPI were compared with LEAD diagnoses. These measured symptoms of attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, separation anxiety disorder, generalized anxiety disorder, and major depressive disorder.

Results: The criterion validity for BCFPI versus LEAD diagnoses was fair for oppositional defiant disorder (area under curve, 0.73), generalized anxiety disorder (0.73) and major depressive disorder (0.78), good for attention-deficit hyperactivity disorder (0.81) and conduct disorder (0.83), and excellent for separation anxiety disorder (0.90). The screening properties of BCFPI and CBCL were similar.

Conclusion: The BCFPI is a concise and valid tool, performed along with the larger and more established CBCL, in screening for major psychiatric disorders. It is well suited as an intake interview in CAMHS.

Background: Repetitive Negative Thinking (RNT) is a well-established predictor in adolescents of emotional problems, such as depression. Surprisingly little research, however, has looked at the relative importance of RNT vs. more interpersonally relevant variables in the context of depression, such as loneliness and lack of social connectedness.

Objective: The present study, therefore, set out to examine whether RNT is a significant predictor when taking into account the contribution of loneliness and social connectedness.

Methods: A sample of 135 typically developing adolescents (N = 135; 79.3% girls; M _age = 17.5; range 16-21) completed measures of depressive symptoms, RNT, loneliness and social connectedness at two time points with a 3-month interval.

Results: Results showed that above and beyond baseline depressive symptoms, RNT was the only other significant predictor of prospective depressive symptoms.

Conclusions: According to these results, RNT seems a relatively more important factor to consider in the context of adolescent depression than factors in the interpersonal or social context. Consequently, targeting RNT might be expected to yield more significant gains in reducing or preventing depressive symptoms in adolescents compared to focusing on feelings of loneliness or social connectedness - a hypothesis that remains to be tested.

Background: Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services that is both suitable for adolescents and in line with policy. Shared decision-making has the potential to combine user participation and evidence-based treatment. Research and governmental policies emphasize shared decision-making as key for high quality mental healthcare services.

Objective: To explore adolescents' experiences with user participation and shared decision-making in mental healthcare inpatient units.

Method: We carried out ten in-depth interviews with adolescents (16-18 years old) in this qualitative study. The participants were admitted to four mental healthcare inpatient clinics in Norway. Transcribed interviews were subjected to qualitative content analysis.

Results: Five themes were identified, representing the adolescents' view of gaining trust, getting help, being understood, being diagnosed and labeled, being pushed, and making a customized treatment plan. Psychoeducational information, mutual trust, and a therapeutic relationship between patients and therapists were considered prerequisites for shared decision-making. For adolescents to be labeled with a diagnosis or forced into a treatment regimen that they did not initiate or control tended to elicit strong resistance. User involvement at admission, participation in the treatment plan, individualized treatment, and collaboration among healthcare professionals were emphasized.

Conclusions: Routines for participation and involvement of adolescents prior to inpatient admission is recommended. Shared decision-making has the potential to increase adolescents' engagement and reduce the incidence of involuntary treatment and re-admission to inpatient clinics. In this study, shared decision-making is linked to empowerment and less to standardized decision tools. To be labeled and dominated by healthcare professionals can be a barrier to adolescents' participation in treatment. We suggest placing less emphasis on diagnoses and more on individualized treatment.

Background: The foundation of a healthy life begins in pregnancy and early adversity can have detrimental long-term consequences for affected children.

Objective: This paper examines the effects of the Incredible Years Parents and Babies program (IYPB) at one-year follow-up when offered as a universal parenting intervention to parents with newborn infants.

Method: We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to IYPB intervention (n = 76) or usual care (n = 36). The IYPB program is a group intervention with eight two-hour sessions. Follow-up outcomes collected a year after the intervention ended include parental stress, depression, well-being, reflective function, sense of competence, and child cognitive and socio-emotional development.

Results: There were no intervention effects on any of the primary or secondary parent-reported outcomes at one-year follow-up when the children were 18 months old. When examining the lowest-functioning mothers in moderator analyses, we found that mothers assigned to the IYPB group reported significantly lower scores for the interest and curiosity subscale of the parent reflective function scale than control mothers (β=-1,07 [-2.09,-0.06]).

Conclusion: We found no long-term effects of the IYPB when offered as a universal intervention for a relatively well-functioning group of parents with infants in a setting with a high standard of usual care. The intervention was developed for more vulnerable families in settings with a low level of universal care and the program may be effective for families in those circumstances.

Catatonia is a well-established psycho-motor disorder occurring in the background of various psychiatric and medical disorders. Catatonia is commonly associated with psychiatric disorders, especially affective disorders followed by schizophrenia. However, almost 20% occur in the background of different medical and neurological disorders which need to be properly examined and investigated. Catatonia is a serious medical and psychiatric emergency condition; most probably caused by alteration in GABAergic circuits and basal ganglia. If untreated, catatonia can cause life threatening complications like dyselectrolemia, respiratory aspiration, venous thromboembolism, acute renal failure and cardiac arrest because of poor oral intake, immobility and muscular rigidity. The risk of mortality or serious life threatening events further increases in cases of children and adolescents. In children and adolescents, thus, it becomes even more important to diagnose catatonia early and start appropriate treatment. Lorazepam is considered to be the first line treatment and is safe both in adults and children. But evidence is scarce for treatment of lorazepam-resistant adolescent Catatonia. In this report we discuss two adolescent patients diagnosed with catatonia with no medical or neurological disorders in the background. Neither of the patients responded to lorazepam alone or even after augmentation with second generation antipsychotic (olanzapine). Zolpidem, like lorazepam, has a positive allosteric effect on GABA A Receptors (GABAAR) and has been used in some cases successfully to treat resistant catatonia. Here we used zolpidem 30 mg/day in divided doses with marked improvement in few days in all the symptoms. Both cases were discharged on zolpidem extended release (ER) three times a day and maintained well through the next two follow ups in over a two month period. Zolpidem can be a good alternative for children and adolescents in resistant cases.

Background: Traditional bullying (or peer bullying) is considered a common and unpleasant experience among students and has serious consequences such as mental health problems and unhealthy behavior. In recent years, another type of bullying named cyberbullying has emerged as a growing problem with negative effects on school achievement, physiology, and mental health of its victims.

Objective: The purpose of this research is to examine and compare the roles of traditional and cyberbullying victimization in substance use, self-harm and suicide attempts.

Methods: This was a cross-sectional study and conducted in 2019. A total of 425 high school students were selected for the study in Kermanshah, Iran. For conducting the survey, a multi-stage cluster randomized procedure was used and 18 classes in six different high schools in three urban areas were selected. A total of 400 students (mean age 16.61 years, 53.2% girls) responded to the survey, and it provided usable information for the research. Data were analyzed through binary logistic regression analyses.

Results: The analysis results revealed that 54.2% of students (n = 217) have experienced traditional or cyber victimization. Any kind of victimization was associated with self-harm. Cyber victimization alone and the combination of cyber plus traditional victimization showed significant association with suicide and substance use. Risk of substance use, self-harm, and suicide was higher when students experienced both types of bullying than when they experienced just one kind of bullying alone.

Conclusions: The results of this study suggest that traditional and cyber victims may require immediate intervention to reduce the negative effects of victimization. Also, prevention programs should consider the possible relationship between traditional and cyber victimization and substance use, self-harm, and suicide.