Self-rated psychopathic traits in a sample of treatment-seeking adolescent girls with internalizing and externalizing disorders: comparisons to girls in the community.

BACKGROUND: Psychopathy research has thus far focused mostly on child, male, and delinquent samples, but the results are most likely non-generalizable to adolescent girls with mental health disorders. AIM: The present study aimed to compare self-rated psychopathic traits between female psychiatric outpatients and girls in the community, and to investigate how psychopathic traits relate to psychiatric disorders. METHOD: The outpatient sample comprised 163 girls aged 15-17-years recruited from municipal mental health services. Psychiatric diagnoses were assessed based on the ICD-10 classification. The community sample comprised 355 girls from secondary, vocational, and high schools. The Youth Psychopathic trait Inventory (YPI) served as a self-assessment tool. RESULTS: Treatment-seeking girls exhibit a more impulsive and irresponsible lifestyle than do girls in the community. Girls with externalizing psychopathology, unlike those with an internalizing disorder, exhibit more deficient affective experience than do girls in the community. Psychopathic traits associate with having a psychiatric disorder, a depressive disorder, ADHD, and a conduct disorder. CONCLUSIONS: The psychiatric examination of treatment-seeking adolescent girls would likely benefit from screening for psychopathy and its underlying components.

Self-assessed limited prosocial emotions do not distinguish community youth with psychosocial problems from those without them.

BACKGROUND: In DSM 5, conduct disorder was expanded with the new specifier 'with limited prosocial emotions (LPE)'. These callous-unemotional traits have been emphasized as the 'core' of psychopathy syndrome providing greater information about current and future impairment. Individuals with callous-unemotional traits have shown elevated levels of impairment, and these traits have been suggested to serve as a useful indicator for psychiatric vulnerability and psychosocial maladjustment also among community youth. AIM: The aim of this study was to investigate the prevalence of LPE in a sample of Finnish mid-adolescent community youth, and to determine whether adolescents with and without LPE differ from each other in general psychopathology. METHODS: A classroom survey was conducted among 9th graders at secondary schools (n = 446). The Antisocial Process Screening Device-Self-Report (APSD-SR) was used to assess LPE. The adolescents' general psychopathology was assessed using the Youth Self Report (YSR). RESULTS: Almost 10% of the adolescents met the criteria for LPE. Youth with LPE did not differ significantly from those without LPE on the Total Problems Score or on externalizing psychopathology. Only one statistically significant difference emerged in group comparisons; adolescents with LPE scored significantly lower on somatic complaints than their counterparts without LPE. CONCLUSIONS: LPE are a common phenomenon among community youth, and the specifier-as measured with a self-assessment-does not distinguish adolescents with psychosocial problems from those without them. More research is obviously needed to elucidate the role of LPE in juveniles.

Short report: self-reported psychopathic traits in Finnish and Dutch samples of non-referred adolescents: exploration of cultural differences.

BACKGROUND: Culture-related differences in psychopathic traits have been reported for adults, but for adolescents such knowledge is lacking. The aim of this cross-national study was to compare self-reported psychopathic traits between Finnish and Dutch samples of mid-adolescent community youth. METHODS: The Youth Psychopathic traits Inventory (YPI) was filled in by 372 Finnish and 474 Dutch 15- to 16-year-old pupils. As gender-specific differences exist in psychopathic traits, we analyzed the data separately for boys and girls. RESULTS: Dutch boys scored significantly higher than Finnish boys on total and all dimensional scores of the YPI as well as on most sub-dimensional scores. Dutch girls scored significantly higher than Finnish girls on the Affective dimension and on the two corresponding sub-dimensions: remorselessness and callousness. Finnish girls scored significantly higher on grandiosity, which loads to the Interpersonal dimension of the YPI. CONCLUSIONS: Our findings suggest that culture influences the manifestation of psychopathic traits already in adolescence and that this relation is more prominent in boys.

Self-reported psychopathic traits among non-referred Finnish adolescents: psychometric properties of the Youth Psychopathic traits Inventory and the Antisocial Process Screening Device.

BACKGROUND: In general psychiatric services, cost-benefit screening instruments for psychopathic traits in adolescents are needed. The aim of the present study was to study the psychometric properties of the Finnish versions of the Youth Psychopathic traits Inventory (YPI) and the Antisocial Process Screening Device (APSD-SR) in community youth. As gender-specific differences exist in psychopathic traits, we analyzed the data separately in girls and boys. METHODS: The YPI and the APSD-SR were administered to 372 9th graders (174 boys and 198 girls) with a mean age of 15.06 years (SD 0.28). Cronbach's alphas were used to study internal consistency. The factor structures of the self-assessments were studied using both Confirmatory Factor Analysis (CFA) and Principal Component Analysis (PCA). RESULTS: In both self-assessments, boys scored significantly higher in the total scores, Interpersonal and Affective dimension scores as well as in most sub-dimensions. In the YPI, the alpha values for total and dimensional scores ranged from 0.55 to 0.91 in boys and from 0.74 to 0.89 in girls and, in the APSD-SR, respectively, from 0.38 to 0.78 and from 0.29 to 0.78. In CFA, the three-factor model produced poor fit for both self-assessments. For the ten sub-dimensions of the YPI, the PCA suggested two factors. Extending the model into three components showed sub-dimension loadings according to the original dimensions. For the APSD-SR, the PCA revealed a five-factor structure in the male sample and a six-factor one in the female group. When limiting the model to a three factor- model, we obtained a structure, which resembled the original dimensions. CONCLUSIONS: Both the YPI and the APSD-SR are promising tools of screening for psychopathic features in Finnish community youth. The YPI turned out to be slightly better than the APSD- SR in both reliability and factor structure. However, the original three-factor models did not find support. Both self-assessments were somewhat weak for tapping the callous-unemotional traits of the psychopathic character, but, again, the YPI worked better than the ASPD-SR. Both self-assessments revealed significant gender differences in psychopathic character traits.

A comparison of two hospital districts with low and high figures in the compulsory care of minors: an ecological study.

BACKGROUND: The last decade in Finland has seen a vast increase both in involuntary psychiatric treatment of adolescents and in the numbers of adolescents taken into care under the Child Welfare Act. Moreover, the variation in figures between different hospital districts is remarkable. The reasons for this are not known, but it cannot be due to variation in the epidemiology of mental disorders in minors. AIM: The aim of the study was to explore features associated with compulsory care of adolescents at regional level by comparing two hospital districts clearly differing in this regard. The characteristics of involuntarily treated adolescents and adolescents taken into care, the resources and structures of adolescent psychiatric services and child welfare services, and the environmental factors associated with adolescent well-being and adaptation, such as indicators of social deprivation of families were all considered. MATERIALS AND METHODS: For the present study, 2 out of the 22 hospital districts in Finland were selected, one using compulsory psychiatric care and taking into care of 13-17-year olds above and the other below the average in Finland. Register data on patient characteristics, services, and social deprivation were used. Absolute and population adjusted figures (95% confidence intervals) from the variables are given. The differences in incidences between health care districts were compared using Poisson regression analysis. RESULTS: Proportions of divorces, single parent families, social exclusion and outpatient mental health service use, and detoxification treatment use of adults were higher in the health care district with above average coercion figures than in the area with below average coercion figures. The numbers of adolescent psychiatric outpatient visits were higher in the health care district with coercion figures below average despite the fact that the number of positions in adolescent outpatient services was lower than in the health care district with above average coercion figures. CONCLUSION: Factors other than the characteristics of the adolescents themselves are associated with use of compulsory care on them, although an ecological study design cannot establish causality.

The involuntary treatment of adolescent psychiatric inpatients--a nation-wide survey from Finland.

This national cross-sectional study investigates the prevalence rates, regional differences and factors associated with the involuntary inpatient treatment of adolescents in Finland on a chosen day in 2000. The proportion of inpatients with involuntary legal status was 29.5% (n=82) giving a prevalence rate of 2.5 per 10,000/12-17 years old inhabitants. Forty-eight per cent of involuntarily inpatients were 16-17 years old and 62% had psychotic disorders. Twenty-six per cent of inpatients with involuntary legal status were voluntarily admitted. Regional differences of involuntary treatment were rather modest. Psychotic disorders, suicidal acts, and substance use disorders were independently associated with involuntary legal status. There is a need for further studies to investigate the long-term effects of involuntary treatment on the adolescents' subsequent well-being. Further studies on alternatives methods for involuntary treatment are warranted, likewise the clinical guidelines for involuntary treatment practices.

Increase in involuntary psychiatric treatment and child welfare placements in Finland 1996-2003. A nationwide register study.

BACKGROUND: Emotional and behavioural problems are common in young people and mental health problems are frequently intertwined with social problems. Both involuntary psychiatric treatment and taking into care may be used in order to manage youth behavioural problems. Compulsory interventions always endanger violating basic civil rights and therefore careful monitoring of them is warranted. AIM: The aim of this study was to evaluate trends in Finland in involuntary psychiatric inpatient treatment and taking into care 12- to 17-year-old adolescents from the mid-1990s to the early 2000s. METHOD: A nationally representative retrospective register study of the period 1996-2003 using the hospital discharge register and child welfare register in Finland. RESULTS: Both types of compulsory interventions increased vastly during the study period. The numbers of involuntary psychiatric treatment periods and child welfare placements of adolescents varied considerably in relation to each other, and across different regions of the country. CONCLUSIONS: As there is no evidence of a vast increase in mental disorders or serious behavioural problems in young people, there is an obvious need for further research on reasons of the significant increase in the use of coercion and for the wide regional variation. Possible explanations discussed are different service structures and treatment cultures.