Association between parent mental health and paediatric TBI: epidemiological observations from the 1987 Finnish Birth Cohort.

BACKGROUND: This study examined whether parental mental illness has implications for child risk for traumatic brain injuries (TBI). METHOD: Data on 60 069 Finnish children born in 1987 and their parents were examined for demographic and mental health-related variables in relationship with paediatric TBI. Altogether, 15 variables were derived from the cohort data with ICD-10 F-codes being available for mental health diagnoses for all parents. Bivariate and multivariate analyses were carried out using inpatient and outpatient diagnoses of child TBI. RESULTS: Paternal disorders due to psychoactive substance use (F10-F19) was associated with an increased inpatient TBI (OR=1.51; CI=1.07 to 2.14). Mood disorders (F30-F39) were associated with higher rates of outpatient TBI (OR=1.42; CI=1.06 to 1.90). Paternal personality and behavioural disorders (F60-F69) were linked with a twofold increase in risk across both categories of child TBI (OR=2.35; CI=1.41 to 3.90) and (OR=2.29; CI=1.45 to 3.61), respectively. Among the maternal mental health factors associated with child TBI, schizophrenia and other non-mood psychotic disorders (F20-F29) were associated with an increase in inpatient traumatic brain injuries (iTBI) (OR=1.78; 1.22 to 2.59). Mothers having mood disorders (F30-F39) were more likely to have had a child who experienced an iTBI (OR=1.64; CI=1.20 to 2.22). Mothers with personality and behavioural disorders (F60-F69) were also found to have had children with an increased risk for iTBI (OR=2.30; CI=1.14 to 3.65). CONCLUSION: Taken together, these data should call attention to methods and strategies designed to augment and support caregiving environments with modalities that can foster mutually supportive households in cooperation with parents who have been diagnosed with a mental disorder.

Associations of social support and alexithymia with psychological distress in Finnish young adults.

The positive influence of social support on psychological wellbeing is well documented but the research among young adults is scarce. Additionally, it is still unclear what type of social support explains the positive influence in this age group. Alexithymia has been linked to lacking social support and higher levels of psychological distress, but the underlying mechanisms are not well known. We aimed to assess the association of social support and alexithymia with psychological distress in a sample of young adults. The non-clinical sample comprised 316 young Finnish adults (mean age 23 years). Psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12), alexithymia was measured with the Toronto Alexithymia Scale (TAS-20) and social support with the Multidimensional Scale of Perceived Social Support (MSPSS). The associations were assessed using regression analyses. The TAS-20 (p = 0.002) and MSPSS (p = < 0.001) total scores were significantly associated with the GHQ-12 scores even after adjustment for sociodemographic variables. For the model with the TAS-20 and MSPSS subscales, the Difficulty Identifying Feelings subscale score of the TAS-20 scale (p < 0.001) and the Family subscale score of the MSPSS scale (p = 0.010) were significantly associated with the GHQ-12 scores. Our results show that low social support and high levels of alexithymia are associated with increased psychological distress both in females and males. Perceived social support from family explained the association between social support and psychological distress to a significant extent. Regarding alexithymia, the association with psychological distress was mainly related to difficulties identifying feelings.

Pediatric TBI in Finland: An examination of hospital discharges (1998-2012).

BACKGROUND: Traumatic brain injury constitutes a persistent health problem among pediatric populations worldwide and is often referred to as a silent epidemic. There remains a paucity of scientific exploration with regard to understanding the ecological risk profiles of well-defined populations. In Finland, the healthcare system covers all hospitals, provides uniform access to care and has a universal surveillance system that allows for epidemiological examination of a wide variety of health issues. The present study aims to clarify the incidence, type and geographical presentation of pediatric TBI in Finland. METHODS: We utilized the National Hospital Discharge Register (NHDR) to prospectively identify all new cases of TBI among persons aged 18 years or younger between 1998 and 2012. Incidence rates were computed as average annual rates per 100,000 person years (py). RESULTS: During the study period 1998-2012, 21,457 children and adolescents were hospitalized for TBI. The cumulative incidence rate for the entire period was 99/100,000. Males were approximatively 1.5 times more likely to have sustained a TBI and had consistently higher rates during each year under study. Concussions were the most common form of TBI (92.9/100,000 person years), with diffuse brain injuries being the second most common (8.7/100,000 py). Diagnostic trends differed markedly with southern Finland experiencing the lowest rates of TBI when adjusted for population size. CONCLUSIONS: TBI are serious and potentially disabling conditions. The elevated levels of pediatric TBI in Finland warrant increased attention.

[Problems in the development of emotional expression--dictated by temperament or environment?]. / Tunneilmaisun kehittymisen ongelmat--temperamentin vai ympäristön sanelemaa?

Learning of emotional regulation skills is based on parent-child interaction. The difficulty in recognition and expression of emotions, along with outsourced thinking and weak imagination are collectively termed alexithymia, the inability to express emotions. Temperament has been shown to account for 20 to 40% in the development of alexithymia. Alexithymia has been found to be associated with introversion, negative emotionality and avoidance of problems, and an insecure affectional tie. Attachment theory is based on early interaction, the establishment of which in turn reflects the temperament features of the child and the parent, and differences in these features.

Outcomes from mild and moderate traumatic brain injuries among children and adolescents: A systematic review of studies from 2008-2013.

AIM: To systematically review existing empirical evidence concerning neuropsychological, psychosocial and academic outcomes following mild and moderate TBI during childhood and adolescence. METHOD: The studies reviewed include data on 8553 children and adolescents from ages 0-18 that experienced mild and moderate TBIs. A literature search using MeSH terms for 'children' cross-referenced with terms associated with 'head injuries' and 'cognition' was conducted using Pubmed, CINAHL Plus and Scopus databases as well as other data sources to retrieve grey literature results. Articles published between 1 January 2008 and 22 April 2013 were included. RESULTS: Fifty-five studies were included in the review, with multiple studies including information on both mild and moderate TBI; 46 studies focused on mild TBI outcomes and 22 studies focused on moderate TBI outcomes. The majority of outcomes were described as psychosocial (50%) or neuropsychological (40%); 51% of studies presented adverse outcomes. CONCLUSIONS: The results suggest that not all children with mild or moderate TBI recover without long-term problems. Few studies followed children and adolescents with mild TBIs for extended periods of time, although it is clinically important to monitor patients over time.

Development of alexithymic personality features.

The purpose of this paper is to review the current literature regarding the development of alexithymic personality features. Modern brain imaging technologies provide interesting data on the associations of alexithymia with different aberrations in brain function related to emotion regulation; however, the development of these deviations is poorly understood. A notable amount of research covers the relation of alexithymia to different environmental factors. Many of these associations, for example, with low socio-economic status and general psychopathology in childhood, are well established. However, the retrospective and cross-sectional designs commonly used in these studies, as well as the use of self-report measures, hinder the ability to firmly establish causality. Certain individual developmental factors, such as lagging speech development and congenital cardiac malformations in childhood, have been associated with the development of alexithymia. Regarding the stability of alexithymia, a systematic review of the literature was conducted for this paper. In addition to being characterized as a personality feature in the general population, alexithymia also clearly has a state-like dimension that results in increases and decreases in alexithymic features in conjunction with mental disorder symptoms. An essential question is whether the alexithymic features in adulthood are, in fact, infantile features of a restricted ability to identify and describe emotions that simply persist in individuals through adolescence to adulthood. To firmly establish the roots of alexithymia development, longitudinal studies, particularly in younger populations, are needed. Furthermore, multifaceted study settings are encouraged.

Does alexithymia expose to mental disorder symptoms in late adolescence? A 4-year follow-up study.

OBJECTIVE: To investigate the possible causal link between alexithymia and the emergence of anxiety and depression symptoms, as well as alcohol consumption in a sample of late adolescents. METHOD: The nonclinical sample comprised late adolescents (n = 315), including both females (n = 256) and males (n = 59). The follow-up period was 4 years, and at baseline, the mean age of the subjects was 19 years (range 17-21 years). Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), depression symptoms with the short form of the Beck Depression Inventory (RBDI), anxiety with the State-Trait Anxiety Inventory (STAI) and alcohol consumption with the Alcohol Use Disorders Identification Test (AUDIT). The three TAS-20 subscales were assessed separately. Linear and cumulative logistic regression analyses were used for the evaluation of associations, and the analyses were adjusted with the corresponding baseline scores. RESULTS: The TAS-20 total and subscale scores did not predict the RBDI or AUDIT scores at follow-up. However, the TAS-20 subscale "difficulty identifying feelings" was significantly associated with both STAI-State (P = .007) and STAI-Trait (P = .004) scores at follow-up. CONCLUSIONS: Alexithymic features may be individual predictors of later anxiety symptoms. The significant differences between the various dimensions of alexithymia should be considered in future studies.

Stability of alexithymia in late adolescence: results of a 4-year follow-up study.

The aim of the present study was to assess the stability of alexithymia in adolescents and the effects of parental factors and social support thereon. The sample comprised 315 late adolescents, of whom 259 were female and 56 male. At baseline, the mean age of the subjects was 19 years (range 17-21 years). The follow-up period was 4 years (2008-2012). The 20-item Toronto Alexithymia Scale (TAS-20) was used for the assessment of alexithymia both at baseline and follow-up. The Multidimensional Scale of Perceived Social Support (MSPSS) and the Parental Bonding Instrument (PBI) were used as measures at baseline. Regarding absolute stability, the changes in the TAS-20 total scores and two subscales (DIF and EOT) were statistically significant but the effect sizes for the changes were small (Cohen׳s d 0.21-0.24). The test-retest correlations for the TAS-20 total and subscale scores were high (ρ=0.50-0.64, P<0.001), indicating relative stability. While several parental and social support variables were associated with alexithymia at baseline, low social support from friends was the only to predict higher alexithymia at follow-up. Alexithymia is a stable personality trait also in late adolescence. Low social support from friends is related to alexithymia in young adulthood.

Developing an internet-based support system for adolescents with depression.

BACKGROUND: Depression is the most common mental health problem among adolescents. Despite policy guidance and governmental support to develop usable mental health services, there is still a lack of easily accessible and modern interventions available for adolescents in Finland's majority official language. OBJECTIVE: Our objective was to develop a user-friendly and feasible Internet-based support system for adolescents with depression. METHODS: The Internet-based support system for adolescents with depression was developed. To create this new intervention, some examples of existing interventions were studied, the theoretical basis for the intervention was described, and the health needs of adolescents identified. As an outcome of the process, the results were combined and the content and delivery of a new intervention will be described here. RESULTS: Six individual weekly Internet-based support sessions were delivered by a tutor over a 6-week period of time and developed to form an intervention called Depis.Net. This was an Internet-based support system for adolescents with depression tailored to improve self-management skills and increase awareness of their own well-being and mental health. The intervention was accessible via an electronic platform, which was secured and password protected for users. The intervention on the Depis.Net website consisted of elements identifying adolescents' needs, and offering self-monitoring, access to health information and self-reflective written exercises. An educated nurse tutor gave written feedback to each adolescent via the electronic platform. CONCLUSIONS: An Internet-based support system for adolescents with depression was developed using a systematic approach with four steps. This was done to ensure that the intervention had a sound theoretical background and at the same time caters flexibly for the problems that adolescents commonly face in their daily lives. Its potential for adolescents visiting outpatient clinics will be evaluated in the next phase by means of a randomized controlled trial.

Deficit in speech development at the age of 5 years predicts alexithymia in late-adolescent males.

OBJECTIVE: Assessment of the etiology of alexithymia is in most studies hindered by recall bias. The aim of the present study was to assess the significance of individual developmental factors at the age of 5 years for alexithymia in late adolescence. By using data from a child welfare center check-up at the age of 5 years, it was possible to avoid recall bias. METHODS: The sample consisted of 723 subjects who were comprehensively examined at the age of 5 years at a child welfare center where their state of health and verbal, gross motor, visuomotor, socioemotional, and cognitive development were assessed. In late adolescence (mean age, 19 years) their alexithymic features were measured using the 20-item Toronto Alexithymia Scale. RESULTS: In females, none of the developmental factors remained associated with later alexithymic features in the multivariate analyses. However, in males, emphasis on the variables measuring speech development was important. In particular, a variable measuring the ability to comply with multipart instructions, thus receptive language skills, was strongly related with alexithymic features in late adolescence. CONCLUSION: The results suggest that speech development is a significant factor in the developmental process of alexithymia, at least in males. It is possible that children who have impaired language skills and therefore struggle in social situations have a higher risk of developing alexithymia. This emphasizes the need for further research to assess how the inadequate speech development predisposes to the emergence of alexithymic features and whether it is a sex-specific phenomenon.

The role of gender, affectivity and parenting in the course of disordered eating: a 4-year prospective case-control study among adolescents.

BACKGROUND: Prolonged eating disturbances increase the risk for a full-blown eating disorder and lifelong health impairment. Screening will improve early detection of eating pathology, but the major question still remains: who will benefit from early treatment and who needs little or no intervention. To answer this question, information about the factors that predict the course of disordered eating is valuable. OBJECTIVES: To investigate the course of eating disturbance from middle to late adolescence, to test certain individual and parental factors potentially explaining the differences in the course of eating disturbance, and to estimate the predictive power of these factors in terms of the recurrence of eating disturbance and the onset of new presentations of eating pathology after mid-adolescence. DESIGN: A four-year follow-up study with a case-control design. SETTINGS: School health care and community settings in south-western Finland. PARTICIPANTS: Students who had reported eating disturbance at baseline (n=208, response rate 69%) and a group of non-symptomatic controls (n=514, response rate 81%) were enrolled and matched by school, grade, and gender. METHODS: At baseline assessment, mid-adolescent students (mean age 14.9 years) self-administered the SCOFF eating disorder questionnaire as part of their regular health examination. Background information, including self-reported mood questionnaire RBDI, was obtained from the students' health care records. Four years later, the participants (mean age 19.0 years) responded to the questionnaire by mail. Logistic regression analyses were used to assess the recurrence and onset of eating disturbance and the associated factors. RESULTS: Altogether 52% of girls and 17% of boys who reported eating disorder symptoms in the baseline assessment remained symptomatic at follow-up. Depressiveness--even transient--in mid-adolescence predicted recurrence of eating disturbance in late adolescence. Prolonged dissatisfaction with appearance predicted the onset of eating disturbance in previously symptom-free girls. In general, experience of average parenting was good enough for the girls in terms of recovering from eating disturbance and avoiding the onset of eating problems after mid-adolescence. CONCLUSIONS: Adolescent girls who report both eating disturbance and negative affectivity may benefit from extra support. The beneficial role that parents may have in helping these girls must not be forgotten.

Does perceived social support and parental attitude relate to alexithymia? A study in Finnish late adolescents.

The aim of the present study was to explore the associations of perceived social support and parental attitude with alexithymia in a Finnish adolescent population sample. Of the initial sample of 935 adolescents, 729 (78%) answered the questionnaire and formed the final sample. The mean age of the subjects was 19 years (range 17-21 years). The 20-item Toronto Alexithymia Scale (TAS-20) was used for assessment of alexithymia. Perceived social support from family, friends, and significant other people was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Perceived parental care and overprotection were assessed using the Parental Bonding Instrument (PBI), and separately for mother and father. After controlling for the sociodemographic factors, alexithymia was significantly associated with a lower degree of experienced social support and higher parental overprotection both in females and males. Maternal overprotection was associated (p<0.04) with TAS-20 total score as well as the Difficulty Identifying Feelings (DIF) and Difficulty Describing Feelings (DDF) subscales. The lack of social support from friends appeared to predict alexithymia more strongly than lack of support from family and significant other people. Against our hypothesis, maternal and paternal care was not directly associated with alexithymic features. This study highlights the significance of intrusive and overprotective parental attitudes as a possible risk factor for development of alexithymia. However, to assess causality, we need longitudinal studies. The results also emphasize the need for further studies to establish the significance of peer relationships in the development of alexithymia.

Alexithymia and eating disorder symptoms in adolescents.

An increasing amount of evidence indicates an association between alexithymia and eating disorder symptoms. This possible association was evaluated in a non-clinical sample of late adolescents. Seven hundred and twenty nine adolescents completed the questionnaire and formed the final sample. Alexithymia was measured using the 20-item Toronto Alexithymia Scale and eating disorder symptoms were assessed using the SCOFF questionnaire. The rate of alexithymia was 8.2%, without any gender difference. The mean SCOFF scores differed significantly between alexithymic and non-alexithymic subjects, and the share of SCOFF positive subjects was significantly higher among alexithymics. The results suggest that eating disorder symptoms are more common in alexithymic adolescents.

Alexithymia is associated with anxiety among adolescents.

BACKGROUND: The aim of this study was to explore the possible association between alexithymia and anxiety in a non-clinical sample of late adolescents. METHODS: The questionnaire was sent to 935 adolescents of whom 729 (78%) responded, thus forming the final sample. The mean age of the subjects was 19 years (range 17-21 years). The Finnish versions of the following scales were used: the 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, and anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI). Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT), and depression symptoms were evaluated using the short form of the Beck Depression Inventory, as modified by Raitasalo (RBDI). RESULTS: The prevalence of alexithymia in the sample was 8.2%, with no statistically significant gender difference. The alexithymic subjects had significantly (p<0.001) higher mean STAI scores than the non-alexithymic subjects. A vast majority of the alexithymic subjects were highly anxious, in contrast to the low proportion among the non-alexithymic subjects. The highly anxious alexithymic subjects differed statistically and significantly from the highly anxious non-alexithymic subjects, with higher scores both in the AUDIT and the RBDI. LIMITATIONS: The results are based on self-reported material alone and the cross-sectional design used in this study precludes the assessment of causal links. CONCLUSIONS: The results suggest that anxiety symptoms are independently associated with alexithymia among late adolescents in general population.

Uncovering hidden eating disorders using the SCOFF questionnaire: cross-sectional survey of adolescents and comparison with nurse assessments.

BACKGROUND: The majority of individuals with an eating disorder remain undetected in healthcare. To improve the situation, screening for eating disorder symptoms is suggested to be a routine part of the health examination of adolescents. Given the busy practice of school healthcare, the screening tool needs to be brief and efficient. OBJECTIVES: To evaluate the feasibility of the Finnish version of the SCOFF questionnaire in screening for eating disorder symptoms among adolescents. DESIGN: A natural design with cross-sectional surveys. SETTING: School healthcare in a major city in southwestern Finland. PARTICIPANTS: Students, aged 14-16 years, attending the 8th grade (n=1036, response rate=71%) and the 9th grade (n=855, response rate=62%) at Finnish-speaking secondary schools during the academic years 2003-2005, and their school nurses (n=14). Adolescents attending special classes for those with learning disabilities were excluded from the study. METHODS: Students self-administered the SCOFF questionnaire as part of a health examination. Background information was obtained from the students' healthcare records. Data from school nurses were collected with semi-structured questionnaires designed for this study. Confirmatory factor analysis was used to identify the best factor model of SCOFF for girls and boys. Descriptive statistics were used to assess the efficiency of SCOFF in comparison with established health examination practice for the purpose of detecting potential eating disorder cases among adolescents. RESULTS: Confirmatory factor analyses indicated a good fit of both the unidimensional and a two-factor model of SCOFF and yielded support for the gender-free interpretation of the screening results in mid-adolescent populations. Altogether 81% of the students who self-reported eating disorder symptoms in SCOFF remained undetected in a health examination where no eating disorder questionnaire was used. CONCLUSIONS: SCOFF was found to be an appropriate instrument for screening for eating disorder symptoms in mid-adolescent populations within school healthcare. It may be a useful tool for detecting disordered eating, especially when no objective features of eating disorders appear. However, screening shall not replace a health examination but it is recommended to include it to health examinations so as to best take advantage of both procedures.

Towards understanding gender differences in disordered eating among adolescents.

AIMS AND OBJECTIVES: The aim of the study was to enhance the detection of disordered eating in adolescents. The objectives were to examine gender differences in the prevalence of eating disorder symptoms, in occurrence of health-risk factors and susceptibility to these and to investigate associations between health-risk factors and eating disorder symptoms. BACKGROUND: Disordered eating has a strong female preponderance. Reasons for the gender discrepancy are not well known. However, to develop effective strategies for eating disorder prevention, we need to understand gender differences in disordered eating and the related factors. DESIGN: This is a school-based, cross-sectional cohort study with a natural design. METHODS: The SCOFF and the R-BDI questionnaires were administered to students (14-15 years old) attending the eighth grade of secondary school. Information about health-risk factors was obtained from the adolescents' school health-care records. RESULTS: The results were based on data from 1036 (71% of the sample) students. Self-reported eating disorder symptoms were prevalent in 24% of the girls and 16% of the boys. Girls reported many of the health-risk factors studied at a higher rate than boys. However, there were no gender differences in susceptibility to these factors. Dissatisfaction with appearance or weight, use of tobacco, lack of regular meals and poor communication with parents increased the likelihood of eating disorder symptoms in both genders. CONCLUSIONS: Gender differences in disordered eating are relatively small in adolescence. To enhance the detection of eating disorder symptoms, both girls and boys should be screened for these problems in secondary school. RELEVANCE TO CLINICAL PRACTICE: The results can help nurses to use the information obtained from adolescents' health-care records, their annual health examinations and their responses to the SCOFF questionnaire to identify those who need further intervention, including adolescent boys.

Adolescents with fluctuating symptoms of eating disorders: a 1-year prospective study.

AIM: This paper is a report of a study to investigate the stability of self-reported eating disorder symptoms, factors associated with them and the predictors of their recurrence. BACKGROUND: In western cultures, eating-related problems during adolescence are common but usually temporary. However, in approximately 10% of cases disordered eating is sustained, increasing the risk of a full-blown eating disorder. To distinguish adolescents with temporary eating problems from those whose problems are likely to continue, healthcare providers need to understand the progress of disordered eating and the features of high-risk adolescents. METHODS: The two-stage prospective survey was conducted with a school-based sample of adolescents aged 15-17 years. At baseline, in 2003-2004, the SCOFF ('Sick', 'Control', 'One', 'Fat' and 'Food') questionnaire was administered to students in the 9th year of schooling in Finland. Follow-up assessment took place 1 year later, and 372 students provided data at both assessments. Binary logistic regression analysis was performed to investigate which factors predict the recurrence of eating disorder symptoms, defined as the occurrence of eating disorder symptoms at both assessments. RESULTS: Five per cent of the students reported eating disorder symptoms at both assessments. Typically, they had multiple psychological problems and health complaints. Anxiety perceived earlier in adolescence resulted in an estimated odds ratio of the logistic model of 20 for the recurrence of eating disorder symptoms. CONCLUSION: Earlier anxiety rather than dissatisfaction with appearance had a statistically significant effect on the progress of eating problems. Longitudinal research is needed to confirm the results. Until further knowledge is available, nurses should follow-up all adolescents with disordered eating to identify a possible need for intervention.