Mothers' and their children's emotional and behavioral symptom trajectories and subsequent maternal adjustment: Twenty-seven years of motherhood.

BACKGROUND: This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems). METHODS: The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers. RESULTS: We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning. LIMITATIONS: Maternal and child measures were based on maternal reports only. CONCLUSIONS: The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children.

In search of measures to improve the detection of increased cardiometabolic risk in children using second-generation antipsychotic medications.

PURPOSE: Second-generation antipsychotic medications (SGAs) are widely used in child psychiatry. SGA-induced metabolic disturbances are common in children, but monitoring practices need systematisation. The study's aims were to test an SGA-monitoring protocol, examine the distributions of metabolic measurements compared to reference values in child psychiatry patients, and determine whether using a homeostasis model for the assessment of insulin resistance (HOMA-IR) and triglyceride/high-density lipoprotein (TG/HDL) ratio could improve the detection of increased cardiometabolic risk. MATERIALS AND METHODS: A systematic monitoring protocol was implemented. Weight and height, blood pressure, fasting glucose, insulin, HDL, and TG were measured at baseline and four times during follow-up. HOMA-IR, TG/HDL ratio and zBMI were calculated. Age-, gender- and BMI-specific percentile curves for HOMA-IR were used to define elevated cardiometabolic risk. RESULTS: The study patients (n = 55, mean age 9.9 years) were followed for a median of 9 months. A disadvantageous, statistically significant shift, often appearing within the reference range, was seen in zBMI, TG, HDL, glucose, insulin, HOMA-IR, and TG/HDL ratio. The increase in HOMA-IR appeared earlier than individual laboratory values and was more evident than the TG/HDL ratio increase. An HOMA-IR cut point of 1.98 resulted in a sensitivity and specificity of 83%. Compared to a previous study performed in the same location, the monitoring rates of metabolic parameters improved. CONCLUSION: The monitoring protocol implementation improved the monitoring of metabolic parameters in child psychiatric patients using SGAs. Using HOMA-IR as part of systematic SGA monitoring could help detect metabolic adverse effects.

Current follow-up practices often fail to detect metabolic and neurological adverse reactions in children treated with second-generation antipsychotics.

AIM: This study examined the use and adverse reactions of second-generation antipsychotics (SGAs), alone or combined with other psychotropic medication, to identify areas for standardising prescribing and monitoring practices. METHODS: We conducted a retrospective study at Tampere University Hospital, Finland, involving 128 patients (81% boys) who were under 13 years old at SGA initiation and had SGA treatment between October 2013 and October 2014. RESULTS: The median age at baseline was 9.4 years. Weight gain was reported as an adverse reaction in 33%, but an increase in standardised body mass index, adjusted for age and sex (BMI z-score), was detected in 75% of patients with sufficient data. The statistically significant median changes during the study were an increase of 0.46 in BMI z-score, a reduction of 0.25 mmol/L in fasting plasma high-density lipoprotein and an increase of 0.28 mmol/L in triglyceride values. The weight gain was most apparent in patients treated with just an SGA or SGA plus melatonin. Patients treated with an SGA plus medication for attention deficit hyperactivity disorder were less likely to gain weight. CONCLUSION: SGA-induced metabolic disturbances remained partly unrecognised in children under 13 years of age and more systematic monitoring is needed.

Maternal and infant characteristics connected to shared pleasure in dyadic interaction.

The aim of the study was to analyze which maternal factors (depressive symptoms, effect of life events, maternal sensitivity and structuring) and infant characteristics (temperament, social withdrawal symptoms, interactive behavior, genotype, gender) contribute to shared pleasure (SP) in parent-infant interaction. Participants were 113 mother-infant dyads. The mothers filled in the Edinburgh Postnatal Depression Scale, the Infant Behavior Questionnaire, and the Life Events Questionnaire. The dyads were videotaped in a free-play situation, and the videos were analyzed using the Alarm Distress Baby Scale and the Emotional Availability Scales. The infants were genotyped for four genes involved in emotion regulation. The occurrence and duration of SP (SP-MD) in mother-infant interactions were analyzed from the videotapes. Higher maternal sensitivity and depressive symptoms, better infant responsiveness, and the infant having the GG variant of the gene tryptophan hydroxylase isoform 2 (TPH2) -307 were associated with the occurrence of SP. Lower level depressive symptoms, better maternal structuring, and greater infant involvement were associated with the longer duration of SP. Those dyads where the mother and infant were best able to read each other's positive cues and to respond to them were more likely to experience mutual positive affect, as seen in SP.

El propósito de este estudio fue analizar cuáles factores maternos (síntomas depresivos, efectos de eventos vividos, sensibilidad y estructuración maternas) y características del infante (temperamento, síntomas de despego social, comportamiento interactivo, genotipo, género sexual) contribuyen al placer compartido (SP) en la interacción progenitor-infante. En el estudio participaron 113 díadas madre-infante. Las madres completaron la Escala de Depresión Postnatal de Edimburgo, el Cuestionario de Comportamiento del Infante y el Cuestionario de Eventos de Vida. A las díadas se les grabó en video durante una sesión de juego libre y los videos se analizaron usando la Escala de Alarma de la Angustia del Bebé y las Escalas de Disponibilidad Emocional. A los infantes se les determinó el genotipo en el caso de cuatro genes que tienen que ver con la regulación emocional. Con base en las videograbaciones, se analizó la incidencia y duración de SP (SP-MD) en las interacciones madre-infante. Una más alta sensibilidad materna y síntomas depresivos, mejor sensibilidad por parte del infante, y el hecho de que el infante tenía la variante GG del gen TPH2 -307 se asociaron con la incidencia de SP. Síntomas depresivos de bajo nivel, una mejor estructuración materna y una mayor participación del infante se asociaron con una más larga duración de SP. Aquellas díadas en que la madre y el infante eran más capaces de comprender las señales positivas de cada uno y de responder a las mismas, estaban en mejor condición de experimentar un mutuo afecto positivo, como el que se ve en SP.

Le but de cette étude était d'analyser quels facteurs maternels (symptômes dépressifs, effet d'événements de la vie, sensibilité maternelle et structuration maternelle) et quelles caractéristiques du nourrisson (tempérament, symptômes de retrait social, comportement interactif, génotype, genre) contribuent au plaisir partagé (abrégé ici en français PP) dans l'interaction parent-nourrisson. Les participants ont consisté en 113 dyades mère-nourrisson. Les mères ont rempli l'Echelle de Dépression Postnatale d'Edinbourg, le Questionnaire du Comportement du Nourrisson, et le Questionnaire d'Evénements de la Vie. Les dyades ont été filmées à la vidéo pendant une situation de jeu libre et les vidéos ont été analysées en utilisant l'Echelle d'Alarme de Détresse du Bébé et les Echelles de Disponibilité Emotionnelle. Les nourrissons ont été génotypés pour quatre gènes impliqués dans la régulation de l'émotion. L'apparition et la durée du PP (en anglais SP-MD) dans les interactions mère-nourrisson ont été analysées à partir des vidéos. Une sensibilité maternelle plus élevée et des symptômes dépressifs, une meilleure réaction du nourrisson, le nourrisson ayant la variante GG du gène TPH2 -307 étaient liés à l'apparition du PP. Des niveaux plus bas de symptômes dépressifs, une meilleure structuration maternelle et un engagement plus important du nourrisson étaient liés à une durée plus longue du PP. Les dyades où la mère et le nourrisson étaient le plus capables de lire leurs signaux positifs réciproques et d'y répondre étaient moins à même de faire l'expérience d'une affect positif mutuel, comme on le voit dans le PP.

Associations between cooperation, reactive aggression and social impairments among boys with autism spectrum disorder.

Cooperation is a fundamental human ability that seems to be inversely related to aggressive behaviour in typical development. However, there is no knowledge whether similar association holds for children with autism spectrum disorder. A total of 27 boys with autism spectrum disorder and their gender, age and total score intelligence matched controls were studied in order to determine associations between cooperation, reactive aggression and autism spectrum disorder-related social impairments. The participants performed a modified version of the Prisoner's Dilemma task and the Pulkkinen Aggression Machine which measure dimensions of trust, trustworthiness and self-sacrifice in predisposition to cooperate, and inhibition of reactive aggression in the absence and presence of situational cues, respectively. Autism spectrum disorder severity-related Autism Diagnostic Interview-algorithm scores were ascertained by interviewing the parents of the participants with a semi-structured parental interview (Developmental, Dimensional and Diagnostic Interview). The results showed that albeit the boys with autism spectrum disorder were able to engage in reciprocation and cooperation regardless of their social impairments, their cooperativeness was positively associated with lower levels of reactive aggression and older age. Thus, strengthening inhibition mechanisms that regulate reactive aggression might make boys with autism spectrum disorder more likely to prefer mutual gain over self-interest in cooperation.

Maternal loneliness: concurrent and longitudinal associations with depressive symptoms and child adjustment.

Loneliness has potentially adverse effects on health and is often connected with depression, while maternal depression has been shown to have a harmful effect on many indicators of children's socioemotional outcomes. The prevalence of loneliness among first-time mothers and its associations with depressive symptoms, background factors, and child outcomes in middle childhood and adolescence were investigated in this longitudinal study. A sample of 122 mother-child dyads was collected from maternal health clinics in Tampere, Finland. The mothers reported their feelings of loneliness at three time points: during pregnancy and when their firstborn child was 8-9 and 16-17 years old. Maternal depressive symptoms were screened using the Edinburgh Postnatal Depression Scale (EPDS) at the same time points. The children's internalizing and externalizing problems were assessed using the Child Behavior Checklist (CBCL) and Youth Self Report (YSR) questionnaires. Some 34-38% of the mothers reported loneliness at the different study points. Maternal loneliness showed associations with dissatisfaction with life and the pair relationship, and with the presence of depressive symptoms. The mother's prenatal loneliness predicted the child's internalizing problems in adolescence. Interventions aimed at relieving loneliness should be provided for mothers at all stages of motherhood.

Estimation of occupational cosmic radiation exposure among airline personnel: Agreement between a job-exposure matrix, aggregate, and individual dose estimates.

BACKGROUND: Job-exposure matrices (JEM) are used for exposure assessment in occupational studies, but they can involve errors. We assessed agreement between the Nordic Occupational Cancer Studies JEM (NOCCA-JEM) and aggregate and individual dose estimates for cosmic radiation exposure among Finnish airline personnel. METHODS: Cumulative cosmic radiation exposure for 5,022 airline crew members was compared between a JEM and aggregate and individual dose estimates. RESULTS: The NOCCA-JEM underestimated individual doses. Intraclass correlation coefficient was 0.37, proportion of agreement 64%, kappa 0.46 compared with individual doses. Higher agreement was achieved with aggregate dose estimates, that is annual medians of individual doses and estimates adjusted for heliocentric potentials. CONCLUSIONS: The substantial disagreement between NOCCA-JEM and individual dose estimates of cosmic radiation may lead to exposure misclassification and biased risk estimates in epidemiological studies. Using aggregate data may provide improved estimates. Am. J. Ind. Med. 60:386-393, 2017. © 2017 Wiley Periodicals, Inc.

Shared pleasure in early mother-infant interaction: predicting lower levels of emotional and behavioral problems in the child and protecting against the influence of parental psychopathology.

Shared pleasure (SP) was analyzed in fifty-eight 2-month-old infants and their mothers in face-to-face interaction (T1, at 2 months). The association of SP with child's emotional and behavioral outcome at 2 years (T2) was examined. SP as a possible protecting factor in the presence of parental psychopathology also was studied. Mean duration of SP moments (SP-MD) was related to subsequent socioemotional outcome of the child: Infants of dyads with longer SP-MD showed fewer internalizing and externalizing problems 2 years later. In hierarchical linear regressions, SP-MD uniquely and significantly contributed to internalizing problems after adjusting for infant and maternal factors and mother's interactive behavior. SP protected the child against the influence of parental psychopathology. Father's mental health problems during the follow-up increased the child's risk for higher externalizing and internalizing problems, but only among children with short SP-MD at T1. Internalizing symptoms at T2 increased when moving from the category "no mental health problems" to "mental health problems in one parent" and further to "mental health problems in both parents," but this increase was found only among those with short SP-MD at T1. SP in parent-child interaction is an important feature that fosters positive psychological development and moderates the health effects of other risks such as parental psychopathology.

Long-term trajectories of maternal depressive symptoms and their antenatal predictors.

BACKGROUND: Depressive symptoms, often long-term or recurrent, are common among mothers of young children and a well-known risk for child well-being. We aimed to explore the antecedents of the long-term trajectories of maternal depressive symptoms and to define the antenatal factors predicting the high-symptom trajectories. METHODS: The sample comprised 329 mothers from maternity centers. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) antenatally and at two months, six months, 4-5 years, 8-9 years and 16-17 years after delivery. Maternal expectations concerning the baby were assessed with the Neonatal Perception Inventory (NPI). Background information was gathered with questionnaires. RESULTS: A model including four symptom trajectories (very low, low-stable, high-stable and intermittent) was selected to describe the symptom patterns over time. The high-stable and the intermittent trajectory were both predicted pairwise by a high antenatal EPDS sum score as well as high EPDS anxiety and depression subscores but the other predictors were specific for each trajectory. In multivariate analyses, the high-stable trajectory was predicted by a high antenatal EPDS sum score, a high EPDS anxiety subscore, diminished life satisfaction, loneliness and more negative expectations of babies on average. The intermittent trajectory was predicted by a high antenatal EPDS sum score, a poor relationship with own mother and urgent desire to conceive. LIMITATIONS: Only self-report questionnaires were used. The sample size was rather small. CONCLUSIONS: The results suggest a heterogeneous course and background of maternal depressive symptoms. This should be considered in intervention planning.

Feasibility of the Strengths and Difficulties Questionnaire in assessing children's mental health in primary care: Finnish parents', teachers' and public health nurses' experiences with the SDQ.

BACKGROUND: The aim of the study was to evaluate the feasibility of the Strengths and Difficulties Questionnaire (SDQ). METHOD: Following the administration of the SDQ in medical check-ups of 4-9 year-old children (n = 2 682) the involved parents, teachers and public health nurses were asked to complete a feedback questionnaire of the SDQ. RESULTS: Parents took a maximum of 10-15 minutes to complete the SDQ, and only the public health nurses reported that its use was rather burdensome. The SDQ was an age-appropriate method and it was helpful in increasing information and agreement about the child's mental health and need for support. Using the SDQ was a positive experience for parents, but they expected more dialogue with the professionals about the child's situation. The respondents criticised the questionnaire somewhat for being difficult to interpret and complete. CONCLUSIONS: The SDQ was found to be a feasible method for screening children's mental health in primary health care together with parents, teachers and public health nurses. Using the SDQ was a positive experience for parents. However, they reminded the professionals of the importance of sensitive dialogue when assessing the mental health of the child.

Reactive aggression among children with and without autism spectrum disorder.

Twenty-seven boys and eight girls with ASD and thirty-five controls matched for gender, age and total score intelligence were studied to ascertain whether boys and girls with ASD display stronger reactive aggression than boys and girls without ASD. Participants performed a computerized version of the Pulkkinen aggression machine that examines the intensity of reactive aggression against attackers of varying gender and age. Relative to the control group boys, the boys with ASD reacted with more serious forms of aggression when subjected to mild aggressive attacks and did not consider a child attacker's opposite sex an inhibitory factor. The girls with ASD, on the other hand, reacted less aggressively than the girls without ASD. According to the results boys with ASD may not follow the typical development in cognitive regulation of reactive aggression.

Cutting a long story short? The clinical relevance of asking parents, nurses, and young children themselves to identify children's mental health problems by one or two questions.

BACKGROUND AND AIMS: Assessing young children's mental health is a crucial and challenging task. The aim of the study was to evaluate the clinical relevance of asking parents, nurses, and young children themselves to identify children's mental health problems by only one or two questions. METHODS: In regular health check-ups of 4- to 9-year-old children (n = 2682), parents and public health nurses assessed by one question whether the child had any emotional or behavioral difficulties. The child completed a self-evaluation enquiry on his/her emotional well-being. A stratified proportion of the participating parents were invited to a diagnostic interview. RESULTS: Sensitivities were fairly good for the parents' (68%), nurses' (65%), and their combined (79%) one-question screens. Difficulties identified by parents and nurses were major risks (OR 10-14) for any child psychiatric disorders (P < 0.001). The child's self-evaluation was related to 2-fold to 3-fold risks (P < 0.05) for any psychiatric diagnosis, for any emotional diagnosis, and for negative situational factors. CONCLUSION: The one-question screen for parents and public health nurses together quite adequately identified the young children with mental health problems. The child's self-evaluation provided relevant and complementary information on his/her mental health and especially emotional problems.

Maternal depressive symptoms: associations with adolescents' internalizing and externalizing problems and social competence.

BACKGROUND: The negative effect of maternal depressive symptoms on child wellbeing has been quite extensively studied. There is, however, debate as to whether it is the timing, the recurrence or the chronicity of maternal depressive symptoms that puts the child's wellbeing at risk. AIMS: This study explores the associations between the timing, recurrence and the patterns of maternal depressive symptoms and adolescent psychosocial functioning. METHODS: One hundred and ninety-one mothers and 192 adolescents were followed up from the mother's pregnancy to the child's adolescence. Maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, in early and middle childhood, and at adolescence. The adolescents' outcomes were screened using Child Behavior Checklists and Youth Self Reports. RESULTS: The results indicate that the initial exposure to maternal depressive symptoms at pregnancy is associated with more externalizing problems in adolescence, 2 months postnatally with more internalizing problems, in early childhood with poorer social competence and concurrently with more externalizing problems. Combined analyses indicate that recurrent maternal depressive symptoms best explain adolescents' internalizing problems and the chronic pattern of maternal depressive symptoms externalizing problems. The chronic and intermittent patterns of maternal depressive symptoms best explained adolescents' poorer social competence. CONCLUSIONS: Recurrent or chronic maternal depressive symptoms rather than the timing predict adolescents' psychosocial problems better. The timing, however, may explain the different kinds of problems in adolescence depending on the developmental task at the time of the exposure. The findings should be noted when treating both mothers and children in psychiatric clinics and other health services.

Early physical contact between a mother and her NICU-infant in two university hospitals in Finland.

OBJECTIVE: the first aim of this two-phase study was to describe and compare, between two university hospitals, the early physical contact of mothers and their preterm or sick newborn infants in the delivery room. Secondly, the staff's perceptions of factors facilitating and promoting or impeding this contact were evaluated. Thirdly, the association between early physical contact and the initiation of breast feeding was examined. DESIGN AND SETTING: a structured survey was conducted between November 2008 and March 2009 in two university hospitals in Finland. PARTICIPANTS: in phase I, the sample consisted of all preterm or sick infants who needed NICU care and whose questionnaires were completed by labour ward staff (hospital A, n=178/185, hospital B, n=203/235). In phase II, a subsample of these infants (A, n=76, B, n=94) and their mothers who completed their questionnaires participated in the study. MEASUREMENTS: structured questionnaires developed for this study were used. FINDINGS: the implementation of early physical contact differed between the study hospitals. The infants had physical contact with their mothers more often in hospital A than in hospital B whether they were sick full-term (83% versus 58%, p<0.001) or late preterm (49% versus 34%, p=0.051). None of the very preterm infants (<32 weeks) had early physical contact in the delivery room in either hospital. An infant's unstable condition and delivery by caesarean section were the most common obstacles against early contact. There was a moderate association between early contact and the initiation of breast feeding. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: caring practices concerning early physical contact seemed to be different in the study hospitals. The obstacles impeding early contact should be re-evaluated. Guidelines might enhance early physical contact between preterm or sick infants and their mothers.

Fathers' postnatal depressive and anxiety symptoms: an exploration of links with paternal, maternal, infant and family factors.

BACKGROUND: Postnatal psychological symptoms have been studied less often in fathers than in mothers. However, recent research shows that fathers' psychopathology may have long-term effects on their children's emotional and behavioural development independently of maternal psychopathology. More research is needed on factors associated with paternal symptoms at the early stage of child development. AIMS: The aim of the study was to examine the paternal, maternal, infant and family factors associated with the occurrence of depressive and anxiety symptoms in fathers of infants. METHODS: As part of a study conducted in Tampere, Finland, on infants' social withdrawal symptoms, both parents of 4-, 8- and 18-month-old infants (n = 194) completed the Edinburgh Postnatal Depression Scale (EPDS) and general information questionnaires during routine check-ups of the infants in well-baby clinics. Parental depressive and anxiety symptoms were screened using the recommended cut-off points for this purpose (5/6 for fathers and 7/8 for mothers on the EPDS). The associations between the fathers' symptoms and paternal, maternal, infant and family factors were explored. RESULTS: Twenty-one per cent of the fathers and 24% of the mothers scored above the cut-off points for depressive and anxiety symptoms on the EPDS. Both paternal and maternal factors predicted high paternal symptom level in regression models. Infant factors were not statistically significantly associated with paternal symptoms. CONCLUSIONS: Father's psychological symptoms were associated with many facets of both parents' impaired well-being. The whole family system should be considered whenever there are concerns about either parent's psychological well-being.

Reliability of the strengths and difficulties questionnaire among Finnish 4-9-year-old children.

BACKGROUND: Early recognition of children's mental health problems calls for structured methods in front line services. The Strengths and Difficulties Questionnaire (SDQ) is a commonly used short questionnaire in screening child's mental difficulties. AIM: To test the reliability and descriptive properties of the SDQ in a community sample of Finnish 4-9-year-old children (n = 4178). METHODS: Both parents, two teachers in day-care or a teacher at school completed the SDQ. To control for possible bias, public health nurses rated their concern about every child's mental health, including non-participants. RESULTS: The internal consistencies of the SDQ total score in all informants' reports were satisfactory to good. Agreement (Spearman rho) in total scores between parents was 0.65, between parent and teacher 0.43 and between two teachers in day-care 0.81. The stability in parent's reports over 12 weeks was good. The distributions of the informant-rated scores indicated significant and clinically important gender differences, and the 80th and 90th percentiles were generally below the international cut-off points. Public health nurses reported emotional or behavioural difficulties more commonly in non-participants (12%) than in participants (7%; p < 0.001). CONCLUSIONS: The results supported earlier findings of good internal consistency, inter-rater and cross-informant agreements and test-retest of the method. However, the gender and age of the child, the number of informants and cultural differences in reporting styles affected the results and thus confirmed the need to re-evaluate the SDQ in the culture and population in question.

Autonomic arousal to direct gaze correlates with social impairments among children with ASD.

The present study investigated whether autonomic arousal to direct gaze is related to social impairments among children with autism spectrum disorder (ASD). Arousal was measured through skin conductance responses (SCR) while the participants (15 children with ASD and 16 control children) viewed a live face of another person. Impairments in social skills was assessed with the Developmental, Dimensional and Diagnostic Interview. The level of arousal enhancement to direct gaze in comparison to arousal to faces with averted gaze or closed eyes was positively associated with impairments in social skills (use of language and other social communication skills and use of gesture and non-verbal play) among children with ASD. There was no similar association among children without ASD. The role of arousal-related factors in influencing eye contact behaviour in ASD is discussed.

A longitudinal study of maternal prenatal, postnatal and concurrent depressive symptoms and adolescent well-being.

BACKGROUND: Maternal depression is known to be a risk for abnormal child development. Girls and boys have been found to respond differently to maternal depression. Although prenatal and postnatal depression has been widely studied, longitudinal studies of adolescent outcome are still rare. METHODS: The original sample of 349 mothers in this longitudinal study was collected in 1989-1990 in Tampere, Finland. At the latest stage, of the 327 contacted in 2006, 191 mothers and 192 adolescents aged 16 to 17 years participated in the study. Maternal depressive symptoms were screened using the Edinburgh Postnatal Depression Scale (EPDS) prenatally, postnatally and at the latest stage. Adolescent outcome was examined using the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR). RESULTS: Maternal concurrent depressive symptoms were associated with adolescent behavioral and emotional problems in both genders. Maternal prenatal depressive symptoms were associated with Externalizing Problems in the YSR and boys' lower Social Competence in both the CBCL and YSR. Maternal postnatal depressive symptoms were associated with boys' lower Social Competence both in the CBCL and YSR and Externalizing Problems in the YSR. LIMITATIONS: Being a longitudinal normal population sample, the number of symptomatic mothers and adolescents is relatively small and the number of drop-outs is relatively high. Clinical evaluation of mothers and adolescents is also lacking. CONCLUSIONS: Maternal prenatal and postnatal depressive symptoms are a risk to adolescent boys' wellbeing and concurrent depressive symptoms a risk for both girls' and boys' well-being. This long-term influence should be noted when treating women with depressive symptoms throughout motherhood.

Predicting internalizing and externalizing problems at five years by child and parental factors in infancy and toddlerhood.

This study examined child and parental factors in infancy and toddlerhood predicting subclinical or clinical levels of internalizing and externalizing problems at 5 years of age. Ninety-six children and their families participated. They were assessed when the children were 4-10 weeks old (T1), 2 years (T2) and 5 years old (T3). Child risks (difficult temperament, health problems, early emotional and behavioral problems), parental risks (psychopathology, parenting stress and perception of the child) and family risks (socio-economic status, quality of marital relationship and family violence) were examined. At 5 years, internalizing problems were predicted by family violence during the child's infancy and parenting stress at age 2. Externalizing problems were predicted by psychiatric problems of the mother before pregnancy and child's externalizing problems at 2 years of age. When interventions aiming at preventing emotional and behavioral problems in children are considered, these issues should be recognized early and effective intervention initiated.