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Bracké K, Steegers C, van der Harst T, Pons R, Legerstee J, Dierckx B, de Nijs P, Bax-van Berkel M, van Elburg A, Hekkelaan M, Hokke J, de Jong-Zuidema H, Korthals Altes L, Lengton-van der Spil F, Luijkx J, Schuurmans F, Smeets C, van Wijk L, Woltering C, Vernooij M, Hillegers M, White T, Dieleman G. The implications of the COVID-19 pandemic on eating disorder features and comorbid psychopathology among adolescents with anorexia nervosa and matched controls: a comparative cohort design study. Eat Weight Disord 2024; 29:13. [PMID: 38347293 PMCID: PMC10861646 DOI: 10.1007/s40519-024-01640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE To examine implications of the COVID-19 pandemic on eating disorder (ED) features and psychopathology in female adolescents with anorexia nervosa (AN). METHOD In total 79 females with first-onset AN (aged 12-22 years) were included and were followed up across a period of 1 year. We assessed AN participants recruited pre-pandemic (n = 49) to those recruited peri-pandemic (n = 30). Pre- (n = 37) and peri-pandemic (n = 38) age-, and education-matched typically developing (TD) girls (n = 75) were used as a reference cohort. ED features and psychopathology were assessed at baseline. After 1 year of follow-up the association between pandemic timing and clinical course was assessed. Analyses of covariance were used to examine differences in ED features and psychopathology. RESULTS Peri-pandemic AN participants experienced less ED symptoms at baseline compared to pre-pandemic AN participants. In particular, they were less dissatisfied with their body shape, and experienced less interpersonal insecurity. In addition, the peri-pandemic AN group met fewer DSM-IV criteria for comorbid disorders, especially anxiety disorders. In contrast, peri-pandemic AN participants had a smaller BMI increase over time. In TD girls, there were no differences at baseline in ED features and psychopathology between the pre- and peri-pandemic group. CONCLUSION Overall, peri-pandemic AN participants were less severely ill, compared to pre-pandemic AN participants, which may be explained by less social pressure and peer contact, and a more protective parenting style during the pandemic. Conversely, peri-pandemic AN participants had a less favorable clinical course, which may be explained by reduced access to health care facilities during the pandemic. LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Katrien Bracké
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Cathelijne Steegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Tess van der Harst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Rozemarijn Pons
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Jeroen Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Pieter de Nijs
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | | | - Annemarie van Elburg
- Altrecht-Rintveld, Mental Health Care Organisation for Eating Disorders, Zeist, The Netherlands
| | - Marion Hekkelaan
- Department of Pediatrics, Het Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Joke Hokke
- Emergis-Ithaka, Mental Health Care Organisation for Child and Adolescent Psychiatry, Kloetinge, The Netherlands
| | - Hetty de Jong-Zuidema
- GGZ Delfland, Mental Health Care Organisation for Child and Adolescent Psychiatry, Delft, The Netherlands
| | - Lucas Korthals Altes
- LUMC-Curium, Mental Health Care Organisation for Child and Adolescent Psychiatry, Leiden, The Netherlands
| | - Farida Lengton-van der Spil
- Department for Eating Disorders, Emergis, Organisation for Mental Health and Well-Being, Goes, The Netherlands
| | - Judith Luijkx
- GGZ Westelijk Noord Brabant, Mental Health Care Organisation for Child and Adolescent Psychiatry, Roosendaal and Bergen Op Zoom, Bergen Op Zoom, The Netherlands
| | - Femke Schuurmans
- Department of Pediatrics, The Bravis Hospital, Bergen Op Zoom, The Netherlands
| | - Carien Smeets
- Department of Pediatrics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Lia van Wijk
- Department of Pediatrics, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Claire Woltering
- Department of Pediatrics, Het Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Meike Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Section on Social and Cognitive Developmental Neuroscience, National Institutes of Mental Health, Bethesda, MD, USA
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3015 GD, Rotterdam, The Netherlands.
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Appleton R, Canaway A, Tuomainen H, Dieleman G, Gerritsen S, Overbeek M, Maras A, van Bodegom L, Franić T, de Girolamo G, Madan J, McNicholas F, Purper-Ouakil D, Schulze UME, Tremmery S, Singh SP. Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison. BMJ Ment Health 2023; 26:e300814. [PMID: 37879676 PMCID: PMC10603405 DOI: 10.1136/bmjment-2023-300814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Young people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little is known about the predictors of transitioning to adult mental health services (AMHS), and associated healthcare and societal costs as young people cross the transition boundary. OBJECTIVE To conduct a secondary data analysis exploring predictors of transitioning or falling through the gap and associated costs. METHODS Data were used from a longitudinal study, which followed young people from seven European countries for 2 years after reaching their CAMHS boundary. Predictors of transitioning (including sociodemographic and clinical variables) and longitudinal resource use were compared for 488 young people who transitioned to AMHS versus those who fell through the gap. FINDINGS Young people were more likely to transition to AMHS if they were severely ill. Those from Italy, the Netherlands and the UK were more likely to fall through the gap than transition to AMHS. Healthcare costs fell for all young people over the study, with a sharper decrease for those who fell through the gap. CONCLUSIONS Total healthcare costs fell for all participants, indicating that the intensity of mental health support reduces for all young people as they cross the CAMHS boundary, regardless of clinical need. CLINICAL IMPLICATIONS It is important that alternative forms of mental health support are available for young people who do not meet the AMHS care threshold but still have mental health needs after leaving CAMHS.
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Affiliation(s)
| | | | | | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathilde Overbeek
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- ARQ National Pyschotrauma Centre, Diemen, The Netherlands
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- ARQ National Pyschotrauma Centre, Diemen, The Netherlands
| | - Larissa van Bodegom
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| | - Tomislav Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Fiona McNicholas
- Department of Academic Child and Adolescent Psychiatry, University College Dublin, School of Medicine & Medical Science, Dublin, Ireland
- Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Dublin, Ireland
| | - Diane Purper-Ouakil
- Service de Médecine Psychologique de l'Enfant et de l'Adolescent, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
- Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, Paris, France
| | - Ulrike M E Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
- Centre for Psychiatry Calw, Böblingen, Germany
| | | | - Swaran P Singh
- Warwick Medical School, University of Warwick, Coventry, UK
- Children and Young People's Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
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3
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Canaway A, Appleton R, van Bodegom L, Dieleman G, Franić T, Gerritsen S, de Girolamo G, Maras A, McNicholas F, Overbeek M, Paul M, Purper-Ouakil D, Santosh P, Schulze U, Singh SP, Street C, Tah P, Tremmery B, Tuomainen H, Verhulst FC, Wolke D, Madan J. Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study. BJPsych Open 2023; 9:e175. [PMID: 37749976 PMCID: PMC10617498 DOI: 10.1192/bjo.2023.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems. AIMS To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary. METHOD Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary. RESULTS The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary. CONCLUSIONS Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.
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Affiliation(s)
- Alastair Canaway
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Larissa van Bodegom
- Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Tomislav Franić
- Department of Psychiatry, University Hospital Split, Croatia; and School of Medicine, University of Split, Croatia
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Italy
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Fiona McNicholas
- School of Medicine and Medical Science, University College Dublin, Republic of Ireland; and Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Republic of Ireland
| | - Mathilde Overbeek
- Yulius Academy, Yulius Mental Health Organization, The Netherlands and Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands
| | - Moli Paul
- Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Diane Purper-Ouakil
- Child and Adolescent Psychiatry Unit, Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, France; and Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, France
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, UK; and HealthTracker Ltd, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
| | - Swaran P. Singh
- Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Cathy Street
- Warwick Medical School, University of Warwick, UK
| | - Priya Tah
- Warwick Medical School, University of Warwick, UK
| | | | | | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands; and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Dieter Wolke
- Department of Psychology, University of Warwick, UK
| | - Jason Madan
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
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Dekker L, Hooijman L, Louwerse A, Visser K, Bastiaansen D, Ten Hoopen L, De Nijs P, Dieleman G, Ester W, Van Rijen S, Truijens F, Van der Hallen R. Impact of the COVID-19 pandemic on children and adolescents with autism spectrum disorder and their families: a mixed-methods study protocol. BMJ Open 2022; 12:e049336. [PMID: 35078834 PMCID: PMC8795917 DOI: 10.1136/bmjopen-2021-049336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/03/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is a challenge for everyone, particularly for children and adolescents with autism spectrum disorder (ASD). ASD is a developmental disorder characterised by limitations in social communication, repetitive behavioural patterns, and limited interests, and activities. It is expected that many families with children with ASD will experience more problems due to the COVID-19 pandemic and the related public health restrictions. At the same time, some may experience improved functioning, due to fewer expectations and social demands. METHODS/DESIGN In a mixed-method study to identify the impact of the COVID-19 pandemic, parents of children with ASD (ages 4-21) who were in care pre-COVID-19 at one of three large mental healthcare institutions in the region of Rotterdam participated (68 for T0, 57 for T1). The aims are (1) to investigate the impact of the COVID-19 pandemic on overall functioning and autistic symptoms of the child/adolescent with ASD, as well as parental and family functioning (QUANT-QUAL), in both the short term and longer term, and (2) to investigate risk and protective factors (in light of resilience) (QUANT-qual) and (3) to investigate care and informational needs (QUAL-quant). Pre-COVID-19 baseline data will be retrieved from clinical records. Participants will fill out two surveys (one during a COVID-19 peak-January-May 2021-and one thereafter). Survey participants were invited to participate in interviews (n=27). Surveys include measures thar were included pre-COVID-19 (ie, overall functioning and autism symptoms) as well as specific measures to identify family functioning and COVID-19 impact. The semistructured interviews focus on child, parent and family functioning and care-and informational needs. ETHICS AND DISSEMINATION The Medical Ethics Committee of the Erasmus MC has approved the study. Findings will be available to families of children with ASD, their care providers, the funders, autism societies, the government and other researchers.
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Affiliation(s)
- Linda Dekker
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
| | - Linde Hooijman
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
| | - Anneke Louwerse
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Kirsten Visser
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
- SARR Expert Centre for Autism, Youz Child- and Adolescent Psychiatry, Parnassia Group, Rotterdam, The Netherlands
| | - Dennis Bastiaansen
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
- Yulius Autism, Yulius, Mental Health Organisation, Barendrecht, The Netherlands
| | - Leontine Ten Hoopen
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Pieter De Nijs
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Gwen Dieleman
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Wietske Ester
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
- SARR Expert Centre for Autism, Youz Child- and Adolescent Psychiatry, Parnassia Group, Rotterdam, The Netherlands
- Child- and Adolescent Psychiatry, Curium-LUMC, Oegstgeest, The Netherlands
- Parnassia Bavo Group, Parnassia Bavo Academy, Erasmus MC, The Hague, The Netherlands
| | - Susan Van Rijen
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
| | - Femke Truijens
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
| | - Ruth Van der Hallen
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
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Steegers C, Dieleman G, Moskalenko V, Santos S, Hillegers M, White T, Jansen PW. The longitudinal relationship between set-shifting at 4 years of age and eating disorder related features at 9 years of age in the general pediatric population. Int J Eat Disord 2021; 54:2180-2191. [PMID: 34716719 PMCID: PMC9298047 DOI: 10.1002/eat.23633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Individuals with anorexia nervosa (AN) tend to have rigid thoughts and behaviors regarding their body weight, body image, and eating habits. While a diagnosis of AN implies severe levels of impairment, AN traits can vary on a continuum within the population. However, little is known about how early markers of AN relate to rigid thought patterns and to what extent cognitive rigidity is already present in early childhood. We examined the association of set-shifting abilities as a measure of cognitive flexibility in preadolescents with AN-related features. METHODS Participants included 3,987 children participating in the Generation R Study, a Dutch population-based birth cohort. Set-shifting abilities (mother report) were assessed at 4 years of age, body mass index (BMI) was determined at 4 and 9 years and restrictive eating patterns (mother report) and body image (child report) were assessed at 9 years. RESULTS Lower set-shifting abilities at 4 years were associated with a lower BMI (β = -.44, p = 2.2 × 10-4 ) in girls, and more restrictive eating (β = 0.15, p = 2.7 × 10-6 ) in both boys and girls at 9 years of age. Moreover, set-shifting at age 4 was not associated with body image at age 9. CONCLUSION These findings contribute to the idea that the association between set-shifting problems and AN-related features are present early in childhood, prior to the typical range of the onset of eating disorders (EDs). Longitudinal studies that capture the peak age for the development of EDs will be important to assess whether early cognitive inflexibility is an early marker of AN.
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Affiliation(s)
- Cathelijne Steegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Valeria Moskalenko
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Susana Santos
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands,Department of Pediatrics, Erasmus MC – Sophia Children's HospitalUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands,The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands,Department of Radiology and Nuclear MedicineErasmus MCRotterdamThe Netherlands
| | - Pauline W. Jansen
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands,The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands,Department of Psychology, Education, and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
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6
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Steegers C, Blok E, Lamballais S, Jaddoe V, Bernardoni F, Vernooij M, van der Ende J, Hillegers M, Micali N, Ehrlich S, Jansen P, Dieleman G, White T. The association between body mass index and brain morphology in children: a population-based study. Brain Struct Funct 2021; 226:787-800. [PMID: 33484342 PMCID: PMC7981300 DOI: 10.1007/s00429-020-02209-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023]
Abstract
Brain morphology is altered in both anorexia nervosa and obesity. However, it is yet unclear if the relationship between Body Mass Index-Standard Deviation Score (BMI-SDS) and brain morphology exists across the BMI-SDS spectrum, or is present only in the extremes. The study involved 3160 9-to-11 year-old children (50.3% female) who participate in Generation R, a population-based study. Structural MRI scans were obtained from all children and FreeSurfer was used to quantify both global and surface-based measures of gyrification and cortical thickness. Body length and weight were measured to calculate BMI. Dutch growth curves were used to calculate BMI-SDS. BMI-SDS was analyzed continuously and in two categories (median split). The relationship between BMI-SDS (range − 3.82 to 3.31) and gyrification showed an inverted-U shape curve in children with both lower and higher BMI-SDS values having lower gyrification in widespread areas of the brain. BMI-SDS had a positive linear association with cortical thickness in multiple brain regions. This study provides evidence for an association between BMI-SDS and brain morphology in a large sample of children from the general population and suggests that a normal BMI during childhood is important for brain development. Future studies could determine whether lifestyle modifications optimize BMI-SDS result in return to more typical patterns of brain morphology.
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Affiliation(s)
- Cathelijne Steegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabet Blok
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sander Lamballais
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Vincent Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Fabio Bernardoni
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Meike Vernooij
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Child and Adolescent Psychiatry, Department of Child and Adolescent Health, Geneva University Hospital, Geneva, Switzerland.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Pauline Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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7
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Hendrickx G, De Roeck V, Maras A, Dieleman G, Gerritsen S, Purper-Ouakil D, Russet F, Schepker R, Signorini G, Singh SP, Street C, Tuomainen H, Tremmery S. Challenges during the transition from child and adolescent mental health services to adult mental health services. BJPsych Bull 2020; 44:163-168. [PMID: 31931898 PMCID: PMC8058856 DOI: 10.1192/bjb.2019.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The transition from child and adolescent to adult mental health services for young people with mental health problems is of international concern. Despite the high prevalence of mental disorders during adolescence and their tendency to continue during adulthood, the majority of young people do not experience continuity of care. The aim of this review paper is to unravel the complexity of transitional mental healthcare to clinicians, policy makers and mental health service managers, and to address challenges to a smooth transition process at all levels.
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Affiliation(s)
- Gaelle Hendrickx
- Department of Neurosciences, Centre for Clinical Psychiatry, KU Leuven, Belgium
| | - Veronique De Roeck
- Department of Neurosciences, Child and Adolescent Psychiatry, KU Leuven, Belgium
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, The Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Diane Purper-Ouakil
- Child and Adolescent Psychiatry Unit, University Hospital of Montpellier, France
| | - Frédérick Russet
- Child and Adolescent Psychiatry Unit, University Hospital of Montpellier, France
| | | | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Italy
| | | | - Cathy Street
- Warwick Medical School, University of Warwick, UK
| | | | - Sabine Tremmery
- Department of Neurosciences, Child and Adolescent Psychiatry, KU Leuven, Belgium
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8
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Santosh P, Singh J, Adams L, Mastroianni M, Heaney N, Lievesley K, Sagar-Ouriaghli I, Allibrio G, Appleton R, Davidović N, de Girolamo G, Dieleman G, Dodig-Ćurković K, Franić T, Gatherer C, Gerritsen S, Gheza E, Madan J, Manenti L, Maras A, Margari F, McNicholas F, Pastore A, Paul M, Purper-Ouakil D, Rinaldi F, Sakar V, Schulze U, Signorini G, Street C, Tah P, Tremmery S, Tuffrey A, Tuomainen H, Verhulst F, Warwick J, Wilson A, Wolke D, Fiori F, Singh S. Validation of the Transition Readiness and Appropriateness Measure (TRAM) for the Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare in Europe (MILESTONE) study. BMJ Open 2020; 10:e033324. [PMID: 32580979 PMCID: PMC7312331 DOI: 10.1136/bmjopen-2019-033324] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Young people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16-18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person's readiness for transition, and their outcomes at the transfer boundary. DESIGN MILESTONE prospective study. SETTING Eight European Union (EU) countries participating in the EU-funded MILESTONE study. PARTICIPANTS The first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people. RESULTS The development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported. CONCLUSION The TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person. TRIAL REGISTRATION NUMBER ISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.
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Affiliation(s)
- Paramala Santosh
- Child and Adolescent Psychiatry, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker, Gillingham, UK
| | - Jatinder Singh
- Child and Adolescent Psychiatry, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK
| | - Laura Adams
- School of Psychology, University of Plymouth, Plymouth, Devon, UK
| | - Mathilde Mastroianni
- Child and Adolescent Psychiatry, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK
| | - Natalie Heaney
- Child and Adolescent Psychiatry, King's College London, London, UK
| | | | | | - Giovanni Allibrio
- Unit of Neuropsychiatry, ASST Spedali Civili di Brescia Dipartimento di Salute Mentale, Brescia, Lombardia, Italy
| | - Rebecca Appleton
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nikolina Davidović
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | | | - Tomislav Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Charlotte Gatherer
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Elisa Gheza
- Neuropsychiatry Service of Childhood and Adolescence, Mental Health Department, ASST della Valcamonica, Breno, Lombardia, Italy
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Coventry, UK
| | - Lidia Manenti
- Unit of Neuropsychiatry, ASST Spedali Civili di Brescia Dipartimento di Salute Mentale, Brescia, Lombardia, Italy
| | - Athanasios Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Yulius Academy, Rotterdam, The Netherlands
| | - Francesco Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Puglia, Italy
| | - Fiona McNicholas
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- Geary Institute, University College Dublin, Dublin, Ireland
- Department of Child Psychiatry, Our Lady's Hospital For Sick Children, Crumlin, Ireland
- Lucena Clinic, Saint John of God Hospitaller Services, Dublin, Ireland
| | - Adriana Pastore
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Puglia, Italy
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, Coventry, UK
| | - Diane Purper-Ouakil
- Psychological Medicine for Children and Adolescents, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Francesco Rinaldi
- Neuropsychiatry Service of Childhood and Adolescence, Mental Health Department, ASST della Valcamonica, Breno, Lombardia, Italy
| | - Vehbi Sakar
- Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Priya Tah
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Amanda Tuffrey
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frank Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Coventry, UK
| | - Anna Wilson
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Dieter Wolke
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, University of Warwick, Warwick, UK
| | - Federico Fiori
- Child and Adolescent Psychiatry, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker, Gillingham, UK
| | - Swaran Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, Coventry, UK
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9
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de Lijster J, Dierckx B, Utens E, Verhulst F, Zieldorff C, Dieleman G, Legerstee J. The age of onset of anxiety disorders in samples from the general population: A meta-analysis. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
WorkshopAge of onset of mental disorders: etiopathogenetic and treatment implications.BackgroundAge of onset (AOO) of anxiety disorders could serve as a vital statistic in the formulation of mental health policy. Previous reviews have reported on the AOO of anxiety disorders in the general population. However, these review studies did not systematically estimate the AOO of different anxiety disorder subtypes, and did not examine factors that might have influenced reported AOO.ObjectiveThe aims of the present study were (1) to estimate the AOO for all anxiety disorders and for specific subtypes, (2) to examine gender differences in AOO of anxiety disorders, and (3) to examine the influence of study characteristics on reported AOO.MethodSeven electronic databases were searched with keywords representing anxiety disorder subtypes, AOO and study design. The inclusion criteria were studies using a general population sample that provided data on AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV or ICD-10 criteria. Meta-analysis was used to estimate AOO and gender differences, while meta-regression was used to examine the influence of study characteristics.ResultsA total of 1028 titles were examined, which yielded 24 studies meeting the inclusion criteria. Meta-analysis found an average AOO of all anxiety disorders of 21.3 years (95% CI: 17.46 to 25.07). Separation anxiety disorder, specific phobia and social phobia had their mean onset before the age of 15 years, whereas AOO of agoraphobia, obsessive compulsive disorder, post-traumatic stress disorder, panic disorder and generalized anxiety disorder began on average between 21.1 and 34.9 years. Anxiety disorder is more common in women, but meta-analysis revealed no difference in AOO between genders. Prospective study design and higher developmental level of the study country were associated with earlier AOO.ConclusionResults from this meta-analysis indicate that anxiety disorder subtypes differ in mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards the factors associated with the development of subtypes of anxiety disorder in the age groups with the greatest vulnerability for developing those disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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10
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Hendrickx G, De Roeck V, Russet F, Dieleman G, Franic T, Maras A, McNicholas F, Paul M, Santosh P, Schulze U, Signorini G, Singh SP, Street C, Tuomainen H, Verhulst F, Wolke D, Purper-Ouakil D, Tremmery S. Transition as a topic in psychiatry training throughout Europe: trainees' perspectives. Eur Child Adolesc Psychiatry 2020; 29:41-49. [PMID: 30852723 DOI: 10.1007/s00787-019-01309-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/04/2019] [Indexed: 11/25/2022]
Abstract
The majority of adolescents with mental health problems do not experience continuity of care when they reach the transition boundary of their child and adolescent mental health service. One of the obstacles for a smooth transition to adult mental health services concerns the lack of training for health-care professionals involved in the transition process. This study aims to seek psychiatric trainees' opinions regarding training on transition and the knowledge and skills required for managing transition. A survey was distributed to trainees residing in European countries. Trainees from 36 countries completed the questionnaire, of which 63% reported that they came into contact with youth and young adults (16-26 years) during their clinical practice. Twenty-seven percent of trainees stated they have good to very good knowledge about the transition process. Theoretical training about transition was reported in only 17% of the countries, and practical training in 28% of the countries. Ninety-four percent of trainees indicated that further training about transition is necessary. The content of subsequent transition-related training can be guided by the findings of the MILESTONE project.
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Affiliation(s)
- Gaelle Hendrickx
- Department of Neurosciences, Child and Adolescent Psychiatry, KU Leuven, Leuven, Belgium. .,Department of Child and Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium.
| | - Veronique De Roeck
- Department of Neurosciences, Child and Adolescent Psychiatry, KU Leuven, Leuven, Belgium.,Department of Child and Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Frédérick Russet
- Child and Adolescent Psychiatry Unit, University Hospital of Montpellier, Montpellier, France
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tomislav Franic
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Athanasios Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands.,Yulius Academy, Yulius Mental Health Organization, Barendrecht, The Netherlands
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin, School of Medicine and Medical Science, Dublin, Republic of Ireland.,Geary Institute, University College Dublin, Dublin, Republic of Ireland.,Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland.,Lucena Clinic SJOG, Dublin, Republic of Ireland
| | - Moli Paul
- Warwick Medical School, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Swaran P Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Cathy Street
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Frank Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dieter Wolke
- Warwick Medical School, University of Warwick, Coventry, UK.,Department of Psychology, University of Warwick, Coventry, UK
| | - Diane Purper-Ouakil
- Child and Adolescent Psychiatry Unit, University Hospital of Montpellier, Montpellier, France
| | - Sabine Tremmery
- Department of Neurosciences, Child and Adolescent Psychiatry, KU Leuven, Leuven, Belgium.,Department of Child and Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
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11
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Russet F, Humbertclaude V, Dieleman G, Dodig-Ćurković K, Hendrickx G, Kovač V, McNicholas F, Maras A, Paramala S, Paul M, Schulze UME, Signorini G, Street C, Tah P, Tuomainen H, Singh SP, Tremmery S, Purper-Ouakil D. Training of adult psychiatrists and child and adolescent psychiatrists in europe: a systematic review of training characteristics and transition from child/adolescent to adult mental health services. BMC Med Educ 2019; 19:204. [PMID: 31196080 PMCID: PMC6567390 DOI: 10.1186/s12909-019-1576-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/24/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Profound clinical, conceptual and ideological differences between child and adult mental health service models contribute to transition-related discontinuity of care. Many of these may be related to psychiatry training. METHODS A systematic review on General Adult Psychiatry (GAP) and Child and Adult Psychiatry (CAP) training in Europe, with a particular focus on transition as a theme in GAP and CAP training. RESULTS Thirty-four full-papers, six abstracts and seven additional full text documents were identified. Important variations between countries were found across several domains including assessment of trainees, clinical and educational supervision, psychotherapy training and continuing medical education. Three models of training were identified: i) a generalist common training programme; ii) totally separate training programmes; iii) mixed types. Only two national training programs (UK and Ireland) were identified to have addressed transition as a topic, both involving CAP exclusively. CONCLUSION Three models of training in GAP and CAP across Europe are identified, suggesting that the harmonization is not yet realised and a possible barrier to improving transitional care. Training in transition has only recently been considered. It is timely, topical and important to develop evidence-based training approaches on transitional care across Europe into both CAP and GAP training.
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Affiliation(s)
- Frederick Russet
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
| | - Veronique Humbertclaude
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Gaelle Hendrickx
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | | | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science and Geary Institute, University College Dublin, Dublin, Ireland
| | - Athanasios Maras
- Yulius Academy, Rotterdam, Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Santosh Paramala
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
- HealthTracker Ltd, Gillingham, UK
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Stratford Child and Adolescent Health Service, Coventry and Warwickshire Partnership Trust, Stratford on Avon, UK
| | - Ulrike M. E. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Brescia, Italy
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Priya Tah
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran P. Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
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12
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Signorini G, Singh SP, Marsanic VB, Dieleman G, Dodig-Ćurković K, Franic T, Gerritsen SE, Griffin J, Maras A, McNicholas F, O'Hara L, Purper-Ouakil D, Paul M, Russet F, Santosh P, Schulze U, Street C, Tremmery S, Tuomainen H, Verhulst F, Warwick J, de Girolamo G. Correction to: The interface between child/adolescent and adult mental health services: results from a European 28‑country survey. Eur Child Adolesc Psychiatry 2018. [PMID: 29536191 DOI: 10.1007/s00787-018-1132-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The original version of this article contained an error in Table 1. The correct table is presented below.
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Affiliation(s)
- Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Brescia, Italy.
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Gwen Dieleman
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Katarina Dodig-Ćurković
- Unit for Child and Adolescent Psychiatry, School of medicine, University Health Center in Osijek, Osijek, Croatia
| | - Tomislav Franic
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | | | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Athanasios Maras
- Erasmus University Medical Centre, Rotterdam, Netherlands.,Yulius Academy, Rotterdam, Netherlands
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, SMMS UCD, Belfield, Dublin 4, Ireland.,Geary Institute, University College Dublin, Belfield, Dublin 4, Ireland.,Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland.,Lucena Clinic SJOG, Rathgar, Dublin 6, Ireland
| | - Lesley O'Hara
- Saint John of God Research Foundation, Stillorgan, Co. Dublin, Ireland
| | - Diane Purper-Ouakil
- Child and Adolescent Psychiatry Unit (MPEA1), CHU Montpellier-St Eloi Hospital, Montpellier, France
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frederick Russet
- Child and Adolescent Psychiatry Unit (MPEA1), CHU Montpellier-St Eloi Hospital, Montpellier, France
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,National and Specialist Child and Adolescent Mental Health Services, Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), Maudsley Hospital, London, UK.,HealthTracker Ltd, Gillingham, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child and Adolescent Psychiatry, University of Leuven, Leuven, Belgium.,Department of Child and Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frank Verhulst
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Brescia, Italy
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13
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Both P, Ten Holt L, Mous S, Patist J, Rietman A, Dieleman G, Ten Hoopen L, Vergeer M, de Wit MC, Bindels-de Heus K, Moll H, van Eeghen A. Tuberous sclerosis complex: Concerns and needs of patients and parents from the transitional period to adulthood. Epilepsy Behav 2018; 83:13-21. [PMID: 29631156 DOI: 10.1016/j.yebeh.2018.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Transitioning into adulthood and from pediatric services to adult healthcare are both challenging processes for young adults with rare chronic disorders such as tuberous sclerosis complex (TSC) and their parents. Adult healthcare systems are often less family-oriented and lack multidisciplinary care and experience with TSC, which can result in increased health risks and morbidity. Patient-driven data on care needs are necessary to optimize support for this vulnerable patient group. AIM The aim of this study was to explore the concerns and care needs of young adult patients with TSC in medical, psychological, and socioeconomical domains. METHOD A qualitative study was performed using semistructured interviews with 16 patients (median age: 21years; range: 17 to 30) and 12 parents. Concerns and care needs were organized using the International Classification of Functioning, Disability, and Health (ICF). RESULTS Main concerns involved mental and physical health, participation, self-management skills, family planning, and side effects of medications. Patients expressed the need for multidisciplinary care that is well-informed, easily accessible, and focused on the patient as a whole, including his/her family. Parents reported high stress levels. CONCLUSION The current study provides patient-driven information, allowing recommendations to facilitate the (transition of) care for young adults with TSC. In addition to seizures, tumor growth, and TSC-associated neuropsychiatric disorders (TAND), more attention is needed for concerns and care needs specific to the transitional period, participation, and environmental factors. Adult healthcare providers should offer expert multidisciplinary care for adult patients with TSC, including attention for parental stress.
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Affiliation(s)
- Pauline Both
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lyenne Ten Holt
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sabine Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joke Patist
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - André Rietman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gwen Dieleman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Leontine Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Menno Vergeer
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie-Claire de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pediatric Neurology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Karen Bindels-de Heus
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of General Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriëtte Moll
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of General Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Agnies van Eeghen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands; Department of General Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; The Hartekamp Group, Care and Service for People with Intellectual Disabilities, Haarlem, The Netherlands.
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14
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Signorini G, Singh SP, Boricevic-Marsanic V, Dieleman G, Dodig-Ćurković K, Franic T, Gerritsen SE, Griffin J, Maras A, McNicholas F, O'Hara L, Purper-Ouakil D, Paul M, Santosh P, Schulze U, Street C, Tremmery S, Tuomainen H, Verhulst F, Warwick J, de Girolamo G. Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe. Lancet Psychiatry 2017; 4:715-724. [PMID: 28596067 DOI: 10.1016/s2215-0366(17)30127-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/06/2017] [Accepted: 02/20/2017] [Indexed: 11/15/2022]
Abstract
The WHO Child and Adolescent Mental Health Atlas, published in 2005, reported that child and adolescent mental health services (CAMHS) in Europe differed substantially in their architecture and functioning. We assessed the characteristics of national CAMHS across the European Union (EU), including legal aspects of adolescent care. Using an online mapping survey aimed at expert(s) in each country, we obtained data for all 28 countries in the EU. The characteristics and activities of CAMHS (ie, availability of services, inpatient beds, and clinicians and organisations, and delivery of specific CAMHS services and treatments) varied considerably between countries, as did funding sources and user access. Neurodevelopmental disorders were the most frequent diagnostic group (up to 81%) for people seen at CAMHS (data available from only 13 [46%] countries). 20 (70%) countries reported having an official national child and adolescent mental health policy, covering young people until their official age of transition to adulthood. The heterogeneity in resource allocation did not seem to match epidemiological burden. Substantial improvements in the planning, monitoring, and delivery of mental health services for children and adolescents are needed.
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Affiliation(s)
- Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy.
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Gwen Dieleman
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Tomislav Franic
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | | | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Athanasios Maras
- Erasmus University Medical Centre, Rotterdam, Netherlands; Yulius Academy, Rotterdam, Netherlands
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin; Geary Institute, University College Dublin, Dublin; Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Crumlin, Dublin; Lucena Clinic, Rathgar, Dublin
| | - Lesley O'Hara
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin
| | - Diane Purper-Ouakil
- Département de Médecine Psychologique Enfants et Adolescents, CHU Montpellier-St Eloi Hôpital, Montpellier, France
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK; HealthTracker Ltd, Gillingham, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frank Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Rotterdam, Netherlands
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
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15
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Dieleman G, Huizink AC, Tulen JH, Utens EM, Creemers H, van der Ende J, Verhulst FC. Alterations in HPA-axis and autonomic nervous system functioning in childhood anxiety disorders point to a chronic stress hypothesis. Int J Psychophysiol 2014. [DOI: 10.1016/j.ijpsycho.2014.08.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Tiemeier H, Velders FP, Szekely E, Roza SJ, Dieleman G, Jaddoe VWV, Uitterlinden AG, White TJH, Bakermans-Kranenburg MJ, Hofman A, Van Ijzendoorn MH, Hudziak JJ, Verhulst FC. The Generation R Study: a review of design, findings to date, and a study of the 5-HTTLPR by environmental interaction from fetal life onward. J Am Acad Child Adolesc Psychiatry 2012; 51:1119-1135.e7. [PMID: 23101739 DOI: 10.1016/j.jaac.2012.08.021] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 05/23/2012] [Accepted: 08/23/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE First, we give an overview of child psychiatric research in the Generation R Study, a population-based cohort from fetal life forward. Second, we examine within Generation R whether the functional polymorphism (5-HTTLPR) in the promoter of the serotonin transporter gene interacts with prenatal maternal chronic difficulties, prenatal maternal anxiety or postnatal maternal anxiety to influence child emotional development. METHOD A total of 2,136 northern European children were genotyped for 5-HTTLPR and rs25531. Mothers reported chronic difficulties and anxiety symptoms at 20 weeks' pregnancy and when the child was 3 years old. Child emotion recognition was observed at 3 years, and child emotional problems were assessed with the CBCL/1½-5 at 5 years. RESULTS There were consistent main effects of maternal difficulties and anxiety on child emotional problems, but no main effect of 5-HTTLPR. Moreover, children with the s allele were at increased risk for emotional problems if their mothers reported prenatal anxiety symptoms (β = 2.02, p < .001) or postnatal anxiety symptoms (β = 1.64, p < 0.001). Also, in children of mothers with prenatal anxiety symptoms, the s allele was associated with less accurate emotion-matching (β = -0.11, p = .004). CONCLUSIONS This population-based study shows that vulnerability due to 5-HTTLPR is not specific for certain adverse exposures or severe events, but suggests that the small effects of gene-environment interaction on emotional development become manifest early in life.
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Affiliation(s)
- Henning Tiemeier
- Erasmus Medical Center (MC)-Sophia Children's Hospital, Rotterdam, and the Generation R Study Group at Erasmus MC, Rotterdam.
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17
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Velders FP, Dieleman G, Cents RAM, Bakermans-Kranenburg MJ, Jaddoe VWV, Hofman A, Van IJzendoorn MH, Verhulst FC, Tiemeier H. Variation in the glucocorticoid receptor gene at rs41423247 moderates the effect of prenatal maternal psychological symptoms on child cortisol reactivity and behavior. Neuropsychopharmacology 2012; 37:2541-9. [PMID: 22781842 PMCID: PMC3442349 DOI: 10.1038/npp.2012.118] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prenatal maternal psychopathology affects child development, but some children seem more vulnerable than others. Genetic variance in hypothalamic-pituitary-adrenal axis genes may influence the effect of prenatal maternal psychological symptoms on child emotional and behavioral problems. This hypothesis was tested in the Generation R Study, a population-based cohort from fetal life onward. In total, 1727 children of Northern European descent and their mothers participated in this study and were genotyped for variants in the glucocorticoid receptor (GR) gene (rs6189/rs6190, rs10052957, rs41423247, rs6195, and rs6198) and the FK506-binding protein 5 (FKBP5) gene (rs1360780). Prenatal maternal psychological symptoms were assessed at 20 weeks pregnancy and child behavior was assessed by both parents at 3 years. In a subsample of 331 children, data about cortisol reactivity were available. Based on power calculations, only those genetic variants with sufficient minor allele frequencies (rs41423247, rs10052957, and rs1360780) were included in the interaction analyses. We found that variation in GR at rs41423247 moderates the effect of prenatal maternal psychological symptoms on child emotional and behavioral problems (beta 0.41, SE 0.16, p=0.009). This prenatal interaction effect was independent of mother's genotype and maternal postnatal psychopathology, and not found for prenatal psychological symptoms of the father. Moreover, the interaction between rs41423247 and prenatal psychological symptoms was also associated with decreased child cortisol reactivity (beta -2.30, p-value 0.05). These findings emphasize the potential effect of prenatal gene-environment interaction, and give insight in possible mechanisms accounting for children's individual vulnerability to develop emotional and behavioral problems.
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Affiliation(s)
- Fleur P Velders
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands,The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rolieke AM Cents
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands,The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Vincent WV Jaddoe
- The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Pediatrics, Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marinus H Van IJzendoorn
- Centre for Child and Family Studies, Leiden University, Leiden, The Netherlands,School of Pedagogical and Educational Sciences, Erasmus University, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center—Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands, Tel: +31 10 703 2183, Fax: +31 704 4465, E-mail:
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18
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Dierckx B, Dieleman G, Tulen JHM, Treffers PDA, Utens EMWJ, Verhulst FC, Tiemeier H. Persistence of anxiety disorders and concomitant changes in cortisol. J Anxiety Disord 2012; 26:635-41. [PMID: 22609471 DOI: 10.1016/j.janxdis.2012.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
In a clinical sample of 116 children and adolescents we studied the relation between the course of an anxiety disorder during treatment and the concomitant changes in cortisol levels. Assessments at baseline, after three months, and at one-year follow-up were performed with the Anxiety Disorders Interview Schedule. When we compared cortisol levels at baseline and one-year follow-up, persistence of the anxiety disorder was associated with both increased daytime cortisol production (F=3.2, p=0.04) and a trend towards a decreased cortisol morning rise (F=2.4, p=0.09). At one-year follow-up daytime cortisol production was lowest in the early remitters (109.7±29.2 h mmol/l), higher in the late remitters (121.0±40.0 h mmol/l) and highest in the non-remitters (131.1±48.9 h mmol/l). Early remitters had the highest cortisol morning rise (1.1±1.5 h mmol/l), followed by the late remitters (0.8±1.8 h mmol/l), the non-remitters had the lowest cortisol morning rise (0.07±1.7 h mmol/l). Persistence of an anxiety disorder may thus lead to changes in HPA-axis functioning, underscoring the importance adequate treatment of anxiety disorders.
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Affiliation(s)
- Bram Dierckx
- Department of Child and Adolescent Psychiatry, Erasmus MC, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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19
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Velders FP, Dieleman G, Henrichs J, Jaddoe VWV, Hofman A, Verhulst FC, Hudziak JJ, Tiemeier H. Prenatal and postnatal psychological symptoms of parents and family functioning: the impact on child emotional and behavioural problems. Eur Child Adolesc Psychiatry 2011; 20:341-50. [PMID: 21523465 PMCID: PMC3135831 DOI: 10.1007/s00787-011-0178-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 04/13/2011] [Indexed: 12/28/2022]
Abstract
Although relations of various parental psychological problems and family functioning with child development are well documented, it remains unclear whether specific prenatal or specific postnatal risk factors are independently associated with child emotional and behavioural problems, or whether observed associations can be explained by general parental psychopathology. Using a stepwise approach, we examined the effects of prenatal and postnatal parental depressive symptoms, prenatal and postnatal hostility of the parents, as well as prenatal family functioning on the risk of child emotional and behavioural problems. This study was embedded in Generation R: a population-based cohort from foetal life onwards. Mothers and fathers of 2,698 children provided information about depressive symptoms, symptoms of hostility and family functioning during pregnancy and 3 years after birth. Mother and father each reported on child behaviour when the child was 3 years old. Parental depressive symptoms increased the risk of child emotional and behavioural problems, but this increase was explained by postnatal parental hostile behaviour. Postnatal symptoms of hostility of mothers (OR = 1.34, p value <0.001) and postnatal symptoms of hostility of fathers (OR = 1.30, p value <0.001) each contributed independently to the risk of child emotional and behavioural problems. Postnatal parental hostility is associated with an increased risk of child emotional and behavioural problems, independent of parental depressive symptoms. These findings suggest that prevention and intervention strategies should focus on psychological symptoms of both mothers and fathers, in particular on hostile behaviour, in families with young children.
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Affiliation(s)
- Fleur P. Velders
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands ,The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Jens Henrichs
- The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, The Netherlands ,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, The Netherlands ,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands ,Department of Pediatrics, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - James J. Hudziak
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands ,Departments of Psychiatry, Medicine and Pediatrics, College of Medicine, University of Vermont, Burlington, VT USA ,Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands ,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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20
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van Lang NDJ, Tulen JHM, Kallen VL, Rosbergen B, Dieleman G, Ferdinand RF. Autonomic reactivity in clinically referred children attention-deficit/hyperactivity disorder versus anxiety disorder. Eur Child Adolesc Psychiatry 2007; 16:71-8. [PMID: 16964453 DOI: 10.1007/s00787-006-0575-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
Abstract
This study examined whether children with attention-deficit/hyperactivity disorder (ADHD) have lower autonomic nervous system (ANS) activity and show less stress reactivity than children with an anxiety disorder. It also explored whether such a difference was accounted for by comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) in some of the ADHD children. Forty-three referred children performed a stress task, during which skin conductance (SCL) and heart rate (HR) levels were measured. Results showed that the ADHD group had similar SCL responses as the anxiety disorder group, but showed less HR reactivity immediately after the stress task. The ADHD with ODD/CD group had a slightly higher HR level than the pure ADHD group, but showed similar SCL and HR reactivity and recovery. It was concluded that ADHD children have less HR reactivity immediately after stress than children with an anxiety disorder, which was not accounted for by comorbid ODD/CD symptoms, and which may be related to a stronger parasympathetic than sympathetic activation.
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Affiliation(s)
- Natasja D J van Lang
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, 3000 CB Rotterdam, The Netherlands
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21
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Ferdinand RF, Dieleman G, Ormel J, Verhulst FC. Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents: evidence for distinctions between DSM-IV subtypes. J Abnorm Child Psychol 2007; 35:325-33. [PMID: 17226094 PMCID: PMC1915634 DOI: 10.1007/s10802-006-9093-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 12/22/2006] [Indexed: 11/12/2022]
Abstract
Objective: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population. Method: 2,067 individuals (51.4% girls) from a Dutch community sample, who were assessed for the first time when they were aged 10 to 12 years, were followed up across a period of two years. At both assessments, anxiety symptoms were assessed with the RCADS, a self-report questionnaire. Results: Regression analyses indicated that homotypic continuity was relatively high for SAD, GAD, and SoPh symptoms, and for PD in girls. Conclusions: In many studies, anxiety disorders are treated as one group of disorders, and some widely used assessment instruments, such as the Child Behavior Checklist, do not even contain scales that tap different anxiety dimensions. In the present study, evidence for homotypic continuity was found, especially for symptoms of separation, social, and generalized anxiety, and for symptoms of panic disorder in girls, underscoring the usefulness of making distinctions between different anxiety constructs.
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Affiliation(s)
- Robert F Ferdinand
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam/Sophia Children's Hospital, Dr. Molewaterplein 60, 3000 CB Rotterdam, The Netherlands.
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