Optimizing indicated cognitive behavioral therapy to prevent child anxiety and depression: A cluster-randomized factorial trial

Identifying effective components can lead to interventions that are less resource-intensive and better suited for real-world needs. In this 2×2×2 cluster-randomized factorial trial (clinicaltrials.gov NCT04263558), we investigated the effects of three components of an indicated, transdiagnostic CBT intervention for children: 1) Intervention Delivery Format (child group format versus a blended format with group sessions and automated web-based sessions), 2) Parental Involvement in the intervention (group-based versus psychoeducational brochure), and 3) a Measurement Feedback System (MFS; on versus off). The intervention was delivered at schools in a group-based format. The participants (N = 701 children) were school children (age 8-12 years) with elevated symptoms of anxiety or depression, and their parents. The main outcomes were self-reported (N = 633) and parent-reported (N = 725) symptoms of child anxiety and depression post-intervention. The secondary outcome was children's user satisfaction with the intervention. We did not find significant main or interaction effects of Delivery Format, Parental Involvement, or MFS on children's symptom levels. There were no significant effects on children's user satisfaction. Results were compatible with retaining the least resource intensive combination (i.e., blended format, parental brochure, no MFS) in an optimized intervention.

One year follow-up of participants in a randomised controlled trial of a CBT-based group therapy programme for adolescents diagnosed with ADHD

BACKGROUND

Adolescents with ADHD often struggle on many areas of their lives and have a high risk of adverse outcomes and negative life trajectories. Multimodal treatment including psychosocial interventions is recommended but evidence regarding effect of such interventions is still limited.

MATERIALS AND METHODS

This study was a follow-up study of adolescents participating in a randomised controlled trial (RCT) of a group intervention based on cognitive behavioural therapy (CBT). Participants were adolescents diagnosed with ADHD and still impaired by their symptoms after standard treatment including psychoeducation and medication. All participants were interviewed by telephone one year after inclusion, and outcome measures included both quantitative and qualitative measures.

RESULTS

There were 100 adolescents included in the study. We found no significant differences between treatment and control group on measures of ADHD-symptoms, self-efficacy, overall problems, global psychosocial functioning, or symptom severity at one-year follow-up. Still, participants in the intervention group reported on positive gains and that they learned a lot about ADHD and themselves.

CONCLUSIONS

The intervention delivered in this trial failed to show a treatment effect on symptom level when added to standard care. Participants did however report on positive gains and felt they learned a lot. More research is needed to explore how the programme and delivery of treatment might be improved, and which patients might benefit the most from this type of interventions.

Neurocognitive outcome and associated factors in long-term, adult survivors of childhood acute lymphoblastic leukemia, treated without cranial radiation therapy

OBJECTIVE

There is limited research on neurocognitive outcome and associated risk factors in long-term, adult survivors of childhood acute lymphoblastic leukemia (ALL), without treatment of cranial radiation therapy. Moreover, the impact of fatigue severity and pain interference on neurocognition has received little attention. In this cross-sectional study, we examined neurocognitive outcome and associated factors in this population.

METHOD

Intellectual abilities, verbal learning/memory, processing speed, attention, and executive functions were compared to normative means/medians with one sample t tests or Wilcoxon signed-rank tests. Associations with risk factors, fatigue severity, and pain interference were analyzed with linear regressions.

RESULTS

Long-term, adult survivors of childhood ALL (N = 53, 51% females, mean age = 24.4 years, SD = 4.4, mean = 14.7 years post-diagnosis, SD = 3.4) demonstrated above average intellectual abilities, but performed below average in attention, inhibition, processing speed, and shifting (p < 0.001). Executive functioning complaints were significantly higher than normative means, and positively associated with fatigue (p < 0.001). There was no interaction between sex and fatigue and no neurocognitive impairments were associated with pain interference, risk group, age at diagnosis, or sex.

CONCLUSIONS

Long-term, adult survivors of ALL treated without cranial radiation therapy, demonstrate domain-specific performance-based neurocognitive impairments. However, continued research on the neurocognitive outcome in this population as they age will be important in the coming years. Executive functioning complaints were frequently in the clinical range, and often accompanied by fatigue. This suggests a need for cognitive rehabilitation programs.

Investigating the psychometric properties of PaRCADS-Parenting to Reduce Child Anxiety and Depression Scale in a Norwegian sample

OBJECTIVES

Parents play a pivotal role in child development and several parental factors have been identified as risk or protective factors for childhood anxiety and depression. To assess and target these parental factors in interventions, there is a need for a comprehensive, easy-to-use instrument.

METHOD

This study aimed to investigate the psychometric properties of an adapted version of the Parenting to Reduce Child Anxiety and Depression Scale, PaRCADS(N) in a Norwegian community sample (N = 163) of parents of children aged 8-12 years.

RESULTS

Our findings indicate that PaRCADS(N) has acceptable psychometric properties. These results are comparable to those of the original study of the PaRCADS in Australia.

CONCLUSION

Based on these results, we recommend that PaRCADS(N) can be utilized by health care workers as a tool for assessment and identification of parental practices related to child anxiety and/or depression to target relevant risk and protective factors in treatment and prevention.

Protective factors for suicidal ideation: a prospective study from adolescence to adulthood

Adolescent suicidality is associated with negative outcomes in adulthood. Suicide prevention has traditionally focused on identifying risk factors, yet suicide rates have remained stable. With suicidality often going undetected-especially suicidal ideation, further knowledge about protective factors is needed. The main objective of this study was to investigate potential protective factors for suicidal ideation from adolescence to adulthood. The study employed longitudinal population survey data, "Youth and Mental Health Study" consisting of self-reports at two-time points (mean age 14.9, SD = 0.6 and 27.2, SD = 0.6) (n = 2423 and n = 1198). Protective factors (at individual, social and environmental level) were selected based on a priori knowledge. Internal consistency of scales was analyzed using McDonald's omega. We used a linear mixed model with suicidal ideation as the dependent variable, time-points, a protective factor variable and their interaction as covariates, and individual participant as random effects. We adjusted for sex and also conducted separate analyses for males and females. The Benjamini-Hochberg procedure was used to adjust p-values for multiple hypotheses. Investigated protective factors were associated with temporal change in suicidal ideation (significant interactions). For both sexes, less emotion-orientated coping, higher self-perception scores, greater levels of physical activity and higher school wellbeing/connectedness were protective factors for suicidal ideations. Secure attachment and higher family function were protective factors for females only. The effects in adolescence were mostly maintained in adulthood. In this study, several protective factors for suicidal ideation persisted into adulthood, with distinct differences between males and females.

[Formula: see text] Executive function measured by BRIEF in adolescents diagnosed and treated for ADHD: problem profiles and agreement between informants

Executive functional deficits (EFDs) play an important role in functional impairment in adolescents with attention deficit/hyperactivity disorder (ADHD). More knowledge of executive function (EF) profiles and informant discrepancies will guide clinicians and provide tailored treatment advice. The objectives of this study were to use teacher, parent, and self-reported EF ratings to describe (a) problem profiles and (b) the correlation and agreement between informants. This study included 100 adolescents aged 14-18 years with ADHD still experiencing clinically impairing symptoms despite standard treatment including medication. EFs were measured using the Behavior Rating Inventory of Executive Function (BRIEF). Agreement between informants was quantified using Pearson correlation and informant discrepancies were analyzed using paired samples t-test. Overall, the results indicated considerable EFDs in the study population. Correlation and agreement varied between the informants. Agreement was highest between adolescents and their parents, especially for female participants, and lowest between male participants and their teachers. Teachers reported the highest level of EFDs, whereas adolescents generally self-reported EFDs at a lower level than both parents and teachers. Identifying and tailoring treatment for EFDs might improve future prognosis for adolescents with ADHD, however, self-awareness of these difficulties is a challenge that needs to be considered when planning interventions.

School children's mental health during the COVID-19 pandemic

Introduction

The COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life.

Methods

Our study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations.

Results

Levels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness.

Discussion

Our study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders.Clinical trial registration: NCT04263558.

Structural and Pragmatic Language Impairments in Children Evaluated for Autism Spectrum Disorder (ASD)

Pragmatic language impairments are common in neurodevelopmental disorders, especially in autism spectrum disorder (ASD). The relationship between structural language skills and pragmatic competence in children with autistic symptoms, however, is largely unknown. We investigated this relationship based on the Children's Communication Checklist-2 and early language delay among children (N = 177, 19% females) clinically evaluated for ASD, differentiated into ASD (n = 148) and non-ASD (n = 29). Structural language deficits were common and associated with reduced pragmatic competence in both groups. Pragmatic language impairments were most profound in children with ASD. Early language delay and structural language deficits were less common in females. Our findings suggest that assessment of structural language skills should be included in the evaluation of children with suspected ASD.

Executive functions mediate the association between ADHD symptoms and anxiety in a clinical adolescent population

Objective

Attention-deficit/hyperactivity disorder (ADHD) is associated with a high prevalence of anxiety disorders in children and adolescents. The reasons for this association are poorly understood. Preliminary findings with young adults have suggested that executive functions and functional impairment may mediate the relationship between symptoms of ADHD and mixed anxiety and depressive symptoms. The objective of this study was to explore whether ADHD symptoms, executive functions and functional impairment predict anxiety in a clinical adolescent population. In addition, we investigated the possible mediating role of executive functions and functional impairment in this relationship.

Method

One hundred adolescents with ADHD and their parents completed the ADHD Rating Scale IV (ADHD RS-IV), the Behavior Rating Inventory of Executive Function (BRIEF), and the Weiss Functional Impairment Rating Scale (WFIRS) in relation to an RCT study. The adolescents also completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED). Analyses were conducted using regression and a serial multiple mediator model.

Results

In the regression analyses, parent-rated ADHD symptoms were unable to predict anxiety, but ADHD inattention symptoms predicted anxiety in the self-ratings. Executive dysfunction and functional impairment predicted anxiety in both the parent- and self-reports. In the mediation analyses ADHD symptoms alone did not predict anxiety, but executive dysfunction mediated this relationship as expected. Functional impairment mediated this relationship indirectly through executive functions. The results were similar in the parent- and self- reports.

Conclusion

The results pinpoint executive dysfunction as an important treatment target for alleviating anxiety in adolescents with impairing ADHD symptoms.

The co-occurrence of motor and language impairments in children evaluated for autism spectrum disorder. An explorative study from Norway

BACKGROUND

Current research suggest that motor and language impairments are common and closely related in infants with autism spectrum disorder (ASD). In older children, less is known about how these impairments are related to each other.

AIMS

The current study explored the co-occurrence and potential impact of motor and language impairments in a sample of school-aged children evaluated for ASD by Norwegian specialist health services.

METHODS

Besides clinical evaluation for ASD, all participants (N = 20, mean age 10.7 (SD = 3.4) years) underwent a standardized test of motor performance (MABC-2), parent report measures of current motor (DCDQ'07), language (CCC-2), and social (SRS) skills, and a caregiver interview on everyday functioning, providing an overall impairment score (DD-CGAS).

RESULTS

The majority (85%) had motor and/or structural language deficits in addition to their social impairment. All children identified with motor impairment on both measures (39%) also had structural language deficits. Better motor performance was strongly correlated with better structural language skills (r = .618, p = .006).

CONCLUSIONS

Our findings suggest that co-occurring motor and structural language deficits should be anticipated and assessed when evaluating children for ASD. These deficits may need specific interventions that complement those targeting social skills deficits and other ASD core symptoms.

Cognitive behavioural group therapy as addition to psychoeducation and pharmacological treatment for adolescents with ADHD symptoms and related impairments: a randomised controlled trial

BACKGROUND

Cognitive behavioural therapy (CBT) is recommended for attention-deficit/hyperactivity-disorder (ADHD) in adolescents. However, all CBTs are not created equal, and the guidelines do not specify which CBT interventions are the most effective for this patient group. This study examines the efficacy of a group CBT without parent involvement as follow-up treatment compared to no additional CBT in adolescents with persistent and impairing ADHD symptoms after a short psychoeducational intervention and medical treatment.

METHODS

The authors conducted a two-arm parallel randomized controlled trial in two child and adolescent mental health outpatient clinics in Norway. One hundred patients aged 14-18 years with a diagnosis of ADHD (66%) or subthreshold ADHD (34%) were randomized to either a 12-week group CBT program (N = 50) or a non-CBT control condition (N = 50). Assessments were made at admission to the clinic, two weeks before and two weeks after treatment. The primary outcomes were parent-, teacher- and self-ratings of ADHD symptoms (ADHD Rating Scale-IV), and the secondary outcomes were ratings of ADHD symptom severity, executive function, functional impairment, and emotional problems. Evaluators blinded to group allocation rated ADHD symptom severity with the Clinical Global Impression Scale for Severity (CGI-S) at baseline and post-treatment.

RESULTS

Analyses using mixed-effects models showed no difference between the treatment arms from baseline to post treatment in primary and secondary outcomes.

CONCLUSIONS

Contrary to our hypothesis, we found no incremental treatment effect on the part of a group CBT as follow-up to psychoeducation and pharmacological treatment on ADHD symptoms and accompanying impairments. Limitations with the CBT was the large number and low dosage of treatment components, causing restricted time for practice. Unlike evidence-based, individualized targeted CBTs with parent involvement, a group CBT directed solely at the adolescents with no parent involvement does not appear effective for treating ADHD.

TRIAL REGISTRATION

NCT02937142 , 18/10/2016.

Cognitive behavioural group therapy for adolescents with ADHD: a study of satisfaction and feasibility

BACKGROUND

Adolescents with ADHD are at increased risk of adverse outcomes and a negative life trajectory into adulthood. Evidence regarding treatment specifically tailored for the needs of this age group are still limited. High dropout rates, discontinuation of medication and treatment resistance are common issues in this population, and the patient perspective on new treatment options is therefore important. In this study, we aimed to investigate treatment satisfaction and feasibility of a group CBT program for adolescents with ADHD. We further aimed to identify any baseline characteristics predicting satisfaction.

MATERIALS AND METHODS

This study was part of a larger RCT of group CBT as add-on treatment for adolescents aged 14-18 years (Mean age 15.9 years, SD 1.3) with ADHD in Norway. Satisfaction and feasibility in the treatment group (n = 48) were measured by completion of an evaluation questionnaire, attendance of group sessions and a group-leaders checklist. Predictors of satisfaction were analysed using linear regression.

RESULTS

Overall satisfaction was very high with a significant age effect, the eldest participants being most satisfied. Attendance rate was high with few dropouts and medical adherence during the treatment period was good. Group-leaders generally self-evaluated adherence to treatment manual positively but addressing resistance towards homework as challenging.

CONCLUSIONS

The participants were very satisfied with the group CBT treatment. Treatment options that are accepted and well-liked by the targeted population have the potential of reducing resistance towards treatment, improving future health and adherence to medication. The program is considered suitable for a clinical setting and may represent a feasible treatment supplement for adolescent ADHD.

Psychometric properties of the Brief Problem Monitor (BPM) in children with internalizing symptoms: examining baseline data from a national randomized controlled intervention study

BACKGROUND

Prevention is essential to reduce the development of symptomology among children and adolescents into disorders, thereby improving public health and reducing costs. Therefore, easily administered screening and early assessment methods with good reliability and validity are necessary to effectively identify children's functioning and how these develop. The Brief Problem Monitor (BPM) is an instrument designed for this purpose. This study examined the psychometric properties of the Norwegian version of the BPM parent (BPM-P) and teacher (BPM-T) versions, including internal reliability and construct validity at assessing children with internalizing problems.

METHODS

Baseline data were collected from a national randomized controlled intervention study. Children aged 8-12 years with self-reported symptoms of anxiety and/or depression with one standard deviation above a chosen population's mean were included in this study. Teachers (n = 750) and parents (n = 596) rated children using the BPM-T and BPM-P, respectively. Internal consistency was measured using Cronbach's alpha, and multi-informant agreement between the BPM-P and BPM-T was measured using Spearman's correlations. Construct validity was assessed via confirmatory factor analysis.

RESULTS

Internal consistency was good throughout all domains for both the BPM-P and BPM-T, with a Cronbach's alpha ranging from .763 to .878. Multi-informant agreement between the parents and the teacher was moderate on the externalizing, attention, and total scales and low on the internalizing scale. The model fit for the three-factor structure of the BPM was excellent for the BPM-P and good for the BPM-T.

CONCLUSIONS

Internal consistency was good, and the original three-factor solution of the BPM-P and BPM-T was confirmed based on our sample of school children at-risk for emotional problems. These promising results indicate that the BPM may be a valid short assessment tool for measuring attentional, behavioral, and internalizing problems in children. Trial registration in Clinical Trials: NCT02340637; June 12, 2014.

Cognitive Rehabilitation for Neurocognitive Late Effects in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Feasibility and Case-Series Study

Neurocognitive late effects following the diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) commonly include impaired executive functions (EFs), with negative consequences for one's health-related quality of life and mental health. However, interventions for EF impairments are scarce. Thus, the aims of this study were to (1) explore the feasibility and acceptability of the cognitive rehabilitation program Goal Management Training (GMT) and (2) examine whether GMT is associated with positive outcomes across cases of ALL survivors with EF complaints. Four participants (median age 31.5 years) underwent nine GMT modules in a total of five group sessions. Rehabilitation was focused on compensatory strategies to improve real-life EFs. Participants were evaluated at 2-week and 6-month follow-ups. Evaluation of feasibility and acceptability included adherence, a semi structured interview, self-reports, and safety. Additionally, therapists' experience with implementation was evaluated. Outcome measures included self-reports and neurocognitive tests of attention, EF, and processing speed. All participants completed GMT and rated the intervention as useful, suitable, and satisfactory. The reliable change index showed improved daily life EFs (two participants) and neurocognitive performance (three participants) at 6-month follow-up. Additionally, all participants improved on a "real-life" task involving EF. A future randomized controlled trial is recommended.

Evaluating Delivery of a CBT-Based Group Intervention for Schoolchildren With Emotional Problems: Examining the Reliability and Applicability of a Video-Based Adherence and Competence Measure

Adherence and competence are essential parts of program fidelity and having adequate measures to assess these constructs is important. The Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS CBT) was developed to evaluate the delivery of cognitive therapies for children with clinical anxiety. The present study is an assessment of the slightly adapted version of the CAS CBT evaluating the delivery of a Cognitive Behavioral Therapy (CBT)-based preventive group intervention: EMOTION: Kids Coping with Anxiety and Depression. This study was part of a Norwegian cluster randomized controlled trial (cRCT) investigating the effectiveness of a transdiagnostic intervention, the EMOTION program—an indicated prevention program targeting anxious and depressive symptoms. The applicability and psychometric properties of the CAS CBT were explored. Results are based on six raters evaluating 239 video-recorded sessions of the EMOTION program being delivered by 68 trained group leaders from different municipal services. Interrater reliability (intraclass correlation coefficients, ICC [3, 1]) indicated fair to good agreement between raters. Internal consistency of the instrument's key domains was calculated using the Omega coefficient which ranged between 0.70 to 0.94. There was a strong association between the two scales Adherence and Competence, and inter-item correlations were high across the items, except for the items rating the adherence to the session goals. Competence and Adherence Scale for Cognitive Behavioral Therapy is a brief measure for use in first-line services, with some promising features for easily assessing program fidelity, but some of the results indicated that the instrument should be improved. Future attention should also be made to adapt the instrument to fit better within a group setting, especially regarding evaluation of session goals. More research on how to adequately evaluate fidelity measures are also warranted.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02340637.

Study protocol of a factorial trial ECHO: optimizing a group-based school intervention for children with emotional problems

Background

Youth mental health problems are a major public health concern. Anxiety and depression are among the most common psychological difficulties. The aim of this study is to evaluate an optimized version of a promising indicated group intervention for emotional problems. The program (EMOTION Coping Kids Managing Anxiety and Depression) targets school children 8–12 years with anxious and depressive symptoms and examines three factors. Factor 1 compares the standard EMOTION intervention delivered in 16 group-based sessions (Group), versus a partially-digital EMOTION intervention (DIGGI) delivered as eight group sessions and eight digital sessions. Both versions use virtual reality technology (VR) to improve behavioral experiments. Factor 2 compares parent participation in a 5-session parent group (high involvement) versus sharing information with parents via a brochure (low involvement). Factor 3 compares the use of a measurement and feedback system (MFS) designed to help group leaders tailor the intervention using feedback from children with no MFS.

Methods

Using a cluster-randomized factorial design, 40 schools across Norway will be randomized to eight different experimental conditions based on three, two-level factors. To assess internalizing symptoms in children, children and their parents will be given self-report questionnaires pre-, post-, and one year after intervention. Parents also report on demographics, user satisfaction, personal symptoms and perception of family related factors. Teachers report on child symptoms and school functioning. Group leaders and the head of the municipal services report on implementation issues. The primary outcomes are changes in depressive and anxious symptoms. Some secondary outcomes are changes in self-esteem, quality of life, and user satisfaction. Questions regarding the consequences of the COVID-19 pandemic are included. Treatment fidelity is based on checklists from group leaders, and on user data from the participating children.

Discussion

This study is a collaboration between three regional centers for child and adolescent mental health in Norway. It will provide knowledge about: (1) the effect of school-based preventive interventions on anxiety and depression in children; (2) the effect of feedback informed health systems, (3) the effect and cost of digital health interventions for children, and (4) the effect of parental involvement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00581-y.

Inside the Clockwork of the ECHO Factorial Trial: A Conceptual Model With Proposed Mediators for Prevention of Emotional Problems in Children

Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the total interventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8-12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention.

Cohort profile: The Youth and Mental Health Study (YAMHS) - a longitudinal study of the period from adolescence to adulthood

The aim of this article is to provide a detailed description of the Youth and Mental Health Study (YAMHS),a population-based, representative (cluster sampling), prospective cohort study that was conducted to investigate risk and resilience factors for mental health conditions, specifically depressive symptoms and disorders, from adolescence to adulthood. The baseline data were collected in 1998 (T1) in two counties in central Norway from 2464 adolescents (response rate 88.3%, mean age 13.7 years). The first follow-up was conducted in 1999 (T2) (n = 2432, response rate of 87.1%, mean age 14.9 years). A subgroup of individuals was assessed at T2 (n = 345) with clinical interviews, and this subgroup was reassessed in 2005 (T3) (n = 265, 70.1%, 20 years). The last follow-up (of participants assessed at T1 and T2) was conducted in 2012 (T4) (n = 1266, 51.9%, 27.2 years). Demographics, depressive symptoms, general psychopathology, suicidal ideation and attempts and psychological and somatic factors were recorded. Among adolescents of both sexes, psychosocial variables were correlated with and predicted depressive symptom severity. The strongest predictors were sex (female), the levels of depressive symptoms the preceding year, and the total number of stressful events. The association between stressful life events and depressive symptoms was moderated by physical activity, while the relationship between stressful events and coping style was mediated by depressive symptoms. The rate of use of specialised mental health services among the depressed was low. The lifetime prevalence of depressive disorders was 23% at 15 years, and the most common disorder was minor depression. Adolescents who attempted suicide were more often victims of violence and less resilient than were non-suicide attempters. The existing longitudinal data from the cohort will be further analysed. Follow-up data will be obtained from existing national registries by links created with individual identification numbers.

Change in quality of life and self-esteem in a randomized controlled CBT study for anxious and sad children: can targeting anxious and depressive symptoms improve functional domains in schoolchildren?

BACKGROUND

Quality of life and self-esteem are functional domains that may suffer when having mental problems. In this study, we examined the change in quality of life and self-esteem when targeting anxious and depressive symptoms in school children (8-12 years) using a CBT-based transdiagnostic intervention called EMOTION, Kids Coping with anxiety and depression. The aim of this study was to investigate quality of life and self-esteem in children with elevated levels of anxious and depressive symptoms, and further if the EMOTION intervention could influence these important functional domains.

METHODS

The study had a clustered randomized design (cRCT), where N = 795 children recruited from 36 schools participated. The children were included based on self-reports of anxious and depressive symptoms. Schools were the unit of randomization and were assigned to intervention or control condition. Children in the intervention condition received the 10-week EMOTION intervention. Mixed effects models were used to take account of the possible clustering of data. Separate models were estimated for the dependent variables.

RESULTS

Children with elevated levels of anxious and depressive symptoms reported lower levels of quality of life and self-esteem compared to normative samples, with girls and older children reporting the lowest levels. For both genders and older children, a large and significant increase in quality of life and self-esteem was found among the children who received the intervention compared to the children in the control condition. Children in the intervention group reporting both anxious and depressive symptoms showed a significantly larger increase in both quality of life and self-esteem compared to the controls. Reductions in quality of life and self-esteem were partially mediated by reductions in symptoms of anxiety and depression.

CONCLUSIONS

Participating in an intervention targeting emotional symptoms may have a positive effect on quality of life and self-esteem in addition to reducing anxious and depressive symptoms. Improved quality of life may increase the child's satisfaction and subjective perception of wellbeing. As low self-esteem may lead to anxious and depressive symptoms, improving this functional domain in children may make them more robust dealing with future emotional challenges. Trial registration NCT02340637, retrospectively registered.

Psychometric properties of the Weiss Functional Impairment Rating Scale parent and self-reports in a Norwegian clinical sample of adolescents treated for ADHD

OBJECTIVE

To analyze the psychometric properties of the Norwegian version of the Weiss Functional Impairment Rating Scale parent and self-reports (WFIRS-P and WFIRS-S) in adolescents with ADHD.

METHODS

102 clinically referred patients, of which 86% were enrolled in an ongoing RCT program (Clinical trials NCT02937142), were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV). The conceptual framework of the WFIRS-P and the WFIRS-S was evaluated using confirmatory factor analysis (CFA), reliability was estimated using Cronbach's alpha, convergent and divergent validity was assessed using correlations with the Children's Global Assessment Scale (C-GAS) and the ADHD Rating Scale-IV (ADHD-RS-IV).

RESULTS

CFA supported the original factor structure of the questionnaires, both a first-order and a second-order model revealed acceptable model fit. Internal consistency was satisfactory across domains. The parent-adolescent agreement was moderate. The correlations between the C-GAS and the total scores of the WFIRS-P and WFIRS-S were low to moderate (r = -0.29 to -0.38). The ADHD-RS-IV correlated moderately (r = 0.49) with WFIRS-P, the correlation with WFIRS-S was weak (r = 0.28) supporting divergent validity. In multiple regression analyses, the ADHD-RS total score was the strongest predictor of the total score in both the WFIRS questionnaires, with internalizing disorder showing an additional small contribution. Age, gender and full-scale IQ gave no additional contribution in explaining the variance.

CONCLUSIONS

The findings support the use of the Norwegian version of the WFIRS-S and the WFIRS-P in the evaluation of functional impairment in adolescents with ADHD.

Parental Chronic Illness, Internalizing Problems in Young Adulthood and the Mediating Role of Adolescent Attachment to Parents: A Prospective Cohort Study

Background: Parental chronic illness is associated with an elevated risk for developing social-emotional and behavioral problems in children, in particular internalizing symptoms. This study aimed to investigate the associations between parental chronic illness when participants were adolescents and subsequent internalizing symptoms in young adulthood and whether adolescent attachment to parents or peers mediates these associations. Methods: The study used longitudinal survey data from the Youth and Mental Health Study, a cohort study including a representative sample of youth in central Norway assessed in the period from 1999 to 2000 (mean age 14.9 years) and in 2012 (mean age 27.2 years) (N = 1,266). The data consist of youth self-reports at both time points. Parental chronic illness was reported by the adolescents, quality of attachment was measured using the Inventory of Parent and Peer Attachment (IPPA), and internalizing problems were assessed in young adulthood by using the Adult Self-Report (ASR). Data were analyzed using parallel mediation analyses, controlling for adolescent sex, parental socioeconomic status, and divorce. In addition, separate analyses were conducted for adolescent girls and boys. Results: The total longitudinal effect was significant for both maternal and paternal chronic illness on internalizing problems in young adulthood. The direct effect on internalizing problems was only significant for maternal chronic illness. Attachment to fathers partially mediated the relationship between maternal chronic illness in adolescence and internalizing symptoms in young adulthood, whereas attachment to both mothers and fathers fully mediated the relationship between paternal chronic illness in adolescence and internalizing symptoms in young adulthood. A separate analysis for girls and boys indicated that the results were only significant for girls. Parental chronic illness did not play a significant indirect effect via attachment to peers on internalizing problems. Conclusions: Identifying protective factors in the pathways between parental chronic illness and mental distress in children could guide measures that promote the well-being of the child and family. The study demonstrates the importance of targeting the entire family in chronic illness care.

Age of First Walking and Associations with Symptom Severity in Children with Suspected or Diagnosed Autism Spectrum Disorder

Age of first walking (AOW) is reported to be later in autism spectrum disorder (ASD) compared with typical development. However, the relationship between AOW and variations in ASD symptoms across different neurodevelopmental disorders is largely unknown. This study investigated AOW and its association with autism symptom severity in a large sample of children (N = 490, 23% females) clinically evaluated for suspected ASD, differentiated into ASD (n = 376) and non-ASD (n = 114) diagnoses. Children with ASD achieved independent walking significantly later than children with non-ASD diagnoses. AOW was significantly associated with ASD symptom severity, and females had a non-significant later AOW. The current findings suggest that in cases with delayed AOW, ASD should be considered as an actual differential diagnosis, perhaps particularly in girls.

Cognitive-behavioural group therapy for adolescents with ADHD: study protocol for a randomised controlled trial

INTRODUCTION

Persistence of attention deficit hyperactivity disorder (ADHD) into adolescence is a significant burden to patients. Clinical guidelines recommend non-pharmacological therapies, but the evidence to support this recommendation is sparse. This study aims to evaluate the effect of a 12-week group cognitive-behavioural therapy (CBT) programme for adolescents with ADHD aged 14-18 years, who still have impairing symptoms after treatment with medication. We will study the effect of the treatment on ADHD symptoms and examine moderators and mediators of the effect of the treatment on ADHD.

METHODS AND ANALYSIS

We conduct a randomised controlled trial of CBT group therapy in adolescents with ADHD recruited from child psychiatric outpatient units in Mid-Norway. 99 adolescents who met inclusion criteria and consented to participation have been randomised to a 12-week group intervention or to a control group receiving treatment as usual. Assessments are made at admission to the clinic, preintervention, postintervention and at a 9-month follow-up, obtaining adolescent, parent and teacher reports. Clinicians blinded to group allocation rate all participants as to their functioning preintervention and at the two postintervention assessment points. The primary outcome is change in symptom scores on the ADHD Rating Scale-IV.

ETHICS AND DISSEMINATION

The Regional Committee for Medical and Health Research Ethics in South East Norway approved the study protocol (2015/2115). We will disseminate the findings in peer-reviewed publications and conference presentations, to user organisations and at courses attended by families and professionals. Two PhD students will publish and defend dissertations relating to the study. Planned publications include primary and secondary outcomes and patient satisfaction with the treatment. Furthermore, we plan to publish a manual of CBT group therapy in adolescent ADHD to benefit treatment of patients in Norway and elsewhere.

TRIAL REGISTRATION NUMBER

NCT02937142.

School functioning and internalizing problems in young schoolchildren

Background

Symptoms of anxiety and depression are common mental health problems in children and are often referred to as internalizing symptoms. Youth with such symptoms are at greater risk for poor academic achievement, school non-completion, and future mental health problems, all of which, lead to public health consequences and costs to society. The aim of the current study was to investigate associations between young school children’s internalizing symptoms and school functioning, as assessed separately by the teachers and the children.

Methods

This study is a cross-sectional study including children (N = 750. 58% girls) from the ages of 8–12 years with elevated levels of self-reported symptoms of anxiety (MASC-C) and/or depression (SMFQ). Teachers reported the academic achievement, school adaptation (TRF) and internalizing symptoms (BPM-T) of the children. Associations were analyzed using linear regression analyses.

Results

Both teacher-reported internalizing symptoms and children’s self-reported depressive symptoms were associated with poor academic achievement and school adaptation, while self-reported symptoms of anxiety were not. Symptoms of depression as assessed by the children were associated with teacher-rated internalizing symptoms, while self-reported symptoms of anxiety were not.

Conclusion

We found negative associations between school functioning and internalizing symptoms, as assessed by both the teachers and the children. The dual findings strengthen the validity of these relationships. Thus, prevention of depressive and anxiety symptoms in children may lead to positive changes in school domains such as academic achievement and school adaptation. We also identified a negative association between teacher-rated internalizing symptoms and children’s self-report of depressive symptoms, indicating that teachers may have difficulties recognizing children with these symptoms.

Trial registration

Clinical Trials NCT02340637, Registered on June 12, 2014, Retrospectively registered.

Prevention of anxiety and depression in school children: Effectiveness of the transdiagnostic EMOTION program

OBJECTIVE

The objective of the study was to examine the effectiveness of a transdiagnostic program (EMOTION, Coping Kids Managing Anxiety and Depression) targeting symptoms of anxiety and depression in schoolchildren by comparing the intervention condition (EC) to a control condition (CC).

METHOD

A clustered randomized design was used with schools as the unit of randomization. Children (N = 1686) aged 8-12 years in 36 schools completed screening using the Multidimensional Anxiety Scale (MASC-Child) and The Mood and Feelings Questionnaire Short version (SMFQ-Child). Scoring 1 SD above a population-based mean on anxiety and/or depression, 873 children were invited to participate. Intent-to-treat analyses were performed, and mixed-effects models were used.

RESULTS

Analyses revealed significant reductions of anxious and depressive symptoms as reported by the children, in which children in the intervention condition EC had almost twice the reduction in symptoms compared with the control condition CC. For parent report of the child's depressive symptoms, there was a significant decrease of symptoms in the intervention condition EC compared with CC. However, parents did not report a significant decrease in anxious symptoms in the intervention condition EC as compared with CC.

CONCLUSION

A transdiagnostic prevention program, provided in schools, was successful in reducing youth-reported symptoms of anxiety and depression and parent-reported depression. The EMOTION program has the potential to reduce the incidence of anxious and depressive disorders in youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Long-term follow-up of a community sample of adolescents with frequent headaches

Background

Several outcome studies have reported on the short- and long-term effects of migraine in selected clinical samples of children and adolescents. However, current knowledge of the course, incidence, and outcome predictors of frequent headaches in early adolescents in community populations is limited, and little is known about the long-term effects. Headache remains untreated in most of these young people. Here we examined the course, incidence, and outcome predictors of frequent headaches (at least once a week) over the long term (14 years) using previously assessed data at the baseline and 1-year follow-up of early adolescents.

Methods

Out of an original sample of 2440 who participated in the first two assessments, a sample of 1266 participants (51.9% response rate) aged 26–28 years (mean = 27.2 years) completed an electronic questionnaire comprising questions about their headache frequency and duration at the long-term follow-up. These headache characteristics together with gender, age, parental divorce, number of friends, school absence, impairment of leisure-time activities and seeing friends, pain comorbidity, and emotional (in particular, depressive symptoms) and behavioral problems were analyzed.

Results

In these young people, 8.4% reported frequent headaches (at least once a week) at the extended follow-up, while 19% of the participants having such headaches at baseline again reported such levels with a negligible gender difference. Over the follow-up period, 7.4% had developed frequent headaches, and a higher percentage of females reported such headaches (11.3% in females, 1.5% in males). In a multivariate model, frequent headaches at the baseline, gender (worse prognosis in females), impairment of leisure-time activities and seeing friends, and higher level of depressive symptoms significantly predicted headache frequency at the long-term follow-up.

Conclusions

Our findings suggest that gender, greater social impairment, and comorbid depressive symptoms are important indicators for both the short- and long-term prognosis of frequent headaches in early adolescents in community populations.

The Longitudinal Association of Being Bullied and Gender with Suicide Ideations, Self-Harm, and Suicide Attempts from Adolescence to Young Adulthood: A Cohort Study

Longitudinal associations between being bullied during adolescence and suicide ideations, self-harm, and suicide attempts into young adulthood were examined. A large representative sample was examined in 1998 (N = 2,464, MA 13.7), 1999/2000, and 2012 to reassess the outcome measures. At all ages, bullied participants showed more suicide ideation, self-harm, and suicide attempts, regardless of gender. Bullied females showed a decrease in suicide ideation from adolescence to adulthood, while bullied males showed an increase in suicide attempts in the same time period. Being bullied in adolescence strongly predicts suicidal behavior and self-harm. Preventive efforts might reduce the risk of later suicidality.

Study protocol of an RCT of EMOTION: An indicated intervention for children with symptoms of anxiety and depression

Background

High levels of anxiety and depression are common psychological symptoms among children and adolescents. These symptoms affect young people in multiple life domains and are possible precursors of long-term psychological distress. Despite relatively high prevalence, few children with emotional problems are referred for clinical treatment, indicating the need for systematic prevention. The primary aim of this study is to evaluate an indicated preventive intervention, EMOTION Coping Kids Managing Anxiety and Depression (EMOTION), to reduce high levels of anxiety and depressive symptoms.

Methods/Design

This is a clustered randomized controlled trial involving 36 schools, which are assigned to one of two conditions: (a) group cognitive behavioral intervention EMOTION or (b) treatment as usual (TAU). Assessments will be undertaken at pre-, mid - intervention, post-, and one year after intervention. The children (8–11 years old) complete self-report questionnaires. Parents and teachers report on children. The primary outcome will be changes in depressive and anxiety symptoms as measured by the Short Mood and Feelings Questionnaire (SMFQ) and Multidimensional Anxiety Scale for Children (MASC) respectively. Secondary outcomes will be changes in self-esteem, quality of life, and school and daily functioning. Observers will assess implementation quality with ratings of fidelity based on video recordings of group leaders leading the EMOTION group sessions.

Discussion

The present study is an important contribution to the field regarding working with children with symptoms of anxiety and depression. The results of this study will provide an indication whether or not the EMOTION program is an effective intervention for the prevention of later depression and/or anxiety in children. The study will also provide information about the EMOTION program’s effect on quality of life, self-esteem, and school functioning of the children participating in the study. Finally, the project will provide insight into implementation of an indicated intervention for school-aged children within Norwegian health, education, and mental health services.

Trial registration

Clinical Trials NCT02340637, Registered on June 12, 2014, last updated on January 15, 2015. Retrospectively registered.

Self-reported quality of life and self-esteem in sad and anxious school children

Background

Anxiety and depressive symptoms are common in childhood, however problems in need of intervention may not be identified. Children at risk for developing more severe problems can be identified based on elevated symptom levels. Quality of life and self-esteem are important functional domains and may provide additional valuable information.

Methods

Schoolchildren (n = 915), aged 9–13, who considered themselves to be more anxious or sad than their peers, completed self-reports of anxiety (Multidimensional Anxiety Scale for children (MASC-C), depression (The Short Mood and Feelings Questionnaire; SMFQ), quality of life (Kinder Lebensqualität Fragebogen; KINDL) and self-esteem (Beck self-concept inventory for youth (BSCI-Y) at baseline of a randomized controlled indicative study. Using multivariate analyses, we examined the relationships between internalizing symptoms, quality of life and self-esteem in three at-risk symptom groups. We also examined gender and age differences.

Results

52.1 % of the screened children scored above the defined at-risk level reporting elevated symptoms of either Anxiety and Depression (Combined group) (26.6 %), Depression only (15.4 %) or Anxiety only (10.2 %). One-way ANOVA analysis showed significant mean differences between the symptom groups on self-reported quality of life and self-esteem. Regression analysis predicting quality of life and self-esteem showed that in the Depression only group and the Combined group, symptom levels were significantly associated with lower self-reported scores on both functional domains. In the Combined group, older children reported lower quality of life and self-esteem than younger children. Internalizing symptoms explained more of the variance in quality of life than in self-esteem. Symptoms of depression explained more of the variance than anxious symptoms. Female gender was associated with higher levels of internalizing symptoms, but there was no gender difference in quality of life and self-esteem.

Conclusion

Internalizing symptoms were associated with lower self-reported quality of life and self-esteem in children in the at-risk groups reporting depressive or depressive and anxious symptoms. A transdiagnostic approach targeting children with internalizing symptoms may be important as an early intervention to change a possible negative trajectory. Tailoring the strategies to the specific symptom pattern of the child will be important to improve self-esteem.

Trial registration

Trial registration in Clinical trials: NCT02340637, June 12, 2014.

Prevalence, stability, 1-year incidence and predictors of depressive symptoms among Norwegian adolescents in the general population as measured by the Short Mood and Feelings Questionnaire

Background In numerous surveys the prevalence of depressive symptoms in adolescents has been examined in single sites and at one time point. Aims We examined depressive symptoms among adolescents aged 10-19 years in four different large school samples including two cohorts over a 10-year period in different locations in the same health region in central Norway including a total of 5804 adolescents. Two cohorts were retested within a 1-year time period to predict high versus low depressive symptom scores. Changes over a 6-year period in depressive symptom levels were examined in two of the samples of 12-14-year olds. Methods Depressive symptoms were estimated by the 13-item Short Mood and Feelings Questionnaire (SMFQ). Covariates were student age, sex, school size and location. Results "Miserable or unhappy", "Tired", "Restlessness" and "Poor concentration" were the most commonly reported depressive symptoms. Depressive symptom levels and proportions of high scoring students were consistently higher among girls, in particular in mid and late adolescence. Poisson regression analysis showed that all SMFQ items significantly predicted total scores for the whole sample, while sex (girls having a higher risk) emerged as a consistent 1-year predictor of high depressive symptom levels. Conclusions The SMFQ constitutes a short, practical and feasible measure. We recommend that this standardized measure should be used in the assessment of depressive symptoms among adolescents in school, primary care and clinical settings but also to evaluate treatment outcome. High scorers should be evaluated in subsequent clinical interviews for the presence of a depressive disorder.

Associations Between Parental Attachment and Course of Depression Between Adolescence and Young Adulthood

A study of the associations of maternal, paternal and peer attachment with the course of depression from adolescence to young adulthood. In the Youth and Mental Health study 242 adolescents completed the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version for depressive disorders at age 15 and 20. Attachment was measured with the inventory for parent and peer attachment, separately for mother, father, and peers, at age 15. Multinomial logistic regression, indicated insecure attachment relationships with both parents, but not with peers, and were associated with the course of depression. Less secure attachment to mothers was associated with becoming depressed. Less secure attachment to both parents was associated with becoming well and remaining depressed. These results suggest attachment relationships with parents as potential influences on the course of depression and may provide important framework for clinical work with adolescents and young adults.

Prognosis and psychosocial outcomes of attempted suicide by early adolescence: a 6-year follow-up of school students into early adulthood

Adulthood psychiatric and psychosocial outcomes of early adolescence suicidal acts were studied. A representative sample of school adolescents (T1, mean age, 13.7 years; n = 2464; 50.8% female; 88.3% participation) was followed up a year later with the same questionnaire (T2). High scorers of depression were matched with low or moderate scorers and interviewed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (mean age, 14.9 years; n = 345; 94% participation). They were reassessed after 5 years (T3, mean age, 20.0 years; n = 242; 73% participation). Those who attempted suicide before the age of 14 years and repeated suicidal acts between ages 14 and 15 years had worser prognostic profiles than incident cases between ages 14 and 15 years. Male attempters had better psychiatric prognosis than female attempters. Attempters were more likely to have contacted child protection services but not mental health services. Clinicians need to be aware of long-term pervasive outcomes of adolescent suicidality.

Maternal and paternal psychosocial risk factors for clinical depression in a Norwegian community sample of adolescents

BACKGROUND

Parental characteristics can increase the risk of the development of adolescent depression. In this study, we focus on the parental factors of parents in a non-intact relationship, dissatisfaction with personal economy, physical illness or disability, and internalizing and externalizing problems. The aim is to examine which of these parental risk factors, separately for mothers and fathers, are associated with clinical depression in adolescents in a community sample.

METHODS

In the Youth and Mental Health study, 345 adolescents (mean age ± standard deviation 15.0 ± 0.6 years, range 13.8-16.6 years; 72.5% girls) and their parents (79% at least one parent) completed questionnaires and the diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL). Adolescents were classified into current major depressive disorder or dysthymia (n = 46), depression not otherwise specified (n = 48), or no depression (n = 251). The parental risk factors were based on interview and the Adult Self-Report. Risk factors associated with mothers (n = 267) and fathers (n = 167) were separately analyzed using ordinal logistic regression with current depression category as the dependent variable. All analyses were adjusted for youth sex and age.

RESULTS

Mothers' economical dissatisfaction, physical illness/disability, internalizing problems and externalizing problems were associated with adolescent current depression (P ≤ 0.02). Adjusting for all other factors, only mothers' internalizing problems (P < 0.001) remained significantly associated with adolescent depression. Fathers' risk factors were not associated with adolescent depression.

CONCLUSION

Characteristics of mothers are associated with adolescent current depression. Mothers' internalizing problems is independently strongly associated with increased risk of current adolescent depression. Clinicians should assess mothers' mental health when treating depressed adolescents.

Longitudinal course of diagnosed depression from ages 15 to 20 in a community sample: patterns and parental risk factors

The primary aim was to examine the associations of hypothesized maternal and paternal risk factors with course of depression diagnosis in a community sample from ages 15-20. In addition, we describe longitudinal stability and change in depression diagnosis over this period. In the Youth and Mental Health study 242 adolescents completed questionnaires and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime interview at ages 15 and 20, and risk factors were measured by parent report including the Adult Self Report. Both groups who remained depressed and who recovered were more likely to have mothers with internalizing problems. Paternal internalizing problems was also significantly associated with course of depression. These findings suggest treatment of depression in adolescents and young adults may benefit from consideration of the parents' internalizing symptoms.

Is involvement in school bullying associated with general health and psychosocial adjustment outcomes in adulthood?

The aim was to examine prospectively associations between bullying involvement at 14-15 years of age and self-reported general health and psychosocial adjustment in young adulthood, at 26-27 years of age. A large representative sample (N=2,464) was recruited and assessed in two counties in Mid-Norway in 1998 (T1) and 1999/2000 (T2) when the respondents had a mean age of 13.7 and 14.9, respectively, leading to classification as being bullied, bully-victim, being aggressive toward others or non-involved. Information about general health and psychosocial adjustment was gathered at a follow-up in 2012 (T4) (N=1,266) with a respondent mean age of 27.2. Logistic regression and ANOVA analyses showed that groups involved in bullying of any type in adolescence had increased risk for lower education as young adults compared to those non-involved. The group aggressive toward others also had a higher risk of being unemployed and receiving any kind of social help. Compared with the non-involved, those being bullied and bully-victims had increased risk of poor general health and high levels of pain. Bully-victims and those aggressive toward others during adolescence subsequently had increased risk of tobacco use and lower job functioning than non-involved. Further, those being bullied and aggressive toward others had increased risk of illegal drug use. Relations to live-in spouse/partner were poorer among those being bullied. Involvement in bullying, either as victim or perpetrator, has significant social costs even 12 years after the bullying experience. Accordingly, it will be important to provide early intervention for those involved in bullying in adolescence.

Emotional/behavioural, social correlates and one-year predictors of frequent pains among early adolescents: Influences of pain characteristics

In a one-year longitudinal study, emotional/behavioural correlates and predictors of four common pain complaints (headaches, stomach, back and limb pain), were examined in a representative school sample of 2360 adolescents aged 12- to 15-years. At first assessment, 18.3% reported being bothered by a frequent pain (at least once a week) and 40% of the pain sufferers had two or more pain locations, more commonly reported by girls. Subjects having any of the four frequent pains reported having fewer friends and were more often absent from school. Frequency and number of reported pains among adolescents were positively related to levels of internalising and externalising problems. These latter problems were consistently and significantly higher among adolescents with frequent back and limb pains, however, when coexistence of another frequent pain was controlled, differences were small. Number of pains at the one-year follow-up was significantly predicted by frequent back pain and headache, depressive symptoms scores, somatic complaints (other than pain), number of friends and reduced leisure time activities during the follow-up period. Frequent back pain and depressive symptoms also predicted multiple frequent pains (vs single frequent pain) at the follow-up as did recent parental divorce. It is concluded that various emotional and behavioural problems, and which are commonly regarded as being specifically related to pain type or location among adolescents, depend rather on frequency and coexistence of multiple frequent pains. Assessment of adolescents with frequent and multiple pains should, therefore, include broad screening of internalising as well as externalising problems as well as various aspects of impairment.

Prevalence and characteristics of depressive disorders in early adolescents in central Norway

BACKGROUND

Prevalence of depressive disorders among adolescents has varied across studies. The present study aims to assess current and lifetime prevalence and characteristics of adolescent Major Depressive Disorder (MDD), Dysthymia and Depression NOS among adolescents in Central Norway in addition to socio-demographics and use of mental health care.

METHOD

In the Youth and Mental Health Study a representative sample of 2432 junior high school students (mean age 14.9 years, SD = 0.6) from two counties in Central Norway were screened with the Mood and Feelings Questionnaire (MFQ). A subset of 345 of these adolescents (72.5% girls), 220 high scorers (MFQ = > 26), 74 middle scorers (MFQ 7-25), and 50 low scorers (MFQ < 7), 1 unknown score, were drawn and interviewed with the Kiddie SADS-PL (Present-Life Version). In all, 79% had parental interviews as well. All estimates of prevalence rates and population shares were weighted back using a sandwich estimator to yield true population estimates.

RESULTS

Almost one in four subjects (23%) had life-time depression. Prevalences of current Major Depressive Disorder (MDD), Dysthymia and "Double depression" were 2.6%, 1.0% and 0.6%, respectively, and for Depression NOS 6.3%.All depressive disorders were characterized by long duration of episodes with large variations, and for any depressive disorder onset before 12 years of age. In multivariate analyses MDD and Dysthymia were most strongly associated with gender and not living with both biological parents. There was no gender difference for Depression NOS. Although a considerable number of depressed subjects had received mental health care, the reason for contact with services was seldom due to affective symptoms. Less than 20% had been in contact with specialist mental health services.

CONCLUSION

High rates of Depression NOS, early onset of depressive episodes, long duration, and low use of specialized services point to the need for improved diagnostic assessment and treatment for young individuals.

Prevalences and correlates of sleep problems among adolescents in specialty mental health services and in the community: what differs?

AIMS

Knowledge of sleep problems and their relationships among adolescent psychiatric patients is limited. This study investigated whether adolescents in specialty mental health care differ in rate and correlates of sleep problems from adolescents in a community sample; 2465 adolescents from a community sample were compared with a representative clinical sample of 129 adolescent patients.

METHODS

Comparisons were made on frequent sleep problems according to scores on the Youth Self-Report, the Mood and Feelings Questionnaire, and instruments assessing coping styles, stresses and family functioning.

RESULTS

Sleep problems were more frequent in the clinical sample than the community sample (31.3% vs. 5%). Sleeping little and being overtired were the most common sleep problems. Sleep problems were multivariately associated with internalizing problems in both samples. Poor family functioning and distractive coping were multivariately associated with sleep problems among adolescent patients, whereas depressive symptoms were multivariately associated in community adolescents.

CONCLUSIONS

Prevalences of sleep problems were high among adolescent patients. However, sleep problems may be in danger of being unnoticed in clinical practice. Clinicians should ask about such problems and be aware of possible connections with family functioning, depression and suicidality. Therapeutic interventions directed towards sleep problems should be considered.

Prevalence of bullying and aggressive behavior and their relationship to mental health problems among 12- to 15-year-old Norwegian adolescents

The aim of this study was to examine the relationships between being bullied and aggressive behavior and self-reported mental health problems among young adolescents. A representative population sample of 2,464 young Norwegian adolescents (50.8% girls) aged 12-15 years was assessed. Being bullied was measured using three items concerning teasing, exclusion, and physical assault. Self-esteem was assessed by Harter's self-perception profile for adolescents. Emotional and behavioral problems were measured by the Moods and Feelings Questionnaire (MFQ) and the youth self-report (YSR). Aggressive behavior was measured by four items from the YSR. One-tenth of the adolescents reported being bullied, and 5% reported having been aggressive toward others during the past 6 months. More of the students being bullied and students being aggressive toward others reported parental divorce, and they showed higher scores on all YSR subscales and on the MFQ questions, and lower scores on the global self-worth subscale (Harter) than students not being bullied or aggressive. A few differences emerged between the two groups being bullied or being aggressive toward others: those who were aggressive showed higher total YSR scores, higher aggression and delinquency scores, and lower social problems scores, and reported higher scores on the social acceptance subscale (Harter) than bullied students. However, because social problems were demonstrated in both the involved groups, interventions designed to improve social competence and interaction skills should be integrated in antibullying programs.

Specific depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence

OBJECTIVE

To examine the role of depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence.

METHOD

A representative sample of Norwegian school students (N = 2464, mean age 13.7 years) in grades 8 and 9 was reassessed after one year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n = 345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age = 14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n = 252, mean age = 20.0 years) and telephone K-SADS-PL interviews (n = 242). The participation rate was 76.9% (n = 265).

RESULTS

Cognitive symptoms dominated the depressive symptom profile among suicide attempters, irrespective of age and time. Among younger adolescents, suicidal thoughts and acts of self-harm without suicidal intent were associated with suicidal acts. Recurrent thoughts about death, hopelessness, disturbed concentration and middle insomnia were associates of suicidal acts among older adolescents. Worthlessness by 15 years was a significant predictor of suicidal acts between 15 to 20 years. MDD and a depressive episode, not otherwise specified, continued to be significant associates among younger adolescents, while dysthymia by 15 years remained a predictor of suicidal acts between 15 to 20 years, even when controlled for depressive symptoms.

CONCLUSIONS

Self-harm without suicidal intent, middle insomnia, cognitive depressive symptoms and a formal psychiatric diagnosis of any depressive disorder should alert professionals in the risk assessment of suicidal adolescents.

Predictors of suicidal acts across adolescence: influences of familial, peer and individual factors

OBJECTIVE

To examine the influences of familial, peer and individual predictors of suicidal acts in a longitudinal study with a subset of school adolescents reporting high levels of depressive symptoms.

METHOD

A representative sample of Norwegian school students (N=2464, mean age 13.7 years, T1) was reassessed after 1 year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n=345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age=14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n=252, mean age=20.0 years) and telephone K-SADS-PL interviews (n=242). The participation rate at T3 was 76.9% (n=265). The questionnaire explored various relationships with family members, peers and individual factors such as lifestyle habits, and physical health.

RESULTS

Irrespective of time, history of a suicidal act significantly predicted a later suicidal act. Not living with both biological parents and a diagnosis of any depressive disorder were significant predictors for younger and older adolescents, respectively.

CONCLUSIONS

In line with the findings of previous clinical studies, our results underline the importance of identifying previous suicidal acts, depressive disorders, broken homes and risk behaviours such as smoking and intoxication in the assessment of suicidal risk across adolescence.

One‐Year Incidence, Course, and Outcome Predictors of Frequent Headaches Among Early Adolescents

OBJECTIVE

To examine the prevalence rate, course, annual incidence, and predictors of frequent headaches (at least once a week) in a 1-year longitudinal study of a representative school sample of 2355 adolescents aged 12 to 14 years.

METHODS

Information was gathered by means of questionnaires administered to the subjects at school.

RESULTS

The overall prevalence estimates of frequent headaches, including those subjects reporting another type of frequent pain, were 8.1% and 8.9% at the two assessment points (T(1) and T(2)), and 3.3% to 4% for frequent headaches without other frequent pain complaints. Both forms of frequent headaches were about three times more common among girls than boys. Persistence of frequent headaches (with possible pain comorbidity) was high, in that more than one-third of adolescents reporting frequent headaches continued to have such headaches 1 year later. Persistence also increased with age, in particular among 13- to 14-year-old girls. The overall annual incidence of frequent headaches in the whole sample was 6.5%. While incidence was about twice as high among adolescent girls than boys, there was a steady increase among girls, whereas the rates were stable in boys. The results of multivariate regression analyses showed that frequent headaches at 1-year follow-up could be significantly predicted by frequent headaches at first assessment, impairment (reduced leisure time activities), and high depressive symptom scores, in addition to gender (girls had a worse outcome).

CONCLUSIONS

Frequent headaches, among girls in early adolescence in particular, should be carefully evaluated, and treatment offered to those who are impaired in their daily life functioning.

Prevalence, course, incidence, and 1-year prediction of deliberate self-harm and suicide attempts in early Norwegian school adolescents

In this survey of early Norwegian school adolescents, the prevalence, course, and incidence of self-harm behavior with or without suicide intent were examined, in addition to predictors of self-harm for a 1-year follow-up period. Lifetime prevalence rates of self-harm without suicide intent and suicide attempts were 2.9% and 3.0%, respectively, while 1-year incidence rates were 3.6% and 1.7%, respectively. In multivariate analysis, five predictors significantly differentiated self-harmers from non-self-harming adolescents. Early school adolescents having frequent or intense suicidal ideation over an extended time period and attempting self-harm repeatedly with or without suicide intent should be identified and offered treatment.

Adolescents referred to specialty mental health care from local services and adolescents who remain in local treatment: what differs?

BACKGROUND

The study investigates whether adolescents referred to specialty mental health services from local services differ from adolescents who only have received help for psychiatric problems locally. If so, which factors associate strongest with referral?

METHOD

Adolescents (n = 76) from an adolescent population sample (N = 2,538) who had received help during the last year for mental problems from local services were compared to a clinical sample of adolescents (N = 129) referred to specialty mental health services from such local services. Comparisons were made according to scores on the Youth Self-Report (YSR); depressive symptoms; family functioning; attachment to parents; self-concept; coping styles; response styles; dysfunctional attitudes; negative life events; daily hassles; socio-demographics.

RESULTS

As compared to adolescents receiving help locally, adolescents in specialty mental health care scored higher on YSR internalising syndrome; YSR attention problems; YSR thought problems; suicidality; psychosocial stressors; knowing someone who had attempted suicide; parental divorce; substance use; recent moves; living in lodgings; lost a pal or boy/girlfriend; and lower on attachment to parents. Multivariate logistic regression analysis identified four factors associated with receiving specialty mental health care: low family functioning; moved previous year; knowing someone who had attempted suicide; own suicidality.

CONCLUSIONS

Family functioning as reported by the adolescents, and not mental health problems except for suicidality, was found to be the strongest associated with referral to specialty mental health services. Contrary to findings from many other studies, referral was associated with internalising problems, not externalising ones.

School factors and the emergence of depressive symptoms among young Norwegian adolescents

The aims of this study were to examine correlates of self-reported depressive symptoms within the school area, and possible predictors of change in depressive symptom levels over a 1-year period in a large representative sample of 12 to 15-year-old adolescents in central Norway. The school variables were: school stress, class wellbeing, teacher support, and grades. Possible confounding factors were age, SES, ethnicity, and parental divorce. We also examined the strengths of these relationships. In the cross-sectional multivariate analyses of the whole sample, at time-point one (T1), all four school factors were independently associated with depressive symptom levels at small to moderate levels. In the longitudinal multivariate analyses of the whole sample, self-reported depressive symptom levels at time-point two (T2) were predicted by depressive symptom levels at T1, gender and teacher support. For girls, three of the school variables significantly predicted depressive symptom levels at T2, while this was not the case for boys. Prevention in schools might be of importance.

A help-line for children. Seasonal variations in issues

The objectives of the study were to describe monthly variations in issues in calls to a help-line for children and adolescents. All 80,983 calls to a Red Cross Help-Line for children in 1991-1997 were included. In 22,698 calls, information about age, sex or issue could be identified. A monthly variation in frequency of calls with peaks in April and November and a correlation with the absolute values of monthly changes in length of day were found. Conversations concerning psychiatric suffering were more frequent in January or February and less frequent than expected in May/June and December. Conversations about sexuality correlated with the frequencies of births in the adult population 9 months later. A spring and fall peak in total calling and a winter peak in calls for depression, anxiety, pain and neglect were described.

Psychosocial correlates of depressive symptoms among 12-14-year-old Norwegian adolescents

BACKGROUND

The aim of the study was to examine the relationships between various psychosocial factors and depressive symptoms in early adolescence.

METHODS

A representative sample of 2,465 12-14-year-old adolescents comprising 50.8% girls and 49.2% boys, with a mean age of 13.7 years, was recruited in two counties in Norway. The participation rate was 88.3%. Depressive symptoms were measured by the Mood and Feelings Questionnaire (MFQ).

RESULTS

Correlations between the total sum of stressful events/daily hassles and the total sum of MFQ were moderately high, rs = .49 and rs = .53, respectively. Depressive symptoms were more strongly correlated with school-related stress among boys than girls, whereas the correlation between daily hassles and depressive symptoms was higher for girls than boys. The results of univariate analyses showed significantly higher mean total MFQ scores among adolescents not living with both natural parents, those who had moved more than twice and those with more than 3 siblings orhaving fewer than 2 close friends. Further, adolescents from Third World societies and adopted adolescents, those from lower SES groups, having unemployed parents or living in coastal areas had higher mean depressive symptom scores. The results of multiple regression analyses yielded the following six significant predictors of total MFQ scores in order of importance: Sum of daily hassles and sum of stressful life events, gender, number of friends, ethnicity and mother's employment status. Altogether, these variables accounted for 43% of the total variance in MFQ scores.

CONCLUSIONS

It is concluded that these psychosocial predictors should be addressed when assessing depressive symptoms in early adolescence. The findings of the study are discussed in view of previous research in the field and their clinical significance.

Insecure attachment as a risk factor for future depressive symptoms in early adolescence

OBJECTIVE

To investigate whether insecure attachment is a predictor of subsequent depressive symptoms among adolescents 12-14 years of age, when controlled for depressive levels the preceding year, various demographic and psychosocial factors, and stressful life events.

METHOD

A representative sample of 2,360 young adolescents was assessed at two time points 1 year apart. Measures included were depressive symptoms measured by the Mood and Feelings Questionnaire (MFQ), attachment to parents and friends measured by the Inventory of Parent and Peer Attachment, stressful events, and various sociodemographic factors. The initial response rate was 88.3% and the attrition rate was 4.3%.

RESULTS

The proportions of high scorers (MFQ > 33) increased threefold from T1 to T2 (3.4% to 10.9%). Results of multivariate logistic regression analyses showed that the following variables at T1 were predictive of depressive symptoms at T2 : severe depressive symptoms (odds ratio [OR] = 5.30), gender (OR = 4.08), attachment to parents (OR = 1.36), and stressful life events (OR = 1.12). No interactions between attachment and severe depressive symptoms and gender and stressful life events, respectively, were found.

CONCLUSIONS

Insecure attachment to parents may contribute to the development of severe depressive symptoms among young adolescents. Improving the adolescent-parent relationship could be a focus for interventions both in community services and in clinical work.