Booking system, video conferencing (VC) solution and online forms for improving child psychiatric services in Pohjois-Savo region

Abstract Purpose Early detection and timely treatment of child psychiatric problems require multi-professional collaboration and interaction between primary and specialized health care. The “eHealth Services for Child and Adolescent Psychiatry (eCAP), 2015-2018” project aims at improving child psychiatric services in peripheral areas by developing eHealth tools facilitating better cooperation between professionals working with children with mental health problems. Methods The online booking system allows the primary healthcare professionals in Pohjois-Savo region to book a video conference (VC) with experts in child psychiatry for consultation, supervision or follow-up of care. Background information gathered from the parents, teacher and the child by online forms helps the consult to prepare for the meeting, which can be carried out on computer, laptop, table or smartphone. The developed services will be evaluated based on the log data and user experiences from the pilot phase. Results The services will improve the quality, availability and cost-effectiveness of child psychiatric outpatient services in the region. Increased multi-professional collaboration among professionals will support preventive work, early identification and treatment in natural developmental environments of children. The travel needs for families are expected to decrease. Conclusions eHealth can help to meet the global challenge of providing sufficient, timely child psychiatric services in remote, sparsely populated areas with limited resources, but information security and compatibility of different technical applications require innovative solutions. Furthermore, the people-related factors are crucial in introducing a sustainable change: the users must understand the benefits and receive training to adopt the new tools and routines for their work.Abstract Purpose Early detection and timely treatment of child psychiatric problems require multi-professional collaboration and interaction between primary and specialized health care. The “eHealth Services for Child and Adolescent Psychiatry (eCAP), 2015-2018” project aims at improving child psychiatric services in peripheral areas by developing eHealth tools facilitating better cooperation between professionals working with children with mental health problems. Methods The online booking system allows the primary healthcare professionals in Pohjois-Savo region to book a video conference (VC) with experts in child psychiatry for consultation, supervision or follow-up of care. Background information gathered from the parents, teacher and the child by online forms helps the consult to prepare for the meeting, which can be carried out on computer, laptop, table or smartphone. The developed services will be evaluated based on the log data and user experiences from the pilot phase. Results The services will improve the quality, availability and cost-effectiveness of child psychiatric outpatient services in the region. Increased multi-professional collaboration among professionals will support preventive work, early identification and treatment in natural developmental environments of children. The travel needs for families are expected to decrease. Conclusions eHealth can help to meet the global challenge of providing sufficient, timely child psychiatric services in remote, sparsely populated areas with limited resources, but information security and compatibility of different technical applications require innovative solutions. Furthermore, the people-related factors are crucial in introducing a sustainable change: the users must understand the benefits and receive training to adopt the new tools and routines for their work

Burnout and self-perceived health among Finnish psychiatrists and child psychiatrists: a national survey

Aims: This study investigated burnout and related health matters among a sample of Finnish physicians working within the field of psychiatry.Methods: A postal questionnaire was sent to one in three licensed physicians randomly selected from the register of the Finnish Medical Association (FMA). The response rate was 74% (n = 3133).Results: Psychiatrists and child psychiatrists reported burnout, threat of severe burnout, depression, and mental disorder more commonly than other physicians. Moreover, psychiatrists and child psychiatrists reported less often "good" or "rather good" self-perceived health. Depression had a moderate positive correlation with overall MBI score. Lack of possibilities to consult a colleague, and supervision of work, experience of threat of violence, and self-reported depression were significantly associated with overall burnout level and emotional exhaustion.Conclusions: Emotional exhaustion as a symptom of burnout was common among psychiatrists, especially among those working in community care, and child psychiatrists. Problems of general health, as well as mental health, among psychiatrists and child psychiatrists are in need of attention.</p

Childhood predictors of later psychiatric hospital treatment: findings from the Finnish 1981 birth cohort study

Psychiatric hospital treatment (PHT) is expensive and indicates a severe disorder. Investigation of the early identification of this small patient group has though been hindered by small samples or unsatisfactory assessment in childhood. The present study aims to study the predictive association between psychopathology at age 8 using multi-informant assessment and later PHT. A nationwide birth cohort of Finnish children (n = 5,346) was assessed at age 8 to obtain information about psychopathology using the Rutter parent and teacher reports and self-reports of depressive symptoms. The main outcome was admission to any hospital with a primary diagnosis of any psychiatric disorder according to the Finnish National Hospital Discharge Register between age 13 and 24. Between age 13 and 24, 6.2% of the males and 4.1% of the females had been admitted for PHT. Among males, PHT was independently predicted by non-intact family and adult reports of conduct and of emotional symptoms, while among females by self-reported depressive symptoms. However, the combination of conduct and emotional problems was the strongest predictor for PHT in both sexes. Admission due to psychosis among males was associated with childhood conduct, attention, and emotional problems, but with emotional problems among females. Psychopathology at age 8 can be seen as a long-lasting increased risk of severe psychiatric disorders requiring hospital treatment in adolescence or early adulthood. Attention should be paid to self-reports among females and of comorbid conduct and emotional problems in both sexes in the early identification of this patient group

Psychosocial factors associated with becoming a young father in Finland: a nationwide longitudinal study

Peer reviewe

The dynamic course of peripartum depression across pregnancy and childbirth

Objective Peripartum depression (PPD) pertaining to depression in pregnancy and postpartum is one of the most common complications around childbirth with enduring adverse effects on mother and child health. Although psychiatric symptoms may improve or worsen over time, relatively little is known about the course of PPD symptoms and possible fluctuations Methods We applied a person-centered approach to examine PPD symptom patterns across pregnancy and childbirth. 824 women were assessed at three time points: first trimester (T1), third trimester (T2), and again at eight weeks (T3) postpartum. We assessed PPD symptoms, maternal mental health history, and childbirth variables Results Growth mixture modeling (GMM) analysis revealed four discrete PPD symptom trajectory classes including chronic PPD (1.1%), delayed (10.2%), recovered (7.2%), and resilient (81.5%). Delivery complications were associated with chronic PPD but also with the recovered PPD trajectory class. History of mental health disorders was associated with chronic PPD and the delayed PPD class Conclusion The findings underscore that significant changes in a woman’s depression level can occur across pregnancy and childbirth. While a minority of women experience chronic PDD, for others depression symptoms appear to significantly alleviate over time, suggesting a form of recovery. Our findings support a personalized medicine approach based on the woman’s symptom trajectory. Future research is warranted to identify the mechanisms underlying modifications in PPD symptoms severity and those implicated in recovery.Peer reviewe

Kuopio birth cohort - design of a Finnish joint research effort for identification of environmental and lifestyle risk factors for the wellbeing of the mother and the newborn child

Background: A Finnish joint research effort Kuopio Birth Cohort (KuBiCo) seeks to evaluate the effects of genetics, epigenetics and different risk factors (medication, nutrition, lifestyle factors and environmental aspects) during pregnancy on the somatic and psychological health status of the mother and the child. Methods: KuBiCo will ultimately include information on 10,000 mother-child pairs who have given their informed consent to participate in this cohort. Identification of foetal health risk factors that can potentially later manifest as disease requires a repository of relevant biological samples and a flexible open up-to-date data handling system to register, store and analyse biological, clinical and questionnaire-based data. KuBiCo includes coded questionnaire-based maternal background data gathered before, during and after the pregnancy and bio-banking of maternal and foetal samples that will be stored in deep freezers. Data from the questionnaires and biological samples will be collected into one electronic database. KuBiCo consists of several work packages which are complementary to each other: Maternal, foetal and placental metabolism and omits; Paediatrics; Mental wellbeing; Prenatal period and delivery; Analgesics and anaesthetics during peripartum period; Environmental effects; Nutrition; and Research ethics. Discussion: This report describes the set-up of the KuBiCo and descriptive analysis from 3532 parturients on response frequencies and feedback to KuBiCo questionnaires gathered from June 2012 to April 2016. Additionally, we describe basic demographic data of the participants (n = 1172). Based on the comparison of demographic data between official national statistics and our descriptive analysis, KuBiCo represents a cross-section of Finnish pregnant women.Peer reviewe

The association between gestational diabetes mellitus and postpartum depressive symptomatology : A prospective cohort study

Background: The literature suggests an association between type 2 diabetes mellitus and depression, but data on the association between gestational diabetes mellitus (GDM) and postpartum depressive symptomatology (PPDS) are scarce. Methods: Altogether, 1066 women with no previous mental health issues enrolled in the Kuopio Birth Cohort (KuBiCo, www.kubico.fi) were selected for this study. GDM was diagnosed according to the Finnish Current Care Guidelines. Depressive symptomatology was assessed with the Edinburgh Postnatal Depression Scale (EPDS) during the third trimester of pregnancy and eight weeks after delivery. Additionally, a subgroup of women (n = 505) also completed the EPDS during the first trimester of pregnancy. Results: The prevalence rates of GDM and PPDS in the whole study population were 14.1% and 10.3%, respectively. GDM was associated with an increased likelihood of belonging to the PPDS group (OR 2.23, 95% CI 1.23-4.05; adjusted for maternal age at delivery, BMI in the first trimester, smoking before pregnancy, relationship status, nulliparity, delivery by caesarean section, gestational age at delivery, neonatal intensive care unit admission and third-trimester EPDS scores). A significant association between GDM and PPDS was found in the subgroup of women with available data on first-trimester depression (n = 505). Limitations: The participation rate of the KuBiCo study was relatively low (37%). Conclusions: Women with GDM may be at increased risk of PPDS. Future studies should investigate whether these women would benefit from a closer follow-up and possible supportive interventions during pregnancy and the postpartum period to avoid PPDS.Peer reviewe

Why Am I the Only One You’re Talking to, Talk to Them, They Haven’t Said a Word? : Pitfalls and Challenges of Having the Child in the Focus of Family Therapy

Children with conduct disorders are at risk of being positioned in the family therapy as ‘the problem’. This study describes how the difficulties were talked about and how the child coped in this situation. The results showed: the parents produced symptom-oriented problem talk about the child’s behavior, rendering systemic reformulation of the problem challenging. The negative interaction made the climate unsafe and impaired consideration of the child’s behavior as a meaningful way for the child to become seen and heard. This study enriches understanding of the therapeutic challenge therapists face with high-risk families from the very beginning of the treatment.peerReviewe

“You helped me out of that darkness” : Children as dialogical partners in the collaborative post‐family therapy research interview

Applying Dialogical Methods for Investigations of Happening of Change (DIHC), this study investigated how children who had been diagnosed with an oppositional defiant or conduct disorder participated in a collaborative post‐therapy research interview and talked about their experiences of family therapy. The results showed that the children participated as dialogical partners talking in genuine, emotional, and reflective ways. Encountered as full‐membership partners, the children also co‐constructed meanings for their sensitive experiences. However, their verbal initiatives and responses appeared in very brief moments and could easily have been missed. The collaborative post‐therapy interview offered a safe forum for co‐reflection by participants on what they had found useful or difficult in the family therapy process. In this interview setting, the family first listens to reflection by the therapists on the therapy process and their thoughts on some of the family's related sensitive issues. The results indicate that when therapists present themselves as not‐knowing, receptive and accountable, therapists may facilitate reflection for all family members, including children.peerReviewe