Pain symptoms and sleep problems among school-aged children. Long-term prevalence changes, and pain symptoms as predictors of later mental health

Children’s pain symptoms and sleep problems are among the most common health complaints. They distract children from activities, decrease the quality of life, contribute to a significant economic burden, and have shown continuity into adulthood. The main aims of this thesis were to investigate long-term changes in the prevalence of pain symptoms and sleep problems among Finnish school-aged children, and the later mental health of those who in childhood experience pain. Prevalence, co-occurrence, and associated psychosocial factors of pain symptoms and sleep problems were also assessed. In study I, prevalence changes in eight-year-old children’s pain symptoms and sleep problems were investigated in three cross-sectional population-based samples (years 1989: n=1038, 1999: n=1035, and 2005: n=1030). In study II, cross-sectional associations between pain symptoms, sleep problems, and psychosocial factors were assessed among 13-18-year-old adolescents (n=2476). In studies III and IV, associations between pain symptoms at age eight (n=6017), and register-based data on antidepressant use and severe suicidality by age 24, were examined in a nationwide birth cohort. Pain symptoms and sleep problems were common and often co-occurred. A considerable number of children’s pain symptoms remained unrecognized by the parents. The prevalence of pain symptoms, sleep problems, and multiple concurrent symptoms approximately doubled from 1989 to 2005. Psychiatric difficulties or demographic factors did not explain the increase. Psychosocial factors that were associated with pain, sleep problems, and a higher number of symptoms, were female sex, psychological difficulties, emotional symptoms, smoking, victimization, and feeling not cared about by teachers. In longitudinal analyses, the child’s own report of headache, and to a smaller degree the parental report of the child’s abdominal pain predicted later antidepressant use. Parental report of the child’s abdominal pain predicted severe suicidality among males. If one of the symptoms is present, health care professionals should inquire about other symptoms as well. Questions should be directed to the children, not only to their parents. Inquiring about psychiatric difficulties, substance use, victimization, and relations with teachers should be included as a part of the assessment. Further studies are needed to clarify the reasons that underlie the increased prevalence rates, and the factors that may increase or decrease the risk for later mental health problems among pain-suffering children.Siirretty Doriast

Secular trends in childhood pain and comorbid psychiatric symptoms: a population-based study

Purpose Pain symptoms are common in childhood. They often lead to functional impairment and co-occur with psychiatric difficulties. Although children's lives have undergone enormous changes in recent decades, long-term data on changes in pain symptoms, and in comorbid psychiatric difficulties, is lacking. This knowledge is crucial, as co-occurring psychiatric symptoms are significant predictors of long-term outcome for children who suffer from pain. The main purpose of the present study was to explore secular changes in comorbid pain and psychiatric symptoms. Methods Four population-based, cross-sectional surveys of 8-9-year-old children were conducted in Southwest Finland in 1989, 1999, 2005, and 2013. Identical methodologies and questionnaire-based measures were used each study year. Participation ranged from 891 to 986 over the study period. The children were asked about the frequency of headache, abdominal pain, and other pains. Children, their parents, and teachers provided information on the child's psychiatric difficulties, including internalizing and externalizing symptoms. Results The cumulative odds ratios and 95% confidence intervals for the overall prevalence of pain symptoms increased among both genders from 1989 to 2013 and ranged from 1.4 (1.03-1.8) for other pains to 2.4 (1.7-3.3) for abdominal pain. Comorbid internalizing symptoms increased among girls with odd ratios and 95% CIs of 1.8 (1.03-3.1) for children with any kind of pain, and 3.0 (1.4-6.2) for children with headache. No changes were found among boys. Conclusion Overall pain symptoms doubled in both genders, but the most novel finding was that comorbid emotional difficulties tripled among girls who reported headaches. Further research is needed to confirm, and explain, these findings

Time trends in treated incidence, sociodemographic risk factors and comorbidities : a Finnish nationwide study on anxiety disorders

Background There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings. Methods This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born). Results Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%). Conclusion Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.Peer reviewe

Matalan kynnyksen hoito lasten ahdistuneisuuteen: Voimaperheet – Huolet hallintaan -mallin kehittäminen

Ahdistuneisuushäiriöt ovat yleisimpiä mielenterveyden häiriöitä lapsuus- ja nuoruusiässä. Hoitamattomina ne lisäävät riskiä aikuisiän mielialahäiriöihin, päihteiden käyttöön ja itsemurhiin. Kognitiivinen käyttäytymisterapia on tutkitusti tehokas hoitokeino, mutta sitä on tarjolla liian vähän. Näyttöön perustuvan hoidon saatavuutta on mahdollista lisätä internetissä toteutettavien­ ­interventioiden avulla. Tällainen on Turun yliopistossa kehitetty Huolet hallintaan -hoito-ohjelma. Ohjelma koostuu lapselle ja vanhemmille suunnatuista internetsivustoista ja siihen liittyyvalmentajan viikoittainen puhelinohjaus

Selective mutism and the risk of mental and neurodevelopmental disorders among siblings

The siblings of children with mental disorders are more likely to experience mental health issues themselves, but there has been a lack of sibling studies on selective mutism (SM). The aim of this population-based study was to use national registers to examine associations between children with SM and diagnoses of various mental disorder in their siblings. All singleton children born in Finland from 1987 to 2009, and diagnosed with SM from 1998 to 2012, were identified from national health registers and matched with four controls by age and sex. Their biological siblings and parents were identified using national registries and the diagnostic information on the siblings of the subjects and controls was obtained. The final analyses comprised 658 children with SM and their 1661 siblings and 2092 controls with 4120 siblings. The analyses were conducted using generalized estimating equations. Mental disorders were more common among the siblings of the children with SM than among the siblings of the controls. The strongest associations were observed for childhood emotional disorders and autism spectrum disorders after the data were adjusted for covariates and comorbid diagnoses among SM subjects. The final model showed associations between SM and a wide range of disorders in siblings, with strongest associations with disorders that usually have their onset during childhood. Our finding showed that SM clustered with other mental disorders in siblings and this requires further research, especially the association between SM and autism spectrum disorders. Strong associations with childhood onset disorders may indicate shared etiologies

Parental age and risk of depression: A nationwide, population-based case-control study

Background: The global prevalence of depression has increased in recent decades and so has the average age of parenthood. Younger and older parental age have been associated with several mental disorders in their offspring, but the associations for depression have been inconsistent.Methods: This study comprised 37,682 singleton births in Finland from 1987- 2007. The subjects were living in Finland at the end of 2012 and had a depressive disorder recorded in the Care Register for Health Care. We also randomly identified 148,795 controls from the Population Register. When missing obsevations excluded the sample was Ncases=18,708 and Ncontrols=77,243. The results were adjusted for the parents' psychiatric history, depression history, marital status and place of birth, the mothers' maternal socioeconomic status, smoking during pregnancy and previous births and the children's birth weight.Results: We found a U-shaped association between offspring depression and the age of both parents. The highest odds of depression occurred when the fathers were aged 50 plus years (adjusted Odds Ratio (ORa) 1.51, 95% CI 1.23-1.86) and the mothers were under 20 (ORa 1.44, 95% CI 1.29-1.60) compared to the reference category of parents aged 25-29 years.Limitations: The study was limited to depression diagnosed by specialised health care services and had a relatively short follow-up period. Some data were missing and that could lead to risk estimation biases.Conclusion: Diagnosed depression was higher among the offspring of younger and older parents. The results suggest that the age of the parent is etiologically associated with offspring depression.Keywords: Maternal age; Offspring depression; Parental age; Paternal age.</div

Time trends in the incidence of diagnosed depression among people aged 5-25 years living in Finland 1995-2012

Background: Knowledge of time trends for depression is important for disease prevention and healthcare planning. Only a few studies have addressed these questions regarding the incidence and cumulative incidence of diagnosed depression from childhood to early adulthood and findings have been inconclusive. Aim: The aim of this national register-based Finnish study was to report the time trends of the age-specific and gender-specific incidence and cumulative incidence of diagnosed depression. Methods: The study sample included all 1,245,502 singletons born in Finland between 1 January 1987 and 31 December 2007 and still living in Finland at the end of 2012. The participants were divided into three cohorts by birth year: 1987-1993, 1994-2000 and 2001-2007. Depression diagnoses (ICD-9: 2961; ICD-10: F32, F33) given in 1995-2012 were available and identified from the Care Register for Health Care. Results: Ten percent of the females and five percent of the males were diagnosed with depression in specialized services by age 25 years. The cumulative incidence of depression by age 15 years rose from 1.8% (95% CI 1.8-1.9) to 2.9% (95% CI 2.8-3.0) in females and from 1.0% (95% CI 1.1-1.2) to 1.6% (95% CI 1.6-1.7) in males when the cohorts born 1987-1993 and 1994-2000 were compared. Conclusions: A larger proportion of young people in Finland are diagnosed with depression in specialized services than before. This can be due to better identification, more positive attitudes to mental health problems and increased availability of the services.Peer reviewe

Psychometric properties of the screen for child anxiety related emotional disorders (SCARED) among elementary school children in Finland

Anxiety disorders are the most common mental disorders in children and youth. Effective screening methods are needed to identify children in need of treatment. The Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire is a widely used tool to assess childhood anxiety. We aim toevaluate the psychometric properties of the SCARED questionnaire, test the SCARED factor structure, and evaluate the prevalence of anxiety symptoms in a community sample of Finnish elementary school children, based on both a child and parent report. The sample included all pupils (n = 1,165) in grades 2 through 6 (ages 8-13) in four elementary schools in the city of Turku, Finland. Children completed a Finnish translation of the SCARED questionnaire at school, with one parent report questionnaire per child completed at home. In total, 663 child-parent dyads (56.9%) completed the questionnaire. Internal consistency was high for both child and parent reports on all subscales (0.71-0.92), except for school avoidance (0.57 child, 0.63 parent report). Inter-rater reliability ranged from poor to fair across subscales (intraclass correlation 0.27-0.47). Self-reported anxiety scores were higher than the parent reported scores. Females had significantly higher total scores than males based on the child reports (p = 0.003), but not the parent reports. In the confirmatory factor analysis, hypothesized models did not have a good fit with the data, and modification was needed. The Finnish SCARED questionnaire has good internal consistency. Low child-parent agreement calls for the importance of including both child and parental reports in the assessment of anxiety symptoms.</p

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

BackgroundThere has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.MethodsThis study comprised national register data of all singleton children born in Finland from 1992–2006 who were diagnosed with anxiety disorders from 1998–2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992–1996, 1997–2001 and 2002–2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992–1996 born).ResultsComparing the 1992–1996 and 2002–2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45–1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87–2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79–0.86) or semi-urban areas (OR 0.79, 95% CI 0.76–0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%).ConclusionAnxiety disorders diagnosed by specialized Finnish services increased from 1998–2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.</div

Preterm birth, poor foetal growth and anxiety disorders in a Finnish nationwide register sample

Aim: We examined the associations between preterm birth, poor foetal growth and anxiety disorders among children and adolescents. Additionally, we examined the im-pact of common comorbidities and specific anxiety disorders separately.Methods: Three  Finnish  registers  provided  data  on  a  nationwide  birth  cohort  of  22,181 cases with anxiety disorders and 74,726 controls. Conditional logistic regres-sion was used to examine the associations.Results: Extremely very preterm birth and moderate- late preterm birth were associ-ated with increased adjusted odds ratios (aOR) for anxiety disorders (aOR 1.39, 95% CI  1.11–1.75  and  aOR  1.13,  95%  CI  1.03–1.23,  respectively).  Weight  for  gestational  age of less than −2SD (aOR 1.29, 95% CI 1.17–1.42) and −2SD to −1SD (aOR 1.08, 95% CI 1.03–1.14) were associated with increased odds ratios for anxiety disorders. When comorbidities were considered, the associations became statistically insignificant for pure anxiety disorders, but remained significant in the groups with comorbid depres-sive or neurodevelopmental disorders.Conclusion: Preterm birth and poor foetal growth increased the odds for anxiety dis-orders. However, the associations seem to be explained by the conditions of comorbid depressive  and  neurodevelopmental  disorders.  Comorbidities  should  be  considered  when examining and treating child and adolescent anxiety disorders.</p