Characteristics of children with emotional problems and depressed mood : examination of associations with behaviour, sleep and inhibitory control

Emotional symptoms are symptoms of anxiety and depression that are included in the broad dimension of internalising symptoms encompassing feelings and behaviours such as fearfulness, worry, sadness, and withdrawal. Elevated levels of emotional symptoms are prevalent in children and often a precursor of adolescent and adulthood mental health disorders, such as major depression, one of the leading causes of disability in Finland and worldwide. The prevention of depression is a global challenge. Although major depression is a relatively rare condition in childhood, the more common emotional symptoms and subthreshold conditions of depression in childhood have been identified as possible targets for preventive action in the battle against depression. Results of studies involving adolescent participants suggest that examining the precursors of depression at the symptom level could aid in recognising individuals at risk for escalation to more severe disorders. Depressed mood, an emotional symptom that is one of the core symptoms of depression, has been associated with a future risk of psychopathology and may also cause current impairment, increasing the importance of early detection. However, there has not been much research on depressed mood in children. The present study examined the associations between emotional problems and depressed mood and three suggested risk factors for emerging, prolonging, and escalating emotional symptoms: inhibitory control, sleep problems, and co-occurring behaviour problems. The aim of the study was to provide data that would aid in the early recognition and prevention of emotional problems. Cross-sectional questionnaire data from the Strengths and Diffculties Questionnaire (SDQ) and the Quality of Life Questionnaire 17D were used in studies I–III, and the go/no-go task was used to assess children’s inhibitory control in the longitudinal study IV. The first study examined the prevalence of emotional problems and depressed mood in a population-based sample of 1,714 children aged 4–12. The associations of emotional problems and depressed mood with conduct problems and hyperactivity, as well as with child and family factors were also examined. In the population-based sample, 5.8% of the children had emotional problems and 16.0% had depressed mood. Both emotional problems and depressed mood were associated with sleep problems, illness or disability in children, and not living with both parents. Emotional problems and depressed mood were both significantly associated with conduct problems and hyperactivity. Of the emotional symptoms, depressed mood had the strongest association with both conduct problems and hyperactivity. The second study examined the prevalence of emotional problems and depressed mood in a child psychiatric outpatient sample of 862 children aged 6–12 and the associations of emotional problems and depressed mood with conduct problems and hyperactivity. The impact of depressed mood on children’s global functioning was also assessed. In the clinical sample, 13.1% of the children had emotional problems, and 59.4% had depressed mood. Emotional problems and depressed mood were signicantly associated with conduct problems but not hyperactivity. Irrespective of diagnosis, depressed mood was consistently associated with poorer global functioning. The third study examined the associations of child-reported sleep problems and emotional symptoms in a child psychiatric outpatient sample of 432 children aged 6–12. Child-reported sleep problems were the most common among children with depression or anxiety, and sleep problems were significantly associated with depressive disorders. Even among children with attention-deficit/hyperactivity disorder or oppositional deant or conduct disorder, sleep problems were associated with emotional symptoms, suggesting that child-reported sleep problems are indicative of subthreshold emotional problems in these children. The fourth study assessed the association between inhibitory control skills and internalizing symptoms in a sample of 2,874 children aged 7–9 using a longitudinal design with a statistical model that distinguishes within-person variance from between-person variance between the constructs. Over the course of the study, the association between inhibitory control and internalizing symptoms was explained at the between-person level. This nding supports the hypothesis that among children at this developmental stage, inhibitory control and emotional symptoms are associated as trait-like constructs. However, no cross-lagged associations suggesting a potential causal relationship were found. The findings of these four studies suggest that depressed mood is associated with similar risk factors as emotional problems in general. When emotional problems are associated with conduct problems or hyperactivity, this association is mostly explained by depressed mood. The global functioning level was poorer among child psychiatric patients with depressed mood than among those with normal mood. The findings also suggest that when a child has a sleep problem, it is useful to evaluate the presence of emotional problems and depressed mood. The association between emotional problems and inhibitory control suggests they could have a shared background.Vakava masennus on yksi yleisimmistä työkyvyttömyyden syistä Suomessa ja kansainvälisesti. On esitetty, että vakavaa masennusta voisi ehkäistä vaikuttamalla lapsuudessa yleisempiin tunne-elämän oireisiin ja diagnoosikynnyksen alle jääviin masennusoireisiin. Yksi masennuksen ydinoireista, masentunut mieliala, voi paitsi lisätä myöhemmän häiriön riskiä jo itsessään aiheuttaa toimintakyvyn laskua. Tutkimuksessa selvitettiin tunne-elämän oireiden ja masentuneen mielialan yhteyttä lapsen inhibitiokykyyn, univaikeuksiin ja käyttäytymisen oireisiin väestö- ja potilasaineistoissa. Tavoitteena oli tuottaa tietoa, jonka avulla voidaan edistää tunne-elämän oireiden varhaista tunnistamista sekä ennaltaehkäisyä. Osatutkimukset I–III ovat poikkileikkaustutkimuksia, joissa hyödynnettiin Vahvuudet ja vaikeudet -kyselyllä sekä elämänlaatumittari 17D:llä kerättyä tietoa. Pitkittäisasetelmassa toteutetussa osatutkimuksessa IV käytettiin lisäksi go/no-go-tehtävää lasten inhibitiokyvyn mittarina. Väestöaineistossa 6 %:lla lapsista esiintyi tunne-elämän ongelmia ja 16 %:lla masentunutta mielialaa. Tunne-elämän ongelmat ja masentunut mieliala olivat yhteydessä lapsen univaikeuksiin, lapsen sairauteen tai vammaan sekä siihen, että molemmat vanhemmat eivät asuneet yhdessä lapsen kanssa. Tunne-elämän ongelmat ja masentunut mieliala olivat yhteydessä käytösongelmiin ja ylivilkkausoireisiin. Yksittäisistä tunne-elämän oireista masentunut mieliala oli vahvimmin yhteydessä sekä käytösongelmiin että ylivilkkausoireisiin. Potilasaineistossa 13 %:lla lapsista oli tunne-elämän ongelmia ja 59 %:lla masentunutta mielialaa. Sekä tunne-elämän ongelmat että masentunut mieliala olivat yhteydessä käytösongelmiin, mutta eivät ylivilkkausoireisiin. Masentunut mieliala oli yhteydessä alentuneeseen. Potilasaineistossa univaikeudet olivat yleisimpiä lapsilla, joilla oli mieliala- tai ahdistushäiriö. Aktiivisuuden ja tarkkaavuuden häiriössä sekä uhmakkuus- tai käytöshäiriössä univaikeudet olivat yhteydessä tunne-elämän oireiden määrään. Pitkittäistutkimuksessa lasten inhibitiokyky ja tunne-elämän oireet olivat yhteydessä toisiinsa kuten piirteet, joilla on kehityksellistä jatkuvuutta. Inhibitiokyvyn ja tunne-elämän oireiden välillä ei havaittu ristiviiveyhteyksiä, jotka voisivat viitata kausaalisuhteisiin. Tuloksemme viittaavat siihen, että masentunut mieliala on yhteydessä samankaltaisiin riskitekijöihin kuin tunne-elämän oireet yleensä. Tunne-elämän ongelmien ja käyttäytymisen oireiden yhteys vaikuttaa selittyvän pääasiassa masentuneen mielialan yhteydellä käyttäytymisen oireisiin. Lastenpsykiatrisilla potilailla masentunut mieliala on yhteydessä alentuneeseen toimintakykyyn, ja lapsen ilmoittama univaikeus voi viitata tunne-elämän oireisiin. Tunne-elämän oireilla ja alentuneella inhibitiokyvyllä voi olla yhteinen tausta

Low mood in a sample of 5-12 year-old child psychiatric patients : a cross-sectional study

Background: Not much is known about low mood and its associates in child psychiatric patients. In this study, we examined the prevalence of low mood, how it associates with disruptive behaviour, and affects clinician-rated global functioning in child psychiatric outpatients. Methods: The study population consisted of 862 5-12 year-old child psychiatric patients. The study sample was a subsample of all 1251 patients attending a child psychiatric outpatient clinic at Helsinki University Hospital in 20132015 formed by excluding 4 year-old and 13 year-old patients and those with missing or incomplete data. The parentrated Strengths and Difficulties Questionnaire, collected as part of the routine clinical baseline measure, was used as a measure of psychiatric symptoms. The diagnoses were set according to ICD-10 by the clinician in charge after an initial evaluation period. The Children's Global Assessment Scale (CGAS) score set by clinicians provided the measure of the patients' global functioning. All information for the study was collected from hospital registers. Associations between emotional symptoms and conduct problems/hyperactivity scores were examined using ordinal regression in univariate and multivariate models, controlling for age and sex. The independent samples T test was used to compare the CGAS values of patient groups with low/normal mood. Results: In our sample, 512 children (59.4%) showed low mood. In multivariate ordinal regression analysis, low mood associated with conduct problems (OR 1.93, 95% CI 1.39-2.67), but no association was found between low mood and hyperactivity. Low mood was prevalent among children with oppositional defiant disorder or conduct disorder (51.8%). The global functioning score CGAS was lower among children with parent-reported low mood (52.21) than among children with normal mood (54.62, p <0.001). The same was true in the subgroup of patients with no depression diagnosis (54.85 vs. 52.82, p = 0.001). Conclusions: Low mood is prevalent in child psychiatric outpatients regardless of depression diagnosis and it has a negative effect on global functioning. Low mood and behavioural problems are often associated. It is important to pay attention to low mood in all child psychiatric patients. We recommend prevention measures and low-threshold services for children with low mood.Peer reviewe

Dual training as clinician-scientist in child and adolescent psychiatry : are we there yet?

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Sleep and psychiatric symptoms in young child psychiatric outpatients - a Follow-up study

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