Changes in mental health symptoms, bullying involvement, loneliness and service use among Finnish-speaking children aged 8-9 years over a 24-year period : A population-based study

ABSTRACT Cross-sectional studies, which have been collected using similar study design and measures at different time points can provide important and reliable information on changes in children’s mental health and related problems in a population level. The aim of this thesis was to study changes in children’s psychiatric problems, in bullying perpetration and victimization, in loneliness and friendships, and in mental health service use during 24 years with four cross-sectional population-based studies. The research data was collected in 1989, 1999, 2005 and 2013 from the area of Turku University Hospital in South-West Finland. The target population was about 1000 8-9 years old Finnish-speaking children at every time point. The response rates were high varying from 86% to 95%. In the study, children and their parents and teachers filled out questionnaires concerning child’s psychiatric symptoms and background information. The questionnaires were Rutter A2 for parents, Rutter B2 for teachers and Children’s Depression Inventory (CDI) for children. Only minor prevalence changes were seen, parent reported conduct and emotional problems among boys and emotional problems among girls decreased during 24 years. However, mental health service use increased constantly, almost four times among boys and six times among girls, but still many children with problems were not in contact with services. Parent reported bullying perpetration and victimization decreased in 24 years time, but there were no decreases between the two last assessment points even though a national KiVa anti-bullying program was launched in between times. Children’s loneliness was stable resulting about 20% of children being lonely at every time point and 25% of children wishing to have more friends. Study results are important for policy-makers to develop services that are needed. Low-threshold help for children and families should be available both in school, health care and social care as early as possible. When developing bullying and loneliness interventions, the mental health aspects should be included.TIIVISTELMÄ Poikkileikkaustutkimukset, jotka on kerätty samanlaisia tutkimusasetelmia ja mittareita käyttäen eri ajankohtina, voivat tarjota tärkeää ja luotettavaa tietoa lasten mielenterveyden ja niihin liittyvien ongelmien muutoksista väestötasolla. Tämän väitöskirjatutkimuksen tarkoituksena oli tutkia lasten psyykkisten ongelmien, kiusaamisen ja kiusatuksi tulemisen, yksinäisyyden ja ystävyyssuhteiden sekä palveluiden käytön muutosta 24 vuoden aikana neljän väestöpohjaisen poikkileikkaustutkimuksen avulla. Tutkimusaineisto kerättiin vuosina 1989, 1999, 2005 ja 2013 Varsinais-Suomen sairaanhoitopiirin alueelta. Tutkimuksen kohderyhmänä oli noin 1000 8–9-vuotiasta suomenkielistä lasta jokaisena ajankohtana. Vastausprosentit olivat korkeita vaihdellen 86% ja 95% välillä. Tutkimuksessa lapset ja lasten vanhemmat ja opettajat täyttivät lapsen psyykkisiä oireita ja taustatietoja kartoittavat kyselylomakkeet. Lomakkeet olivat Rutter A2 –lomake vanhemmille, Rutter B2 –lomake opettajille ja Lasten masennusseula (CDI) lapsille. Esiintyvyydessä tapahtui vain pieniä muutoksia, vanhempien raportoimat käyttäytymisen ja tunne-elämän ongelmat pojilla ja tunne-elämän ongelmat tytöillä vähenivät 24 vuoden aikana. Mielenterveyspalveluiden käyttö kasvoi kuitenkin jatkuvasti, noin nelinkertaiseksi pojilla ja kuusinkertaiseksi tytöillä, mutta silti moni ongelmia omaava lapsi ei ollut palveluiden piirissä. Vanhempien raportoima kiusaaminen ja kiusatuksi tuleminen vähenivät 24 vuoden aikana, mutta vähenemistä ei tapahtunut kahden viimeisimmän arviointiajankohdan välillä, jossa kansallinen kiusaamisen vastainen KiVa-ohjelma otettiin käyttöön. Lasten yksinäisyys oli pysyvää, noin 20% lapsista oli yksinäisiä kaikkina ajankohtina ja 25% lapsista toivoi, että heillä olisi enemmän ystäviä. Tutkimustulokset ovat tärkeitä päätöksentekijöille, jotta tarvittavia palveluita voitaisiin kehittää. Matalan kynnyksen apua pitäisi olla tarjolla lapsille ja perheille koulussa, terveydenhuollossa ja sosiaalihuollossa mahdollisimman varhaisessa vaiheessa. Kehitettäessä interventioita kiusaamiseen ja yksinäisyyteen, mielenterveyden näkökulma tulisi sisällyttää mukaan

Förändringar i barns psykiska problem och vårdanvändning i ljuset av tidstrendsforskning

Psykiska problem hos barn, exempelvis problem med beteende och känsloliv, är vanliga ochmycket belastande både för individen och för samhället. I medierna och inom hälso- ochsjukvården har det förts fram att problemen skulle ha ökat de senaste decennierna. Studier rapporterarom ökad användning av vård relaterad till psykiska problem, men resultaten gällandeökning av själva problemen är motstridiga. Trots den ökade vårdanvändningen får fortfarandebara en liten del av barnen hjälp med problemen. Med studier av tidstrender kan man blandannat klargöra trender i förekomsten av samma fenomen mätt vid olika tidpunkter samtförändringhastigheten. Målet med denna översikt är att presentera forskningsresultat gällandeförändringar i förekomsten av psykiska problem hos barn och i användningen av vård.</p

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

Relative age is associated with bullying victimisation and perpetration among children aged eight to nine

Aim: To assess whether relative age was associated with bullying involvement and whether the associations were independent of child psychiatric symptoms. Methods: Bullying was assessed among 8576 children in the second grade, aged 8 years, by using four cross-sectional population-based studies with identical methodology completed by children, parents and teachers in 1989 (response rate 97%), 1999 (93%), 2005 (90%) and 2013 (86%). The main outcomes were bullying victimisation and perpetration. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with the relatively oldest as the reference group and adjusted for child psychiatric symptoms. Results:The relatively youngest children, born September to December, were compared with the relatively oldest, born January to April. The youngest children had increased odds of being victims according to child (OR 1.2, 95% CI 1.1-1.4) and parent reports (OR 1.2 95% CI 1.008-1.4). The youngest also had decreased odds of being perpetrators according to child (OR 0.8, 95% CI 0.7-0.96) and teacher reports (OR 0.8, 95% CI 0.7-0.95). These findings were independent of psychiatric symptoms. Conclusion:The relative age effects which were found in bullying involvement were independent of psychiatric symptoms. Considering this newly recognised risk factor for victimisation is important within anti-bullying practices.</div

Relative age and specific learning disorder diagnoses: A Finnish population-based cohort study

BackgroundBeing among the youngest in class has previously been associated with attention-deficit/hyperactivity disorder (ADHD) and academic disadvantage, but the relative age effect on learning disorders is less well understood. This study examined whether relatively young children are more likely to be diagnosed with specific learning disorders than their older peers.MethodsThe setting included all 388,650 children born singleton in Finland from 1996 to 2002. Cases diagnosed with specific learning disorders in specialized health care by the age of 10 were identified from national registers. Cumulative incidences of specific learning disorders and the corresponding incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated for each birth month compared to January.ResultsDuring follow-up, 3162 (0.8% of 388,650) children were diagnosed with a specific learning disorder. Children born in December displayed higher cumulative incidences for specific learning disorders than children born in January (IRR: 1.77, 95% CI: 1.50–2.11). The findings were similar for girls (IRR: 2.01, 1.44–2.83) and boys (IRR: 1.70, 1.39–2.08). ADHD did not explain the association, as the IRR for the youngest children with specific learning disorders and ADHD was 1.59 (1.13–2.26) compared to those without ADHD (IRR: 1.84, 1.51–2.24).ConclusionsRelatively younger children in Finnish schools were more likely to be diagnosed with a specific learning disorder by the age of 10. Increased awareness of how relative age differences affect the likelihood for children to be diagnosed with specific learning disorders is needed among parents, clinicians, and teachers.</p

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

Registered psychiatric service use, self-harm and suicides of children and young people aged 0-24 before and during the COVID-19 pandemic : a systematic review

Background The COVID-19 pandemic has impacted on psychiatric symptoms of children and young people, but many psychiatric services have been disrupted. It is unclear how service use, self-harm and suicide has changed since the pandemic started. To gain timely information, this systematic review focused on studies based on administrative data that compared psychiatric service use, self-harm and suicide before and during the pandemic among children and young people. Methods and finding A systematic review of studies published in English from 1 January 2020 to 22 March 2021 was conducted, using the Web of Science, PubMed, Embase and PsycINFO databases. Increases or reductions in service use were calculated and compared using percentages. Of the 2,676 papers retrieved, 18 were eligible for the review and they provided data from 19 countries and regions. Most studies assessed changes during the early phase of the COVID-19 pandemic, from March to July 2020, and three assessed the changes until October 2020. Fifteen studies reported a total of 21 service use outcomes that were quantitively examined. More than three-quarters of the 21 outcomes (81%) fell by 5-80% (mean reduction = 27.9%, SD = 35%). Ten of the 20 outcomes for psychiatric emergency department (ED) services reduced by 5% to 80% (mean = 40.1%, SD = 34.9%) during the pandemic. Reductions in service use were also recorded for ED visits due to suicide ideation and self-harm, referrals to secondary mental health services, psychiatric inpatient unit admissions and patients receiving treatment for eating disorders. However, there were also some increases. Suicide rate and the number of ED visits due to suicide attempts have increased, and there was an increase in the number of treatment sessions in a service that provided telemedicine. Conclusion Most of the studies showed reductions in the use of psychiatric services by children and young people during the early phase of the pandemic and this highlighted potential delays or unmet needs. Suicide rate has increased during the second wave of the pandemic. Further studies are needed to assess the pattern of service use in the later phases of the COVID-19 pandemic.Peer reviewe

Digital mental health literacy-program for the first-year medical students' wellbeing: a one group quasi-experimental study

Background Medical students are prone to mental disorders, such as depression and anxiety, and their psychological burden is mainly related to their highly demanding studies. Interventions are needed to improve medical students' mental health literacy (MHL) and wellbeing. This study assessed the digital Transitions, a MHL program for medical students that covered blended life skills and mindfulness activities.Methodology This was a one group, quasi-experimental pretest-posttest study. The study population was 374 first-year students who started attending the medical faculty at the University of Turku, Finland, in 2018-2019. Transitions was provided as an elective course and 220 students chose to attend and 182 agreed to participate in our research. Transitions included two 60-minute lectures, four weeks apart, with online self-learning material in between. The content focused on life and academic skills, stress management, positive mental health, mental health problems and disorders. It included mindfulness audiotapes. Mental health knowledge, stigma and help-seeking questionnaires were used to measure MHL. The Perceived Stress Scale and General Health Questionnaire measured the students' stress and health, respectively. A single group design, with repeated measurements of analysis of variance, was used to analyze the differences in the mean outcome scores for the 158 students who completed all three stages: the pre-test (before the first lecture), the post-test (after the second lecture) and the two-month follow-up evaluation.Results The students' mean scores for mental health knowledge improved (-1.6, 95% Cl -1.9 to -1.3, PP=.040). The changes were maintained at the two-month follow up (-1.7, 95% Cl -2.0 to -1.4, PP=.019, respectively). The students' stress levels reduced (P=.022) and their attitudes towards help-seeking improved after the program (PP=.13).Conclusions: The digital Transitions program was easily integrated into the university curriculum and it improved the students' mental health literacy and wellbeing. The program may respond to the increasing global need for universal digital services, especially during the lockdowns due to the COVID-19 pandemic.</p

A systematic review of the mental health changes of children and young people before and during the COVID-19 pandemic

There is increasing knowledge that the COVID-19 pandemic has had an impact on mental health of children and young people. However, the global evidence of mental health changes before compared to during the COVID-19 pandemic focusing on children and young people has not been systematically reviewed. This systematic review examined longitudinal and repeated cross-sectional studies comparing before and during COVID-19 pandemic data to determine whether the mental health of children and young people had changed before and during the COVID-19 pandemic. The Web of Science, PubMed, Embase and PsycINFO databases were searched to identify peer-reviewed studies that had been published in English and focused on children and young people between 0 and 24 years of age. This identified 21 studies from 11 countries, covering more than 96,000 subjects from 3 to 24 years of age. Pre-pandemic and pandemic data were compared. Most studies reported longitudinal deterioration in the mental health of adolescents and young people, with increased depression, anxiety and psychological distress after the pandemic started. Other findings included deteriorated negative affect, mental well-being and increased loneliness. Comparing data for pandemic and pre-pandemic periods showed that the COVID-19 pandemic may negatively impact the mental health of children and young people. There is an urgent need for high-quality research to address the impact, risks and protective factors of the pandemic on their mental health, as this will provide a good foundation for dealing with future health emergencies and other crises