Publications by authors named "Jorma Piha"

56 Publications

Mother's marital satisfaction associated with the quality of mother-father-child triadic interaction.

Scand J Psychol 2016 Aug 20;57(4):305-12. Epub 2016 May 20.

Department of Psychology, University of Turku, Turku, Finland.

Low marital satisfaction has been shown to be a risk factor for early parenthood and parent-child relationship problems (Erel & Burman, ; McHale, ). The aim of this study was to assess how parental reports of marital satisfaction related to family alliance and coordination in the observed triadic interaction. The study group included 120 families. Marital satisfaction was evaluated during pregnancy, at 4 months, and at 18 months using the Revised Dyadic Adjustment Scale (RDAS; Busby, Christensen, Crane & Larsson, ) for both parents. Mother-father-child interaction was analyzed in the Lausanne Triadic Play setting and coded using the Family Alliance Assessment Scale (Favez, Lavanchy Scaiola, Tissot, Darwiche & Frascarolo, ) when the child reached 18 months of age. The mother's higher marital satisfaction at every measuring point was associated with a cooperative family alliance and/or higher family coordination at 18 months. The father's experience of marital satisfaction was not related to family interaction at any assessment point. Our study suggests that a mother's experience of lower marital satisfaction during pregnancy may be an early sign of later problems in family relationships.
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http://dx.doi.org/10.1111/sjop.12294DOI Listing
August 2016

Intercorrelations and developmental pathways of mothers' and fathers' loneliness during pregnancy, infancy and toddlerhood--STEPS study.

Scand J Psychol 2015 Oct 24;56(5):482-8. Epub 2015 Jul 24.

Turku Institute for Child and Youth Research, University of Turku, Finland.

Our aim was to study the inter-correlations and developmental pathways of mothers' and fathers' social and emotional loneliness during pregnancy (20th pregnancy week), infancy (child aged 8 months), and early childhood (child aged 18 months). Moreover, we aimed to study whether mothers and fathers who have different developmental profiles (identified by latent growth curve mixture models) differ in their experiences of marital dissatisfaction (RDAS), social phobia (SPIN) and depression (BDI) during pregnancy. Both mothers' social and emotional loneliness and fathers' social and emotional loneliness were highly stable, and within individuals these loneliness factors were strongly correlated. However, the correlations between mothers' loneliness experiences and fathers' loneliness experiences were weaker than expected. Separate latent growth curve groups were identified, which differed in feelings of marital dissatisfaction, social phobia, and depression. These groupings revealed that the higher the loneliness was, the more the parents experience these other psychosocial problems.
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http://dx.doi.org/10.1111/sjop.12241DOI Listing
October 2015

Parents' psychological well-being and parental self-efficacy in relation to the family's triadic interaction.

Infant Ment Health J 2015 May-Jun;36(3):298-307. Epub 2015 May 4.

The Turku Institute for Child and Youth Research, University of Turku, Turku, Finland.

The aim of the study was to assess whether a parent's psychological well-being and/or self-efficacy relate to interaction within the family. This study is part of a Finnish follow-up study called Steps to the Healthy Development and Well-Being of Children (STEPS;). The study group included 120 families. Mother's and father's social anxiety and depression were assessed during pregnancy and at 18 months of the child's age using self-report questionnaires; the mother's and father's self-efficacy were assessed at 18 months using a parental self-efficacy scale validated within the STEPS study. Mother-father-child triadic interaction was studied at 18 months within a Lausanne Triadic Play setting. Results showed that maternal symptoms of depression during pregnancy and maternal social anxiety at 18 months were related to triadic interaction within the family. There was no relation between father's psychological well-being and triadic interaction within the family. Father's self-efficacy in teaching tasks and the Mother's self-efficacy in emotional support were associated with family interaction. The findings suggest that maternal psychological well-being and self-efficacy in emotional support may be important components of family triadic interaction whereas paternal self-efficacy in teaching tasks seems to support family coordination in triadic interaction.
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http://dx.doi.org/10.1002/imhj.21512DOI Listing
January 2016

[Update in Current Care guidelines. Evaluation of a suspected child sexual abuse].

Duodecim 2013 ;129(12):1290-1

According to Finnish Child Welfare Law, the authorities are obligated to report suspicions of child sexual abuse immediately to the police and to social services to ensure the well being of the child. The investigating police may request assistance for forensic interviews and medical assessments from specialized units. The child's disclosure is often the most important part of the evaluation. The timing of medical examination is crucial to obtain biological trace of evidence and to document evidence of acute injury or infection. The need for crisis support must be evaluated.
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August 2013

[Update in Current Care guidelines. Evaluation of a suspected child sexual abuse].

Duodecim 2013 ;129(12):1290-1

According to Finnish Child Welfare Law, the authorities are obligated to report suspicions of child sexual abuse immediately to the police and to social services to ensure the well being of the child. The investigating police may request assistance for forensic interviews and medical assessments from specialized units. The child's disclosure is often the most important part of the evaluation. The timing of medical examination is crucial to obtain biological trace of evidence and to document evidence of acute injury or infection. The need for crisis support must be evaluated.
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August 2013

Childhood bullying and becoming a young father in a national cohort of Finnish boys.

Scand J Psychol 2012 Dec 24;53(6):461-6. Epub 2012 Aug 24.

Department of Child Psychiatry, University of Turku, Itäinen Pitkäkatu 1, Varia, Finland.

Childhood bullying is known to be associated with various adverse psychosocial outcomes in later life. No studies exist on its association with becoming a young father. The study is based on a national cohort, which included 2,946 Finnish boys at baseline in 1989. Information on bullying was collected from children, their parents and their teachers. Follow-up data on becoming a father under the age of 22 were collected from a nationwide register. The follow-up sample included 2,721 boys. Bullying other children frequently was significantly associated with becoming a young father independently of being victimized, childhood psychiatric symptoms and parental educational level. Being a victim of bullying was not associated with becoming a young father when adjusted for possible confounders. When the co-occurrence of bullying and victimization was studied, it was found that being a bully-victim, but not a pure bully or a pure victim, is significantly associated with becoming a young father. This study adds to other studies, which have shown that the risk profile and relational patterns of bully-victims differ from those of other children, and it emphasizes the importance of including peer relationships when studying young fathers.
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http://dx.doi.org/10.1111/j.1467-9450.2012.00971.xDOI Listing
December 2012

Childhood predictors of becoming a teenage mother among Finnish girls.

Acta Obstet Gynecol Scand 2012 Nov 18;91(11):1319-25. Epub 2012 Sep 18.

Department of Child Psychiatry, University of Turku, Turku, Finland.

Objective: To study predictive associations between psychosocial factors at age 8 and becoming a mother under the age of 20.

Design: Prospective follow-up study.

Setting: Finland.

Population: 2867 girls born in 1981.

Methods: Information on family background and psychiatric symptoms was collected at age 8. The associations between these factors and becoming a teenage mother were analyzed using logistic regression analysis.

Main Outcome Measures: Data on births by the age of 20 collected from the hospital discharge register.

Results: 128 girls (4.8%) had given birth at the age of 15-19 years. Childhood conduct problems and hyperactive problems, having young mother and family structure other than two biological parents had an independent association with becoming a teenage mother.

Conclusions: Girls with externalizing type of problems in childhood have an increased risk of becoming teenage mothers. These problems may also complicate their motherhood.
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http://dx.doi.org/10.1111/j.1600-0412.2012.01517.xDOI Listing
November 2012

Childhood predictors of antipsychotic use among young people in Finland.

Pharmacoepidemiol Drug Saf 2012 Sep 4;21(9):964-71. Epub 2012 Apr 4.

Department of Child Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland.

Objective: Information on who uses antipsychotic medication is limited to cross-sectional data. The objective of this study was to study the patterns of psychopathology at age 8 years and antipsychotic use between the ages of 12 and 25 years.

Methods: A total of 5525 subjects from the Finnish Nationwide 1981 birth cohort were linked to the National Prescription Register and the Hospital Discharge Register between 1994 and 2005. Information about parent-reported and teacher-reported conduct, hyperkinetic and emotional symptoms, and self-reported depressive symptoms was gathered at age 8 years. Information about antipsychotic use and about psychiatric disorders treated in hospitals between the ages of 12 and 25 years was register based. Diagnostic classes of hospital treatment included non-affective psychoses, affective disorders, and other psychiatric disorders.

Results: The cumulative incidence of antipsychotic use by age 25 years was 2.8% among men (n = 69) and 2.1% among women (n = 55). In both sexes, living with other than two biological parents at age 8 years was associated with antipsychotic use, and three fourths of antipsychotic users had been treated for psychiatric disorders in a hospital. Among men, the most common hospital diagnosis was non-affective psychoses (44% of all antipsychotic users), and antipsychotic use was associated with childhood conduct problems. Among women, the most common hospital diagnosis was affective disorders (38% of all antipsychotic users), and antipsychotic use was associated with emotional problems and self-reported depressive symptoms in childhood.

Conclusions: Antipsychotic use in adolescence and young adulthood is different among men versus women both with regard to hospital diagnoses and childhood psychiatric problems.
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http://dx.doi.org/10.1002/pds.3265DOI Listing
September 2012

Pain at age eight as a predictor of antidepressant medication use by age 24: findings from the Finnish nationwide 1981 birth cohort study.

J Affect Disord 2012 Apr 6;138(1-2):153-9. Epub 2012 Feb 6.

Department of Child Psychiatry, University of Turku, Finland.

Background: The existing knowledge about long-term psychosocial consequences of childhood pain is scarce. The current study investigated childhood pain symptoms as potential risk factors for antidepressant use in adolescence and early adulthood.

Methods: A representative sample of eight-year-old children (n=6017) and their parents were asked about the prevalence of the child's headache, abdominal pain, and unspecified pain symptoms. The associations with antidepressant purchases by age 24, based on the nationwide prescription register, were analyzed separately for each symptom and each reporter. Sex, parental educational level, and child-, parent- and teacher-reported child's psychiatric symptoms at baseline were included as confounding variables.

Results: In the sex-adjusted model, the child's own report of headache and other pains, and the parents' report of their child's abdominal pain, predicted antidepressant purchases. When confounding variables were included in the final model, only the child's own report of headache predicted antidepressant use with a dose-response relationship. The hazard ratios and 95% confidence intervals for frequent and for almost daily headache were 1.6 (1.3-2.0) and 2.1 (1.5-2.9), respectively, in the sex-adjusted model, and 1.5 (1.2-1.8) and 1.7 (1.2-2.5) in the final model.

Limitations: The assessment of each pain symptom was based on one question for each reporter. The specific indications for the described medication could not be defined.

Conclusions: Health care professionals should also ask children themselves about the pain symptoms. They should be aware that children with pain are at increased risk of suffering later from conditions that require antidepressant treatment.
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http://dx.doi.org/10.1016/j.jad.2012.01.003DOI Listing
April 2012

Pain at age eight as a predictor of antidepressant medication use by age 24: findings from the Finnish nationwide 1981 birth cohort study.

J Affect Disord 2012 Apr 6;138(1-2):153-9. Epub 2012 Feb 6.

Department of Child Psychiatry, University of Turku, Finland.

Background: The existing knowledge about long-term psychosocial consequences of childhood pain is scarce. The current study investigated childhood pain symptoms as potential risk factors for antidepressant use in adolescence and early adulthood.

Methods: A representative sample of eight-year-old children (n=6017) and their parents were asked about the prevalence of the child's headache, abdominal pain, and unspecified pain symptoms. The associations with antidepressant purchases by age 24, based on the nationwide prescription register, were analyzed separately for each symptom and each reporter. Sex, parental educational level, and child-, parent- and teacher-reported child's psychiatric symptoms at baseline were included as confounding variables.

Results: In the sex-adjusted model, the child's own report of headache and other pains, and the parents' report of their child's abdominal pain, predicted antidepressant purchases. When confounding variables were included in the final model, only the child's own report of headache predicted antidepressant use with a dose-response relationship. The hazard ratios and 95% confidence intervals for frequent and for almost daily headache were 1.6 (1.3-2.0) and 2.1 (1.5-2.9), respectively, in the sex-adjusted model, and 1.5 (1.2-1.8) and 1.7 (1.2-2.5) in the final model.

Limitations: The assessment of each pain symptom was based on one question for each reporter. The specific indications for the described medication could not be defined.

Conclusions: Health care professionals should also ask children themselves about the pain symptoms. They should be aware that children with pain are at increased risk of suffering later from conditions that require antidepressant treatment.
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http://dx.doi.org/10.1016/j.jad.2012.01.003DOI Listing
April 2012

Childhood predictors of use and costs of antidepressant medication by age 24 years: findings from the Finnish Nationwide 1981 Birth Cohort Study.

J Am Acad Child Adolesc Psychiatry 2011 Apr 3;50(4):406-15, 415.e1. Epub 2011 Mar 3.

Department of Child Psychiatry, University of Helsinki and Helsinki University Hospital, Finland.

Objective: Prior studies on antidepressant use in late adolescence and young adulthood have been cross-sectional, and prospective associations with childhood psychiatric problems have not been examined. The objective was to study the association between childhood problems and lifetime prevalence and costs of antidepressant medication by age 24 years.

Method: A total of 5,547 subjects from a nation-wide birth cohort were linked to the National Prescription Register. Information about parent- and teacher-reported conduct, hyperkinetic and emotional symptoms, and self-reported depressive symptoms was gathered at age 8 years. The main outcome measure was national register-based lifetime information about purchases of antidepressants between ages 8 and 24 years. In addition, antidepressant costs were analyzed using a Heckman maximum likelihood model.

Results: In all, 8.8% of males and 13.8% of females had used antidepressants between age 13 and 24 years. Among males, conduct problems independently predicted later antidepressant use. In both genders, self-reported depressive symptoms and living in other than a family with two biological parent at age 8 years independently predicted later antidepressant use. Significant gender interactions were found for conduct and hyperkinetic problems, indicating that more males who had these problems at age 8 have used antidepressants compared with females with the same problems.

Conclusions: Childhood psychopathology predicts use of antidepressants, but the type of childhood psychopathology predicting antidepressant use is different among males and females.
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http://dx.doi.org/10.1016/j.jaac.2010.12.016DOI Listing
April 2011

Childhood bullying as a predictor for becoming a teenage mother in Finland.

Eur Child Adolesc Psychiatry 2011 Jan 7;20(1):49-55. Epub 2010 Dec 7.

Department of Child Psychiatry, University of Turku, Itäinen Pitkäkatu 1 / Varia, 20014, Turku, Finland.

The aim of this study is to examine the association between bullying behaviour at the age of 8 and becoming a mother under the age of 20. This birth cohort study included 2,867 Finnish girls at baseline in 1989. Register-based follow-up data on births was collected until the end of 2001. Information, both on the main exposure and outcome, was available for 2,507 girls. Both bullies and victims had an increased risk of becoming a teenage mother independent of family-related risk factors. When controlled for childhood psychopathology, however, the association remained significant for bullies (OR 2.2, 95% CI 1.2-4.1) and bully-victims (OR 1.8, 95% CI 1.05-3.2), but not for pure victims. Reports of bullying and victimisation from the girls themselves, their parents and their teachers were all associated with becoming a teenage mother independent of each other. There is a predictive association between being a bully in childhood and becoming a mother in adolescence. It may be useful to target bullies for teenage pregnancy prevention.
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http://dx.doi.org/10.1007/s00787-010-0147-zDOI Listing
January 2011

Bullying at age eight and criminality in adulthood: findings from the Finnish Nationwide 1981 Birth Cohort Study.

Soc Psychiatry Psychiatr Epidemiol 2011 Dec 1;46(12):1211-9. Epub 2010 Dec 1.

Department of Child Psychiatry, Turku University and Turku University Hospital, 20520 Turku, Finland.

Context: There are no prospective population-based studies examining predictive associations between childhood bullying behavior and adult criminality.

Objective: To study predictive associations between bullying and victimization at age eight and adult criminal offenses.

Design: Nationwide birth cohort study from age 8 to 26 years.

Participants: The sample consists of 5,351 Finnish children born in 1981 with information about bullying and victimization at age eight from parents, teachers, and the children themselves.

Main Outcome Measures: National police register information about criminal offenses at age 23-26 years.

Results: When controlled for the parental education level and psychopathology score, bullying sometimes and frequently independently predicted violent (OR 3.9, 95% CI 1.9-7.9, p < 0.001; OR 2.5, 95% CI 1.6-4.1, p < 0.001, respectively), property (OR 2.3, 95% CI 1.2-4.7, p < 0.05; OR 1.7, 95% CI 1.1-2.7, p < 0.05), and traffic (OR 2.8, 95% CI 1.8-4.4, p < 0.001; OR 1.6, 95% CI 1.3-2.1, p < 0.001) offenses. The strongest predictive association was between bullying frequently and more than five crimes during the 4-year period (OR 6.6, 95% CI 2.8-15.3, p < 0.001) in adjusted analyses. When different informants were compared, teacher reports of bullying were the strongest predictor of adult criminality. In adjusted analyses, male victimization did not independently predict adult crime. Among girls, bullying or victimization at age eight were not associated with adult criminality.

Conclusions: Bullying among boys signals an elevated risk of adult criminality.
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http://dx.doi.org/10.1007/s00127-010-0292-1DOI Listing
December 2011

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

Eur Child Adolesc Psychiatry 2010 Nov 7;19(11):823-33. Epub 2010 Sep 7.

Department of Child Psychiatry, University of Helsinki, PO.BOX 22, Lastenlinnantie 2, 00014 University of Helsinki, Finland.

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.
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http://dx.doi.org/10.1007/s00787-010-0129-1DOI Listing
November 2010

Relations between maternal attachment representations and the quality of mother-infant interaction in preterm and full-term infants.

Infant Behav Dev 2010 Jun 24;33(3):330-6. Epub 2010 Apr 24.

Department of Child Psychiatry, University of Turku & University Hospital of Turku, Turku, Finland.

The aim of the study was to assess the relationship between maternal representations and the quality of mother-infant interaction in a group of preterm and full-term infants. The study groups consisted of 38 mothers and their preterm infants (
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http://dx.doi.org/10.1016/j.infbeh.2010.03.010DOI Listing
June 2010

Motherhood and early interaction in a schizoaffective patient: the story of a long-term psychotherapy.

Am J Psychother 2010 ;64(1):73-89

Child Psychiatry Clinic, University of Turku and Turku University Hospital, Finland.

This paper focused on motherhood in a patient with a schizoaffective disorder. The core of the treatment was to build a strong therapeutic alliance in which compliance with medication and elaboration of mental processes could be achieved. Pregnancy and motherhood are a time of crisis in the life of women. For the schizoaffective patient this crisis threatens the deepest level of functioning and challenges attachment patterns. Comprehensive treatment including psychosocial support, medication and psychotherapy is able to protect the baby to be, the early relationship between mother and baby, and the development of the child over time in this high-risk family. However, the commitment over years of the same psychotherapist also seems one of the most powerful tools.
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http://dx.doi.org/10.1176/appi.psychotherapy.2010.64.1.73DOI Listing
May 2010

Factors associated with reported childhood depressive symptoms at age 8 and later self-reported depressive symptoms among boys at age 18.

Soc Psychiatry Psychiatr Epidemiol 2011 Mar 10;46(3):207-18. Epub 2010 Feb 10.

Institute of Clinical Medicine, University of Tromsø, Tromsö, Norway.

Aims: This study aimed to study conditions associated with depressive symptoms at ages 8 and 18 in a representative birth cohort of Finnish males.

Methods: The participants in this community-based 10-year follow-up study consisted of 2,348 boys born in 1981. At age 8, three informant sources were used: parents, teachers, and the children themselves. Depressive symptoms were established using the Children's Depression Inventory (CDI). At age 18, self-report questionnaires were used to study the boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI).

Results: Poor adaptive functioning at age 18 was independently associated with both child and late adolescent depressive symptoms. Use of illicit drugs and somatic health problems were independently associated with later depressive symptoms. Parental divorce in early childhood independently predicted depressive symptoms both in childhood and in late adolescence. Teacher reports of child's total problems at age 8 independently predicted depressive symptoms at age 18.

Conclusions: Depression in males at ages 8 and 18 is particularly associated with stressful life events in childhood, whereas late depression is associated with somatic health problems and substance use. Further population-based studies comparing conditions associated with childhood and adolescent depression are needed.
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http://dx.doi.org/10.1007/s00127-010-0182-6DOI Listing
March 2011

Cancer during pregnancy: Two case studies.

Infant Ment Health J 2010 Jan;31(1):71-93

University of Turku and Turku University Hospital, Turku, Finland.

When a pregnant woman develops cancer, death and life are competing in her body and in her mind. In this article, two cases of pregnant cancer patients are described. The pregnant women were accompanied through their journey toward delivery and during the first months with their newborn. The process of being in intensive cancer treatment during pregnancy, of giving birth, and of building an early relationship with the infant is explored.
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http://dx.doi.org/10.1002/imhj.20243DOI Listing
January 2010

Child mental health problems and obesity in early adulthood.

J Pediatr 2010 Jan;156(1):93-7

Division of Child and Adolescent Psychiatry, Columbia University-NYSPI, New York, NY 10032, USA.

Objective: To examine whether mental health problems in childhood increase the likelihood of overweight or obesity during early adulthood among male subjects.

Study Design: In a national prospective population-based study conducted in Finland, child mental health, including depression, emotional problems, conduct problems, and hyperactivity (determined on the basis of child, parent, and teacher information), was assessed at age 8 years. Body mass index (BMI) was obtained from military examination records (n = 2209) conducted in early adulthood (age range, 18-23 years).

Results: Both moderate (50th-90th percentile) and high (>90th percentile) levels of conduct problems at age 8 years were prospectively associated with a young adult being obese (BMI > or = 30; odds ratio [OR], 2.0; 95% CI, 1.2-3.2; and OR, 2.9; 95% Confidence interval [CI], 1.5-5.9; respectively). Conduct problems were also prospectively associated with a young adult being overweight (25 < or = BMI < 30; OR, 1.5; 95% CI, 1.1-1.9 for moderate levels of conduct problems, and OR, 1.9; 95% CI, 1.2-2.8 for high levels), after controlling for hyperactive problems and sociodemographic factors.

Conclusions: Conduct problems in childhood are prospectively associated with overweight and obese in young adulthood. Future studies should address the potential for interventions to reduce obesity risk in young adulthood for boys who manifest conduct problems early in life.
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http://dx.doi.org/10.1016/j.jpeds.2009.06.066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586427PMC
January 2010

Childhood bullying behavior and later psychiatric hospital and psychopharmacologic treatment: findings from the Finnish 1981 birth cohort study.

Arch Gen Psychiatry 2009 Sep;66(9):1005-12

Regional Center of Child and Adolescent Psychiatry, Institute of Clinical Medicine, Tromsö University, Tromsö, Norway.

Context: No prospective population-based study examining predictive associations between childhood bullying behavior and long-term mental health outcomes in both males and females exists.

Objective: To study predictive associations between bullying and victimization in childhood and later psychiatric hospital and psychopharmacologic treatment.

Design: Nationwide birth cohort study from age 8 to 24 years.

Participants: Five thousand thirty-eight Finnish children born in 1981 with complete information about bullying and victimization at age 8 years from parents, teachers, and self-reports.

Main Outcome Measures: National register-based lifetime information about psychiatric hospital treatments and psychopharmacologic medication prescriptions.

Results: When controlled for psychopathology score, frequent victim status at age 8 years among females independently predicted psychiatric hospital treatment and use of antipsychotic, antidepressant, and anxiolytic drugs. Among males, frequent bully-victim and bully-only statuses predicted use of antidepressant and anxiolytic drugs. Frequent bully-victim status among males also predicted psychiatric hospital treatment and use of antipsychotics. However, when the analysis was controlled with total psychopathology score at age 8 years, frequent bully, victim, or bully-victim status did not predict any psychiatric outcomes among males.

Conclusions: Boys and girls who display frequent bullying behavior should be evaluated for possible psychiatric problems, as bullying behaviors in concert with psychiatric symptoms are early markers of risk of psychiatric outcome. Among females, frequent childhood victimization predicts later psychiatric problems irrespective of psychiatric problems at baseline.
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http://dx.doi.org/10.1001/archgenpsychiatry.2009.122DOI Listing
September 2009

[Use of children's mental health services].

Duodecim 2009 ;125(9):959-64

Turun yliopisto, lastenpsykiatria, PL 52, 20521 Turku.

According to studies carried out in various countries, many parents (7-28%) contact some professionals due to a child's behavioral or emotional disorder, but a large part of children presenting psychic symptoms has remained outside of mental health services. Seeking for care has strongly increased in Finland over the last few years. Schools and day care centers are important not only in recognizing the problems but also in providing support and directing to specialized services.
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July 2009

Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer: a multinational study.

Cancer 2009 Sep;115(17):4030-9

Department of Psychology, University of Aarhus, Denmark.

Background: This study aimed to evaluate prevalence and risk factors for emotional and behavioral problems in dependent children of cancer patients using a multinational research design.

Methods: The sample comprised 350 ill parents, 250 healthy partners, and 352 children. Parents assessed the child's psychological functioning using the Child Behavior Checklist, parental depression using the Beck Depression Inventory, family functioning using the General Functioning subscale of the Family Assessment Device, quality of life using short-form questionnaire, and adolescents (N = 168) self-reported psychological functioning using the Youth Self Report.

Results: Children and adolescents, in particular latency-aged boys and adolescent girls, were of higher risk of psychosocial problems than norms. There was a higher risk of problems when the father was ill than when the mother was ill, but it remains unclear whether this difference was due to the different diagnoses of fathers and mothers, gender or other factors. The best predictor of internalizing problems in children and adolescents was parental depression, and the best predictor of externalizing problems in children and adolescents was family dysfunction.

Conclusions: The results indicate the need for a family-oriented approach to psychological support of cancer patients.
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http://dx.doi.org/10.1002/cncr.24449DOI Listing
September 2009

Attachment representations in mothers of preterm infants.

Infant Behav Dev 2009 Jun 14;32(3):305-11. Epub 2009 May 14.

Department of Child Psychiatry, Turku University Hospital, Turku, Finland.

The aim of the study was to assess attachment representations in mothers of preterm infants using the Working Model of Child Interview (WMCI) at the 12 months of the infant's corrected age. In addition, the relation between WMCI representation categories and the Edinburgh Postnatal Depression Scale score at 6 months of the infant's corrected age was studied. There were 38 mothers of preterm infants (<1500 g or <32 gestational weeks) and 45 mothers of full-term infants. The results showed no differences between the study groups in the distribution of the three main representation categories (balanced, disengaged and distorted). However, there were qualitative differences in representations between the groups. Furthermore, maternal depression symptoms were associated with distorted representation category. We suggest that despite the qualitative differences in the mothers' representations, mothers of preterm infants are as likely to form balanced attachments with their infants as mothers of full-term infants.
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http://dx.doi.org/10.1016/j.infbeh.2009.04.003DOI Listing
June 2009

Attachment representations in mothers of preterm infants.

Infant Behav Dev 2009 Jun 14;32(3):305-11. Epub 2009 May 14.

Department of Child Psychiatry, Turku University Hospital, Turku, Finland.

The aim of the study was to assess attachment representations in mothers of preterm infants using the Working Model of Child Interview (WMCI) at the 12 months of the infant's corrected age. In addition, the relation between WMCI representation categories and the Edinburgh Postnatal Depression Scale score at 6 months of the infant's corrected age was studied. There were 38 mothers of preterm infants (<1500 g or <32 gestational weeks) and 45 mothers of full-term infants. The results showed no differences between the study groups in the distribution of the three main representation categories (balanced, disengaged and distorted). However, there were qualitative differences in representations between the groups. Furthermore, maternal depression symptoms were associated with distorted representation category. We suggest that despite the qualitative differences in the mothers' representations, mothers of preterm infants are as likely to form balanced attachments with their infants as mothers of full-term infants.
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http://dx.doi.org/10.1016/j.infbeh.2009.04.003DOI Listing
June 2009

Childhood psychopathology and sense of coherence at age 18: findings from the Finnish from a boy to a man study.

Soc Psychiatry Psychiatr Epidemiol 2009 Dec 31;44(12):1097-105. Epub 2009 Mar 31.

Deapartment of Psychiatry, Turku University, Turku, Finland.

Objective: To examine associations between childhood psychopathology and family factors at age 8, and sense of coherence (SOC) at age 18.

Methods: The sample includes 2,314 Finnish boys born 1981 with information about psychopathology from parents and teachers using Rutter scales, and self-reports of depressive symptoms using Child Depression Inventory (CDI), and self-reports of SOC at age 18.

Results: Low parental education level and living in other than two biological parent family at age 8 were associated with low SOC 10 years later. Boys with internalizing symptoms based on parent/teacher reports, and depressive symptoms based on self-reports at age 8 were at risk for lower SOC at follow-up. Comorbidity of internalizing and conduct problems had the strongest association with low SOC.

Conclusion: The study shows that internalizing symptoms, comorbid conduct and emotional problems, low parental education level and nonintact family at age 8 predict low SOC at age 18. Future research whether universal, selective or indicated early interventions targeted on risk factors of childhood mental health problems may result in promotion of well-being (including good SOC) in early adulthood is warranted.
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http://dx.doi.org/10.1007/s00127-009-0032-6DOI Listing
December 2009

Childhood antecedents of being a cigarette smoker in early adulthood. The Finnish 'From a Boy to a Man' Study.

J Child Psychol Psychiatry 2009 Mar 21;50(3):343-51. Epub 2009 Jan 21.

Department of Psychiatry, University of Turku, Turku, Finland.

Objective: To identify childhood psychiatric symptoms as antecedents of cigarette smoking at age 18.

Methods: In 1989, a general population sample of 2946 8-year-old boys born in Finland in 1981 was assessed using the Rutter's parent and teacher questionnaires, and the Child Depression Inventory. This birth cohort was followed up in 1999, when the subjects reported for their obligatory military service at age 18. Information about cigarette smoking frequency was obtained from 78% (n = 2307) of the boys attending the study in 1989.

Results: Childhood hyperactivity and self-reported depressive symptoms correlated with moderate daily (1-10 cigarettes), and heavy daily (>10 cigarettes) smoking at age 18. Conduct problems correlated with heavy daily smoking. A high level of childhood depressive symptoms, particularly in conjunction with a low educational level of the father, increased the risk of daily smoking. Emotional problems decreased the risk of smoking at age 18. In general, teacher reports had a better predictive power than parent reports for subsequent smoking.

Conclusion: Future developmental studies with special focus on interaction between individual and environmental factors are warranted to reveal the mechanisms underlying the association between childhood psychopathology and adult smoking. In particular, the associations between childhood depression and future smoking need more clarification.
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http://dx.doi.org/10.1111/j.1469-7610.2008.01968.xDOI Listing
March 2009

Childhood antecedents of being a cigarette smoker in early adulthood. The Finnish 'From a Boy to a Man' Study.

J Child Psychol Psychiatry 2009 Mar 21;50(3):343-51. Epub 2009 Jan 21.

Department of Psychiatry, University of Turku, Turku, Finland.

Objective: To identify childhood psychiatric symptoms as antecedents of cigarette smoking at age 18.

Methods: In 1989, a general population sample of 2946 8-year-old boys born in Finland in 1981 was assessed using the Rutter's parent and teacher questionnaires, and the Child Depression Inventory. This birth cohort was followed up in 1999, when the subjects reported for their obligatory military service at age 18. Information about cigarette smoking frequency was obtained from 78% (n = 2307) of the boys attending the study in 1989.

Results: Childhood hyperactivity and self-reported depressive symptoms correlated with moderate daily (1-10 cigarettes), and heavy daily (>10 cigarettes) smoking at age 18. Conduct problems correlated with heavy daily smoking. A high level of childhood depressive symptoms, particularly in conjunction with a low educational level of the father, increased the risk of daily smoking. Emotional problems decreased the risk of smoking at age 18. In general, teacher reports had a better predictive power than parent reports for subsequent smoking.

Conclusion: Future developmental studies with special focus on interaction between individual and environmental factors are warranted to reveal the mechanisms underlying the association between childhood psychopathology and adult smoking. In particular, the associations between childhood depression and future smoking need more clarification.
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http://dx.doi.org/10.1111/j.1469-7610.2008.01968.xDOI Listing
March 2009

Multinational study of cancer patients and their children: factors associated with family functioning.

J Clin Oncol 2008 Dec 24;26(36):5877-83. Epub 2008 Nov 24.

Child Psychiatry Clinic, University Hospital of Turku, PO Box 51-FI-20521, Turku, Finland.

Purpose: This study examined factors associated with family functioning in cancer patients' families with dependent children.

Patients And Methods: A sample of 381 families (639 parents and 489 children) was recruited simultaneously in six European countries. Patients and family members completed a background questionnaire, the Family Assessment Device (FAD), the Beck Depression Inventory, and the short form version of the Medical Outcomes Health Survey. Descriptive statistics and a multilevel model that allowed a multi-informant design were used. Analyses were carried out with all participants, and separately with parent-rated and children-rated FAD scores.

Results: In descriptive analyses, children reported more impairment in family functioning than parents, but the difference was not significant. Depression prevalence was 35% for ill mothers and 28% for ill fathers. In the multilevel analyses with all participants (ie, adults and children) the ill parent's depression was significantly associated with impaired family functioning on five of seven FAD subscales. In analyses with only children, the perception of impairment of family functioning was not associated with parental depression. Additionally, poorer physical status of the ill parent was significantly associated with impairment on roles and communication.

Conclusion: The ill parent's depression was the most significant factor associated with impairment in family functioning. Screening for depression, active diagnostics, and appropriate treatment of cancer patient's and partner's depression may be important to protect their children from mental disorders. Therefore, support systems need to be more family-oriented and child-centered in their approaches to cancer psychosocial care.
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http://dx.doi.org/10.1200/JCO.2007.12.8132DOI Listing
December 2008

Cross-informant agreement about bullying and victimization among eight-year-olds: whose information best predicts psychiatric caseness 10-15 years later?

Soc Psychiatry Psychiatr Epidemiol 2009 Jan 5;44(1):15-22. Epub 2008 Jul 5.

Institute of Clinical Medicine, University of Tromsø, 9038, Tromsø, Norway.

Objective: To examine cross-informant agreement and whose information (parents, teachers, children) about childhood bullying and victimization carry the strongest weight to late adolescent psychiatric outcome. The importance of frequency of bullying in such predictions is addressed.

Methods: Information from 2,713 boys about bullying and victimization at the age of eight was correlated with information about psychiatric disorder at 18-23.

Results: Agreement between informants was poor. Teachers reported higher levels of frequent bullying than others, whereas children reported the highest percentage of victimization. All three informant groups' reports of "frequent bullying" predicted later psychiatric disorder. Teachers' reports of "frequent victimization" was the strongest predictor of later psychiatric disorder. Informants' report about "infrequent bullying" showed at most a rather low risk of adverse outcome. When the associations between bullying/victimization and psychiatric outcome were adjusted with total psychopathology score at age 8, none of the associations remained significant.

Conclusion: "Frequent bullying" behaviour of boys is a marker of present and later psychopathology. The education system and school health-care service in mid- childhood are of great importance for the early detection of bullying and prevention of later adverse outcomes. A closer integration of these systems in the context of school should be promoted.
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http://dx.doi.org/10.1007/s00127-008-0395-0DOI Listing
January 2009

Does attachment theory offer new resources to the treatment of schizoaffective patients?

Am J Psychother 2008 ;62(1):35-49

Turku University Hospital, Child Psychiatry Clinic, Finland.

This paper focused on considering schizoaffective disorder in the light of Attachment Theory: a case of intensive psychotherapy with a patient with a schizoaffective disorder was presented. In this case, Attachment Theory provided a useful framework for understanding the patient as well for her treatment. The core of the treatment was to build a strong therapeutic alliance in which compliance with medication and elaboration of psychological processes could be achieved. This paper could contribute to opening the discussion about the relationship between schizoaffective disorder and Attachment Theory.
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http://dx.doi.org/10.1176/appi.psychotherapy.2008.62.1.35DOI Listing
July 2008
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