Publications by authors named "Kirsti Kumpulainen"

51 Publications

"You helped me out of that darkness" Children as dialogical partners in the collaborative post-family therapy research interview.

J Marital Fam Ther 2022 Apr 19;48(2):588-603. Epub 2021 Mar 19.

Child Psychiatry, University of Eastern Finland, Kuopio, Finland.

Applying Dialogical Methods for Investigations of Happening of Change (DIHC), this study investigated how children who had been diagnosed with an oppositional defiant or conduct disorder participated in a collaborative post-therapy research interview and talked about their experiences of family therapy. The results showed that the children participated as dialogical partners talking in genuine, emotional, and reflective ways. Encountered as full-membership partners, the children also co-constructed meanings for their sensitive experiences. However, their verbal initiatives and responses appeared in very brief moments and could easily have been missed. The collaborative post-therapy interview offered a safe forum for co-reflection by participants on what they had found useful or difficult in the family therapy process. In this interview setting, the family first listens to reflection by the therapists on the therapy process and their thoughts on some of the family's related sensitive issues. The results indicate that when therapists present themselves as not-knowing, receptive and accountable, therapists may facilitate reflection for all family members, including children.
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http://dx.doi.org/10.1111/jmft.12505DOI Listing
April 2022

The impact of postpartum depressive symptoms on self-reported infant health and analgesic consumption at the age of 12 months: A prospective cohort study.

J Psychiatr Res 2021 04 16;136:388-397. Epub 2021 Feb 16.

Institute of Clinical Medicine / Psychiatry, University of Eastern Finland, P.O. Box 1627, FI, 70211, Kuopio, Finland; Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, FI, 00014, Helsinki, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, FI, 00014, Helsinki, Finland.

The infants of mothers with elevated depressive symptoms (EDS) postpartum appear to be at increased risk of somatic health problems during their first 12 months of life in low- and lower-middle-income countries. However, in higher-income countries, knowledge of this association is scarce. We sought to examine whether maternal reports of infant health problems, adherence to vaccination schedules and analgesic supply to the infant during the first 12 months of life differ between mothers with and without postpartum EDS. Altogether, 969 women who were enrolled in the Kuopio Birth Cohort study (www.kubico.fi) during 2012-2017 were included in this investigation. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale during pregnancy (1st and/or 3rd trimester) and at eight weeks postpartum. Infant health data were collected as a part of a 12-month online follow-up questionnaire for mothers and were based on self-reports of either maternal observations or physician-determined diagnoses. Postpartum EDS were associated with a 2- to 5-fold increased likelihood of abnormal crying and paroxysmal wheezing (based on parental observations), as well as gastroesophageal reflux and food allergy (based on physician-determined diagnoses). Mothers with postpartum EDS also supplied their infants with analgesic medication for longer periods. Adherence to vaccination schedules was similar between the examined groups. In conclusion, infants of mothers with postpartum EDS may be more likely to experience health problems or to be perceived by their mother as having health problems, and thus receive more medications.
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http://dx.doi.org/10.1016/j.jpsychires.2021.02.036DOI Listing
April 2021

The dynamic course of peripartum depression across pregnancy and childbirth.

J Psychiatr Res 2019 06 15;113:72-78. Epub 2019 Mar 15.

Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Psychiatry, University of Helsinki, Helsinki, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.

Objective: Peripartum depression (PPD) pertaining to depression in pregnancy and postpartum is one of the most common complications around childbirth with enduring adverse effects on mother and child health. Although psychiatric symptoms may improve or worsen over time, relatively little is known about the course of PPD symptoms and possible fluctuations.

Methods: We applied a person-centered approach to examine PPD symptom patterns across pregnancy and childbirth. 824 women were assessed at three time points: first trimester (T1), third trimester (T2), and again at eight weeks (T3) postpartum. We assessed PPD symptoms, maternal mental health history, and childbirth variables.

Results: Growth mixture modeling (GMM) analysis revealed four discrete PPD symptom trajectory classes including chronic PPD (1.1%), delayed (10.2%), recovered (7.2%), and resilient (81.5%). Delivery complications were associated with chronic PPD but also with the recovered PPD trajectory class. History of mental health disorders was associated with chronic PPD and the delayed PPD class.

Conclusion: The findings underscore that significant changes in a woman's depression level can occur across pregnancy and childbirth. While a minority of women experience chronic PDD, for others depression symptoms appear to significantly alleviate over time, suggesting a form of recovery. Our findings support a personalized medicine approach based on the woman's symptom trajectory. Future research is warranted to identify the mechanisms underlying modifications in PPD symptoms severity and those implicated in recovery.
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http://dx.doi.org/10.1016/j.jpsychires.2019.03.016DOI Listing
June 2019

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

BMC Pregnancy Childbirth 2018 Sep 21;18(1):381. Epub 2018 Sep 21.

School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.

Background: A Finnish joint research effort Kuopio Birth Cohort (KuBiCo) seeks to evaluate the effects of genetics, epigenetics and different risk factors (medication, nutrition, lifestyle factors and environmental aspects) during pregnancy on the somatic and psychological health status of the mother and the child.

Methods: KuBiCo will ultimately include information on 10,000 mother-child pairs who have given their informed consent to participate in this cohort. Identification of foetal health risk factors that can potentially later manifest as disease requires a repository of relevant biological samples and a flexible open up-to-date data handling system to register, store and analyse biological, clinical and questionnaire-based data. KuBiCo includes coded questionnaire-based maternal background data gathered before, during and after the pregnancy and bio-banking of maternal and foetal samples that will be stored in deep freezers. Data from the questionnaires and biological samples will be collected into one electronic database. KuBiCo consists of several work packages which are complementary to each other: Maternal, foetal and placental metabolism and omics; Paediatrics; Mental wellbeing; Prenatal period and delivery; Analgesics and anaesthetics during peripartum period; Environmental effects; Nutrition; and Research ethics.

Discussion: This report describes the set-up of the KuBiCo and descriptive analysis from 3532 parturients on response frequencies and feedback to KuBiCo questionnaires gathered from June 2012 to April 2016. Additionally, we describe basic demographic data of the participants (n = 1172). Based on the comparison of demographic data between official national statistics and our descriptive analysis, KuBiCo represents a cross-section of Finnish pregnant women.
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http://dx.doi.org/10.1186/s12884-018-2013-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150990PMC
September 2018

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

J Affect Disord 2018 12 15;241:263-268. Epub 2018 Aug 15.

Institute of Clinical Medicine / Psychiatry, University of Eastern Finland, Kuopio, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.

Background: The literature suggests an association between type 2 diabetes mellitus and depression, but data on the association between gestational diabetes mellitus (GDM) and postpartum depressive symptomatology (PPDS) are scarce.

Methods: Altogether, 1066 women with no previous mental health issues enrolled in the Kuopio Birth Cohort (KuBiCo, www.kubico.fi) were selected for this study. GDM was diagnosed according to the Finnish Current Care Guidelines. Depressive symptomatology was assessed with the Edinburgh Postnatal Depression Scale (EPDS) during the third trimester of pregnancy and eight weeks after delivery. Additionally, a subgroup of women (n = 505) also completed the EPDS during the first trimester of pregnancy.

Results: The prevalence rates of GDM and PPDS in the whole study population were 14.1% and 10.3%, respectively. GDM was associated with an increased likelihood of belonging to the PPDS group (OR 2.23, 95% CI 1.23-4.05; adjusted for maternal age at delivery, BMI in the first trimester, smoking before pregnancy, relationship status, nulliparity, delivery by caesarean section, gestational age at delivery, neonatal intensive care unit admission and third-trimester EPDS scores). A significant association between GDM and PPDS was found in the subgroup of women with available data on first-trimester depression (n = 505).

Limitations: The participation rate of the KuBiCo study was relatively low (37%).

Conclusions: Women with GDM may be at increased risk of PPDS. Future studies should investigate whether these women would benefit from a closer follow-up and possible supportive interventions during pregnancy and the postpartum period to avoid PPDS.
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http://dx.doi.org/10.1016/j.jad.2018.08.070DOI Listing
December 2018

[Drug therapy and the most common drugs for childhood psychiatric disorders].

Duodecim 2016 ;132(10):943-50

Psychotropic drugs are more commonly prescribed for children, although scientific evidence about psychotrophic medication and long-term effects thereof in children is scarce. The drugs are often used off-label. ADHD drugs, antipsychotics and antidepressants and melatonin are the most commonly used drugs. ADHD medication possesses the most established status. Antipsychotic drugs are utilized for the treatment of psychoses, bipolar disorder, and conduct disorder symptoms in particular. Antidepressants are utilized for the treatment of childhood depression and anxiety disorders, melatonin for the treatment of children's sleep problems. Drug therapy should always be carried out as part of other psychiatric therapy.
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September 2016

Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age.

JAMA Psychiatry 2016 Feb;73(2):159-65

Department of Child Psychiatry, University of Eastern Finland, Kuopio.

Importance: Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear.

Objective: To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age.

Design, Setting, And Participants: Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015.

Main Outcomes And Measures: Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment.

Results: Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms.

Conclusions And Relevance: Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.
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http://dx.doi.org/10.1001/jamapsychiatry.2015.2419DOI Listing
February 2016

Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age.

JAMA Psychiatry 2016 Feb;73(2):159-65

Department of Child Psychiatry, University of Eastern Finland, Kuopio.

Importance: Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear.

Objective: To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age.

Design, Setting, And Participants: Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015.

Main Outcomes And Measures: Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment.

Results: Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms.

Conclusions And Relevance: Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.
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http://dx.doi.org/10.1001/jamapsychiatry.2015.2419DOI Listing
February 2016

Association between childhood psychosocial factors and induced abortion.

Eur J Obstet Gynecol Reprod Biol 2013 Feb 2;166(2):190-5. Epub 2012 Nov 2.

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

Objective: To examine the predictive associations between psychosocial risk factors in childhood and having an abortion in adolescence or young adulthood.

Study Design: This study is based on a nationwide cohort consisting of 2867 girls born in Finland in 1981. The baseline assessment was conducted at age eight by three informants, and it included information on psychiatric symptoms, school performance and family related risk factors. Register-based follow-up data on abortions were collected until the end of the year when the participants turned 28 years. They were available for 2694 participants. Cox proportional hazards model and logistic regression model were used for statistical analysis.

Results: Altogether 357 women (13.3%) had had an abortion for other than medical reasons during the follow-up. Of the childhood factors, a high level of conduct problems, poor school performance, family structure other than two biological parents, and mother with a low level of education were independently associated with having an abortion. Comparison of the strength of associations between childhood risk factors and first abortion under the age of 20 versus first abortion at a later age, showed no significant differences. Neither did the comparison between one and more abortions.

Conclusions: At age eight there are already psychosocial factors which predict later abortion. This finding needs to be considered when targeting preventive interventions and developing sexual health services.
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http://dx.doi.org/10.1016/j.ejogrb.2012.10.017DOI Listing
February 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

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

BMC Public Health 2012 Jul 27;12:560. Epub 2012 Jul 27.

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

Background: Little is known about the characteristics of boys who become fathers at young age. Some studies have suggested that antisocial adolescents are more likely to be young fathers. The aim of this study was to examine the associations of psychosocial factors in childhood with becoming a young father, and to assess if they are independent of criminal behavior in adolescence.

Methods: The baseline assessment in 1989 included 2,946 boys born in 1981. Information about psychiatric symptoms at age eight was collected with Rutter questionnaires from parents and teachers and with the Child Depression Inventory from the children themselves. Data on criminal offenses at age 16-20 was collected from a police register. Register-based follow-up data on becoming a father under the age of 22 was available for 2,721 boys.

Results: The factors measured at age eight, which were associated with becoming a young father independently of adolescent criminality, were conduct problems, being born to a young father and having a mother with a low educational level. Having repeatedly committed criminal offences in adolescence was associated with becoming a young father independently of psychosocial factors in childhood.

Conclusions: Antisocial tendencies both in childhood and adolescence are associated with becoming a young father. They should be taken into consideration when designing preventive or supportive interventions.
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http://dx.doi.org/10.1186/1471-2458-12-560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412728PMC
July 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

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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November 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

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

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

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

Prevention of public health risks linked to bullying: a need for a whole community approach.

Int J Adolesc Med Health 2008 Apr-Jun;20(2):185-99

Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, Washington, DC, United States.

Bullying is a very toxic psychosocial stressor associated with serious health problems and death, affecting both the victims and the bullies. This form of abuse or maltreatment occurs around the world and along the lifespan. Health professionals have the unique responsibility of promoting the development of community initiatives for the prevention of bullying and related health problems. This effort must include ongoing programs with elements of primary, secondary, and tertiary prevention. These programs should be supported and monitored by a public health policy with a strategy aimed at developing a whole community awareness about bullying and the related health risks, prohibiting bullying, and developing emotionally and physically safe environments in schools and workplace settings. Public health policy should mandate the monitoring, detection, and reporting of bullying incidents; provide guidance for school intervention; and offer guidelines for medical consultation.
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http://dx.doi.org/10.1515/ijamh.2008.20.2.185DOI Listing
November 2008

Psychiatric conditions associated with bullying.

Int J Adolesc Med Health 2008 Apr-Jun;20(2):121-32

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

Bullying is a complex phenomenon moderated not only by the personal characteristics and behavioral traits of the individual but also by family rearing practices, as well as by situational factors such as the frequency and type of bullying. The phenomenon is also affected by group processes among the individuals present during the event. Bullying is a distressing experience that is often continuous over years and predicts both concurrent and future psychiatric symptoms and disorders, even in adulthood. At young ages, attention-deficit hyperactivity disorder and depression, as well as anxiety, are prevalent concurrently with bullying among the children involved. Later in young adulthood, male victims are at risk for anxiety, male bullies for personality disorders, and male bully-victims for both personality disorders and anxiety, and the risk is especially increased if the child is disturbed when involved in bullying at school age. Rarely does any single behavior predict future problems as clearly as bullying does, and additional assessment of psychiatric problems is always warranted, if the child is involved in bullying as a bully, victim or bully-victim. Based on our current knowledge, school-based interventions regulating the behavior of the child, increasing pro-social skills and promoting peer relationships are recommended for those without concurrent psychiatric disturbance, but those displaying psychiatric symptoms and disorders should be referred for psychiatric consultation and intervention.
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http://dx.doi.org/10.1515/ijamh.2008.20.2.121DOI Listing
November 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
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