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    ABSTRACT: Depressive symptoms, often long-term or recurrent, are common among mothers of young children and a well-known risk for child well-being. We aimed to explore the antecedents of the long-term trajectories of maternal depressive symptoms and to define the antenatal factors predicting the high-symptom trajectories.
    Journal of affective disorders. 08/2014; 170C:30-38.
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    ABSTRACT: Background: Early recognition of children's mental health problems is crucial. Although the Strengths and Difficulties Questionnaire (SDQ) is a commonly used screening method, further research is needed on its validity and norms for young children. Aims: The aims of the study were to confirm the adjusted lower (normal/borderline) and upper (borderline/abnormal) cut-offs for the SDQ in a Finnish community sample of 4-9-year-old children, and to explore the SDQ's ability to identify the children with mental health problems. Methods: Parents and teachers completed the SDQs (n = 2666). The Development and Well-Being Assessment (DAWBA) was administered to parents and teachers of 646 children. Results: The overall participation rate was 57%. The suggested cut-offs for the SDQ total difficulties scale rated by parents and teachers were 2-5 points lower than the corresponding published British norms. The sensitivity for the total score normal/borderline cut-off (9/10) was 76% in the parent and 66% in the teacher reports and for the borderline/abnormal cut-off (11/12) 90% and 70% respectively. The respective specificity values were 69%, 63%, 74% and 66%. The area under curve (AUC) values of the higher cut-offs were good for parent (0.87) and satisfactory for teacher rated (0.76) total scores. The presence of a DAWBA-rater assigned diagnosis in the abnormal group compared with the normal group was sixfold in the parent and threefold in the teacher reported SDQs. Conclusions: The suggested cut-offs were clearly lower than the British norms. Yet the properties of the method's discriminative validity were acceptable. Population specific norms, taking into account both the culture and children's age, seem necessary for screening and for international comparisons of the method's validity properties.
    Nordic journal of psychiatry 11/2013; · 0.99 Impact Factor
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    ABSTRACT: Background: The negative effect of maternal depressive symptoms on child wellbeing has been quite extensively studied. There is, however, debate as to whether it is the timing, the recurrence or the chronicity of maternal depressive symptoms that puts the child's wellbeing at risk. Aims: This study explores the associations between the timing, recurrence and the patterns of maternal depressive symptoms and adolescent psychosocial functioning. Methods: One hundred and ninety-one mothers and 192 adolescents were followed up from the mother's pregnancy to the child's adolescence. Maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, in early and middle childhood, and at adolescence. The adolescents' outcomes were screened using Child Behavior Checklists and Youth Self Reports. Results: The results indicate that the initial exposure to maternal depressive symptoms at pregnancy is associated with more externalizing problems in adolescence, 2 months postnatally with more internalizing problems, in early childhood with poorer social competence and concurrently with more externalizing problems. Combined analyses indicate that recurrent maternal depressive symptoms best explain adolescents' internalizing problems and the chronic pattern of maternal depressive symptoms externalizing problems. The chronic and intermittent patterns of maternal depressive symptoms best explained adolescents' poorer social competence. Conclusions: Recurrent or chronic maternal depressive symptoms rather than the timing predict adolescents' psychosocial problems better. The timing, however, may explain the different kinds of problems in adolescence depending on the developmental task at the time of the exposure. The findings should be noted when treating both mothers and children in psychiatric clinics and other health services.
    Nordic journal of psychiatry 09/2013; · 0.99 Impact Factor
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    ABSTRACT: This study investigated associations between pain symptoms in mid-childhood and severe suicidality in adolescence and early adulthood. Severe suicidality was defined as completed suicide or suicidal attempt requiring hospital admission. In a nationwide prospective population-based study (n = 6,017), parents and children were asked about the child's headache and abdominal pain at age eight. The outcome was register-based data on suicide or suicidal attempt requiring hospital treatment by age 24. Family composition, parental educational level, and the child's psychiatric symptoms reported by the child, parents and teacher at baseline were included as covariates in statistical analyses. Boys' abdominal pain reported by the parents was associated with later severe suicidality after adjusting for family composition, parental educational level, and childhood psychiatric symptoms at baseline. In addition, the association between boys' own report of headache and later severe suicidality reached borderline significance in unadjusted analysis. Girls' pain symptoms did not predict later severe suicidality.
    Child Psychiatry and Human Development 04/2013; · 1.93 Impact Factor
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    ABSTRACT: Infant social behavior develops in the context of early parent-infant interaction. Persisting withdrawal from social interaction is a sign of infant distress and linked with the existence of risk factors. Impaired social behavior of the infant may not only be an indicator of pathology in the infant, but the first sign of the effect of a psychosocial risk. In this study we assessed thirty nine 7-month-old infants in videotaped interaction with their mothers and then compared the total score of the observed infant social behavior rated with the ADBB with variables of mother-infant interaction rated with the Emotional Availability Scales (EAS). The ADBB total score had a strong negative correlation with maternal sensitivity in the EAS (r = -0.75) and with the EAS child variables of child involvement (r = -0.82) and child responsiveness (r =-0.85), indicating that infants with more signs of social withdrawal had less sensitive mothers and were less involving and responsive in the interaction. Against our expectations the ADBB total score had no correlation with maternal structuring. Our results give further support to the ability of the ADBB to screen for early signs of pathology in infant social behavior and problems in parent-infant interaction.
    Infant Mental Health Journal 04/2013; · 0.61 Impact Factor
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    ABSTRACT: Background: Postnatal psychological symptoms have been studied less often in fathers than in mothers. However, recent research shows that fathers' psychopathology may have long-term effects on their children's emotional and behavioural development independently of maternal psychopathology. More research is needed on factors associated with paternal symptoms at the early stage of child development. Aims: The aim of the study was to examine the paternal, maternal, infant and family factors associated with the occurrence of depressive and anxiety symptoms in fathers of infants. Methods: As part of a study conducted in Tampere, Finland, on infants' social withdrawal symptoms, both parents of 4-, 8- and 18-month-old infants (n = 194) completed the Edinburgh Postnatal Depression Scale (EPDS) and general information questionnaires during routine check-ups of the infants in well-baby clinics. Parental depressive and anxiety symptoms were screened using the recommended cut-off points for this purpose (5/6 for fathers and 7/8 for mothers on the EPDS). The associations between the fathers' symptoms and paternal, maternal, infant and family factors were explored. Results: Twenty-one per cent of the fathers and 24% of the mothers scored above the cut-off points for depressive and anxiety symptoms on the EPDS. Both paternal and maternal factors predicted high paternal symptom level in regression models. Infant factors were not statistically significantly associated with paternal symptoms. Conclusions: Father's psychological symptoms were associated with many facets of both parents' impaired well-being. The whole family system should be considered whenever there are concerns about either parent's psychological well-being.
    Nordic journal of psychiatry 01/2013; · 0.99 Impact Factor
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    ABSTRACT: 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.
    European journal of obstetrics, gynecology, and reproductive biology 11/2012; · 1.97 Impact Factor
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    ABSTRACT: Lehti, V., Brunstein Klomek, A., Tamminen, T., Moilanen, I., Kumpulainen, K., Piha, J., Almqvist. F. & Sourander, A. (2012). Childhood bullying and becoming a young father in a national cohort of Finnish boys. Scandinavian Journal of Psychology. 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.
    Scandinavian Journal of Psychology 08/2012; · 1.29 Impact Factor
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    ABSTRACT: 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.
    Acta Obstetricia Et Gynecologica Scandinavica 08/2012; · 1.85 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    BMC Public Health 07/2012; 12:560. · 2.08 Impact Factor
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    ABSTRACT: Some mothers who have recently lost a significant attachment figure may become mentally incoherent and sporadically even enter a trancelike, dissociative state. Such states of mind have been shown to predict infant attachment disorganization. Infants born close to the time of a parental loss are at a greater risk for intergenerational trauma. A background of maternal substance abuse is also known to increase such risk. We illustrate by way of a case study how a mother-infant group psychotherapy programme aimed at substance-abusing mothers may help to prevent the transmission of mother's unresolved trauma to the infant. Another goal was to discuss how attachment-derived methods (namely, Adult Attachment Interview, Strange Situation Procedure and the Emotional Availability Scales) may aid in understanding the effects of the intervention.
    Clinical Child Psychology and Psychiatry 05/2012;
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    ABSTRACT: 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. 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. 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. Antipsychotic use in adolescence and young adulthood is different among men versus women both with regard to hospital diagnoses and childhood psychiatric problems.
    Pharmacoepidemiology and Drug Safety 04/2012; 21(9):964-71. · 2.90 Impact Factor
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    ABSTRACT: Background: Early recognition of children's mental health problems calls for structured methods in front line services. The Strengths and Difficulties Questionnaire (SDQ) is a commonly used short questionnaire in screening child's mental difficulties. Aim: To test the reliability and descriptive properties of the SDQ in a community sample of Finnish 4-9-year-old children (n = 4178). Methods: Both parents, two teachers in day-care or a teacher at school completed the SDQ. To control for possible bias, public health nurses rated their concern about every child's mental health, including non-participants. Results: The internal consistencies of the SDQ total score in all informants' reports were satisfactory to good. Agreement (Spearman rho) in total scores between parents was 0.65, between parent and teacher 0.43 and between two teachers in day-care 0.81. The stability in parent's reports over 12 weeks was good. The distributions of the informant-rated scores indicated significant and clinically important gender differences, and the 80th and 90th percentiles were generally below the international cut-off points. Public health nurses reported emotional or behavioural difficulties more commonly in non-participants (12%) than in participants (7%; p < 0.001). Conclusions: The results supported earlier findings of good internal consistency, inter-rater and cross-informant agreements and test-retest of the method. However, the gender and age of the child, the number of informants and cultural differences in reporting styles affected the results and thus confirmed the need to re-evaluate the SDQ in the culture and population in question.
    Nordic journal of psychiatry 03/2012; 66(6):403-13. · 0.99 Impact Factor
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    ABSTRACT: 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. 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. 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. 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. 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.
    Journal of affective disorders 02/2012; 138(1-2):153-9. · 3.76 Impact Factor
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    ABSTRACT: Maternal depression is known to be a risk for abnormal child development. Girls and boys have been found to respond differently to maternal depression. Although prenatal and postnatal depression has been widely studied, longitudinal studies of adolescent outcome are still rare. The original sample of 349 mothers in this longitudinal study was collected in 1989-1990 in Tampere, Finland. At the latest stage, of the 327 contacted in 2006, 191 mothers and 192 adolescents aged 16 to 17 years participated in the study. Maternal depressive symptoms were screened using the Edinburgh Postnatal Depression Scale (EPDS) prenatally, postnatally and at the latest stage. Adolescent outcome was examined using the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR). Maternal concurrent depressive symptoms were associated with adolescent behavioral and emotional problems in both genders. Maternal prenatal depressive symptoms were associated with Externalizing Problems in the YSR and boys' lower Social Competence in both the CBCL and YSR. Maternal postnatal depressive symptoms were associated with boys' lower Social Competence both in the CBCL and YSR and Externalizing Problems in the YSR. Being a longitudinal normal population sample, the number of symptomatic mothers and adolescents is relatively small and the number of drop-outs is relatively high. Clinical evaluation of mothers and adolescents is also lacking. Maternal prenatal and postnatal depressive symptoms are a risk to adolescent boys' wellbeing and concurrent depressive symptoms a risk for both girls' and boys' well-being. This long-term influence should be noted when treating women with depressive symptoms throughout motherhood.
    Journal of affective disorders 02/2012; 136(3):680-92. · 3.76 Impact Factor
  • Infant Mental Health Journal 01/2012; 33:520-534. · 0.61 Impact Factor
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    ABSTRACT: The aim was to study predictive associations between childhood stealing behavior at the of age 8 years with later psychiatric disorders, criminality or suicide attempts and completed suicides up to the age 25 years in a large representative population-based birth cohort. The sample includes 2,592 Finnish males born in 1981 with information about stealing from both parents and teachers. Information about psychiatric disorders, criminality, suicide attempts requiring hospital admission and completed suicides was gathered from four different Finnish nationwide registries until the study participants were 25 years old. One out of ten boys had stealing behavior during the previous 12 months. After adjusting for parental education level and conduct problems or hyperactivity (i.e. potential confounds), stealing at eight independently predicted substance use and antisocial personality disorders, and high level of crimes. Stealing was also associated with completed suicide or severe suicide attempt requiring hospital admission. Comorbid stealing and frequent aggression had the strongest predictive association with any psychiatric diagnosis, crime and completed suicide or severe suicide attempt, while stealing without aggression was not associated with any of the negative outcomes. Stealing accompanied with aggressivity at age eight is predictive of wide range of adversities. However, no increased risk was observed among the group with stealing behaviors but without aggression.
    Social Psychiatry 11/2011; 47(9):1391-400. · 2.05 Impact Factor
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    Tuula Tamminen
    European Child & Adolescent Psychiatry 09/2011; 20(10):495-6. · 3.70 Impact Factor
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    ABSTRACT: This study examined child and parental factors in infancy and toddlerhood predicting subclinical or clinical levels of internalizing and externalizing problems at 5 years of age. Ninety-six children and their families participated. They were assessed when the children were 4-10 weeks old (T1), 2 years (T2) and 5 years old (T3). Child risks (difficult temperament, health problems, early emotional and behavioral problems), parental risks (psychopathology, parenting stress and perception of the child) and family risks (socio-economic status, quality of marital relationship and family violence) were examined. At 5 years, internalizing problems were predicted by family violence during the child's infancy and parenting stress at age 2. Externalizing problems were predicted by psychiatric problems of the mother before pregnancy and child's externalizing problems at 2 years of age. When interventions aiming at preventing emotional and behavioral problems in children are considered, these issues should be recognized early and effective intervention initiated.
    Child Psychiatry and Human Development 09/2011; 43(2):153-70. · 1.93 Impact Factor
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    ABSTRACT: 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. 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. 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. Childhood psychopathology predicts use of antidepressants, but the type of childhood psychopathology predicting antidepressant use is different among males and females.
    Journal of the American Academy of Child and Adolescent Psychiatry 04/2011; 50(4):406-15, 415.e1. · 6.97 Impact Factor

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