Tuula Tamminen

Psychosomatic Medicine, Psychiatry, Primary Care

37.96

Publications

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    ABSTRACT: Shared pleasure (SP) was analyzed in fifty-eight 2-month-old infants and their mothers in face-to-face interaction (T1, at 2 months). The association of SP with child's emotional and behavioral outcome at 2 years (T2) was examined. SP as a possible protecting factor in the presence of parental psychopathology also was studied. Mean duration of SP moments (SP-MD) was related to subsequent socioemotional outcome of the child: Infants of dyads with longer SP-MD showed fewer internalizing and externalizing problems 2 years later. In hierarchical linear regressions, SP-MD uniquely and significantly contributed to internalizing problems after adjusting for infant and maternal factors and mother's interactive behavior. SP protected the child against the influence of parental psychopathology. Father's mental health problems during the follow-up increased the child's risk for higher externalizing and internalizing problems, but only among children with short SP-MD at T1. Internalizing symptoms at T2 increased when moving from the category "no mental health problems" to "mental health problems in one parent" and further to "mental health problems in both parents," but this increase was found only among those with short SP-MD at T1. SP in parent-child interaction is an important feature that fosters positive psychological development and moderates the health effects of other risks such as parental psychopathology. © 2015 Michigan Association for Infant Mental Health.
    Infant Mental Health Journal 03/2015; 36(2). DOI:10.1002/imhj.21505 · 0.61 Impact Factor
  • I. Luoma · M. Korhonen · R. Salmelin · T. Tamminen
    European Psychiatry 03/2015; 30:726. DOI:10.1016/S0924-9338(15)30576-9 · 3.44 Impact Factor
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    Anne-Mari Borg · Raili Salmelin · Matti Joukamaa · Tuula Tamminen
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    ABSTRACT: Background and Aims. Assessing young children's mental health is a crucial and challenging task. The aim of the study was to evaluate the clinical relevance of asking parents, nurses, and young children themselves to identify children's mental health problems by only one or two questions. Methods. In regular health check-ups of 4- to 9-year-old children (n = 2682), parents and public health nurses assessed by one question whether the child had any emotional or behavioral difficulties. The child completed a self-evaluation enquiry on his/her emotional well-being. A stratified proportion of the participating parents were invited to a diagnostic interview. Results. Sensitivities were fairly good for the parents' (68%), nurses' (65%), and their combined (79%) one-question screens. Difficulties identified by parents and nurses were major risks (OR 10-14) for any child psychiatric disorders (P < 0.001). The child's self-evaluation was related to 2-fold to 3-fold risks (P < 0.05) for any psychiatric diagnosis, for any emotional diagnosis, and for negative situational factors. Conclusion. The one-question screen for parents and public health nurses together quite adequately identified the young children with mental health problems. The child's self-evaluation provided relevant and complementary information on his/her mental health and especially emotional problems.
    12/2014; 2014:286939. DOI:10.1155/2014/286939
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    ABSTRACT: Background The aim of the study was to evaluate the feasibility of the Strengths and Difficulties Questionnaire (SDQ).Method Following the administration of the SDQ in medical check-ups of 4–9 year-old children (n = 2 682) the involved parents, teachers and public health nurses were asked to complete a feedback questionnaire of the SDQ.ResultsParents took a maximum of 10–15 minutes to complete the SDQ, and only the public health nurses reported that its use was rather burdensome. The SDQ was an age-appropriate method and it was helpful in increasing information and agreement about the child's mental health and need for support. Using the SDQ was a positive experience for parents, but they expected more dialogue with the professionals about the child's situation. The respondents criticised the questionnaire somewhat for being difficult to interpret and complete.Conclusions The SDQ was found to be a feasible method for screening children's mental health in primary health care together with parents, teachers and public health nurses. Using the SDQ was a positive experience for parents. However, they reminded the professionals of the importance of sensitive dialogue when assessing the mental health of the child.
    Journal of Child and Adolescent Mental Health 12/2014; 26(3):229-38. DOI:10.2989/17280583.2014.923432
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    ABSTRACT: Group-based modeling techniques are increasingly used in developmental studies to explore the patterns and co-occurrence of internalizing and externalizing problems. Social competence has been found to reciprocally influence internalizing and externalizing problems, but studies on its associations with different patterns of these problems are scarce. Using data from a Finnish longitudinal normal population sample, trajectories of internalizing and externalizing problems were formed using the Child Behavior Checklist completed by the mother at the child’s age of 4- to 5-years-old, 8- to 9-years-old, and 16- to 17-years-old (N = 261). The results indicate that adolescent’s self-reported internalizing and externalizing problems based on the Youth Self Report were associated with the trajectories of internalizing and externalizing problems. Social competence both in early childhood and in adolescence was poorer among children with chronic internalizing problems and among those with adolescent-onset externalizing problems. One-third of the children who had a chronically high level of internalizing problems had an initially high but decreasing level of externalizing problems, while 33% of the adolescents with adolescent-onset externalizing problems had a chronically high level of internalizing problems. School psychologists are encouraged to screen for internalizing problems from children with behavioral, academic or social problems.
    School Psychology International 11/2014; 35(6):561-579. DOI:10.1177/0143034314525511 · 0.59 Impact Factor
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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. DOI:10.1016/j.jad.2014.08.017 · 3.71 Impact Factor
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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; 68(7). DOI:10.3109/08039488.2013.853833 · 1.50 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 11/2013; 34(6). DOI:10.1002/imhj.21417 · 0.61 Impact Factor
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    Marie Korhonen · Ilona Luoma · Raili Salmelin · Tuula Tamminen
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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; 68(5). DOI:10.3109/08039488.2013.838804 · 1.50 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; DOI:10.1007/s10578-013-0382-x · 1.93 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; 67(6). DOI:10.3109/08039488.2012.752034 · 1.50 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; 166(2). DOI:10.1016/j.ejogrb.2012.10.017 · 1.63 Impact Factor
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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 09/2012; 21(9):964-71. DOI:10.1002/pds.3265 · 3.17 Impact Factor
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    ABSTRACT: The purpose of this controlled study was to examine the outcome of psychodynamic motherinfant group psychotherapy (PGT) outpatient intervention for drug-abusing perinatal motherinfant dyads. PGT comprised 20 to 24 weekly 3-hr sessions with 3 to 5 months of follow-up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing motherinfant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and motherinfant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug-abusing dyads in PGT, 25 in PSS, and 50 dyads in a non-drug-abusing comparison group. Assessments were pre-intervention and at 4 and 12 months' follow-up, including maternal depressive symptoms and motherchild interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of motherinfant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high-risk dyads.
    Infant Mental Health Journal 09/2012; 33(5):520-534. DOI:10.1002/imhj.21348 · 0.61 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 53, 461–466. 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; 53(6). DOI:10.1111/j.1467-9450.2012.00971.x · 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; 91(11). DOI:10.1111/j.1600-0412.2012.01517.x · 1.99 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. DOI:10.1186/1471-2458-12-560 · 2.32 Impact Factor
  • M. Korhonen · I. Luoma · R. Salmelin · T. Tamminen
    Neuropsychiatrie de l Enfance et de l Adolescence 07/2012; 60(5):S188. DOI:10.1016/j.neurenf.2012.04.336
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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; 18(1). DOI:10.1177/1359104512444116
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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. DOI:10.3109/08039488.2012.660706 · 1.50 Impact Factor

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