GPs' role in the detection of psychological problems of young people: a population-based study.

BACKGROUND: Among young people, about one in three females and one in five males report experiencing emotional distress but 65-95% of them do not receive help from health professionals. AIM: To assess the differences among young people who seek help and those who do not seek help for their psychological problems, considering the frequency of consultations to their GP and their social resources. DESIGN OF STUDY: School survey. SETTING: Post-mandatory school. METHOD: Among a Swiss national representative sample of 7429 students and apprentices (45.6% females) aged 16-20 years, 1931 young people reported needing help for a problem of depression/sadness (26%) and were included in the study. They were divided into those who sought help (n = 256) and those who did not (n = 1675), and differences between them were assessed. RESULTS: Only 13% of young people needing help for psychological problems consulted for that reason and this rate was positively associated with the frequency of consultations to the GP. However, 80% of young people who did not consult for psychological problems visited their GP at least once during the previous year. Being older or a student, having a higher depression score, or a history of suicide attempt were linked with a higher rate of help seeking. Moreover, confiding in adults positively influenced the rate of help seeking. CONCLUSION: The large majority of young people reporting psychological problems do not seek help, although they regularly consult their GP. While young people have difficulties in tackling issues about mental health, GPs could improve the situation by systematically inquiring about this issue.

Parent-child agreement and prevalence estimates of diagnoses in childhood: direct interview versus family history method.

Diagnostic information on children is typically elicited from both children and their parents. The aims of the present paper were to: (1) compare prevalence estimates according to maternal reports, paternal reports and direct interviews of children [major depressive disorder (MDD), anxiety and attention-deficit and disruptive behavioural disorders]; (2) assess mother-child, father-child and inter-parental agreement for these disorders; (3) determine the association between several child, parent and familial characteristics and the degree of diagnostic agreement or the likelihood of parental reporting; (4) determine the predictive validity of diagnostic information provided by parents and children. Analyses were based on 235 mother-offspring, 189 father-offspring and 128 mother-father pairs. Diagnostic assessment included the Kiddie-schedule for Affective Disorders and Schizophrenia (K-SADS) (offspring) and the Diagnostic Interview for Genetic Studies (DIGS) (parents and offspring at follow-up) interviews. Parental reports were collected using the Family History - Research Diagnostic Criteria (FH-RDC). Analyses revealed: (1) prevalence estimates for internalizing disorders were generally lower according to parental information than according to the K-SADS; (2) mother-child and father-child agreement was poor and within similar ranges; (3) parents with a history of MDD or attention deficit hyperactivity disorder (ADHD) reported these disorders in their children more frequently; (4) in a sub-sample followed-up into adulthood, diagnoses of MDD, separation anxiety and conduct disorder at baseline concurred with the corresponding lifetime diagnosis at age 19 according to the child rather than according to the parents. In conclusion, our findings support large discrepancies of diagnostic information provided by parents and children with generally lower reporting of internalizing disorders by parents, and differential reporting of depression and ADHD by parental disease status. Follow-up data also supports the validity of information provided by adolescent offspring.

Zerebrale Probleme in der pädiatrischen Intensivmedizin [Cerebral problems in pediatric intensive care]

This paper presents a review of different methods enabling the monitoring of cerebral function in neonatal and paediatric intensive care. EEG, evoked potentials, conventional radiological studies, computerized tomography, ultrasound, intracranial pressure measurements, nuclear magnetic resonance, Doppler ultrasound, radioisotope studies, angiography, infra-red spectral analysis and last, but not least, clinical examination produce information regarding the neurological state of the patient which must be critically analysed in order to ensure optimal management of the case. Unfortunately, and in spite of impressive progress in non-invasive monitoring of the cerebral function, we are still forced to make important medical and ethical decisions without precise information about the neurological state of our patients.

Qualité des statistiques de causes de décès: problèmes actuels et perspectives. [Quality of statistics on causes of death: current problems and perspectives].

Statistics of causes of death remain an important source of epidemiological data for the evaluation of various medical and health problems. The improvement of analytical techniques and, above all, the transformation of demographic and morbid structures of populations have prompted researchers in the field to give more importance to the quality of death certificates. After describing the data collection system presently used in Switzerland, the paper discusses various indirect estimations of the quality of Swiss data and reviews the corresponding international literature.

Temperamental Dimension and Anxiety Problems in a Clinical Sample of Three- to Six-year old Children: A Study of Variables

In the last few years, many researchers have studied the presence of common dimensions of temperament in subjects with symptoms of anxiety. The aim of this study is to examine the association between temperamental dimensions (high negative affect and activity level) and anxiety problems in clinicalpreschool children. A total of 38 children, ages 3 to 6 years, from the Infant and Adolescent Mental Health Center of Girona and the Center of Diagnosis and Early Attention of Sabadell and Olot were evaluated by parents and psychologists. Their parents completed several screening scales and, subsequently, clinical child psychopathology professionals carried out diagnostic interviews with children from the sample who presented signs of anxiety. Findings showed that children with high levels of negative affect and low activity level have pronounced symptoms of anxiety. However, children with anxiety disorders do not present different temperament styles from their peers without these pathologies

Low prevalence of behavioural and emotional problems among Swiss paediatric patients with inflammatory bowel disease.

OBJECTIVES: Whether behavioural and emotional maladjustment is more prevalent in children with inflammatory bowel disease (IBD) than in healthy controls remains controversial. The aim of this study was to assess paediatric IBD patients for problems with emotional and behavioural adjustment and to examine associations with clinical and demographic variables. METHODS: Data from paediatric patients with IBD enrolled in the Swiss IBD Cohort Study and the results of both the parent-rated Strengths and Difficulties Questionnaire (SDQ) and the self-reported Child Depression Inventory (CDI) were analysed. Of the 148 registered patients, 126 had at least one questionnaire completed and were included. RESULTS: The mean age of 71 patients with Crohn's disease (44 males, 27 females) was 13.4 years, and 12.8 years for the 55 patients with ulcerative or indeterminate colitis. The mean duration of disease was 1.2 and 2.7 years, respectively. The total score of the SDQ was abnormal in 11.4% of cases compared to 10% in the normal population. Abnormal sub-scores were found in 20.2% of subjects for the domain of emotional problems and in 17.1% for problems with peers. The total CDI T score indicated a significantly lower prevalence of clinical depression in IBD patients than in normal youth. No correlation between the total SDQ scores or the CDI T scores and gender, type or duration of IBD, inflammatory markers or disease scores was found. CONCLUSIONS: The prevalence of problems with behavioural and emotional adjustment among Swiss paediatric IBD patients is low and comparable to that of the normal population.

Current trends in illegal drug use and drug related health problems in Switzerland.

As part of the evaluation of the Confederation's measures to reduce drug related problems, a review of available data on drug use and drug related problems in Switzerland has been conducted. Source of data included: population surveys (adults and teenagers), surveys among drug users, health statistics (drug related and AIDS related deaths, HIV case reporting, drug treatments) police statistics (denunciations for consumption). The aims of reducing the number of dependent hard drug users have been achieved where heroin is concerned. In particular, there seems to have been a decrease in the number of people becoming addicted to this substance. For all other illegal substances, especially cannabis, the trend is towards an increased use, as in many European countries. As regards dependent drug users, especially injecting drug users, progress has been made in the area of harm reduction and treatment coverage. This epidemiological assessment can be used in the discussions currently engaged about the revision of the Law governing narcotics and will be a baseline for future follow up of the situation.

Report of the Section of Agencies and Institutions Division of Child Welfare State Department of Social Welfare, 1943

History of child and social welfare in the State of Iowa including legal responsibilities, rules and regulations, inspections and licensing and supervision. it also covers cooperation with state agencies. It also describes in detail the histories, functions and problems of individual welfare homes and schools.

Genetic origin of the relationship between parental negativity and behavior problems from early childhood to adolescence: A longitudinal genetically sensitive study.

Little is known about how genetic and environmental factors contribute to the association between parental negativity and behavior problems from early childhood to adolescence. The current study fitted a cross-lagged model in a sample consisting of 4,075 twin pairs to explore (a) the role of genetic and environmental factors in the relationship between parental negativity and behavior problems from age 4 to age 12, (b) whether parent-driven and child-driven processes independently explain the association, and (c) whether there are sex differences in this relationship. Both phenotypes showed substantial genetic influence at both ages. The concurrent overlap between them was mainly accounted for by genetic factors. Causal pathways representing stability of the phenotypes and parent-driven and child-driven effects significantly and independently account for the association. Significant but slight differences were found between males and females for parent-driven effects. These results were highly similar when general cognitive ability was added as a covariate. In summary, the longitudinal association between parental negativity and behavior problems seems to be bidirectional and mainly accounted for by genetic factors. Furthermore, child-driven effects were mainly genetically mediated, and parent-driven effects were a function of both genetic and shared-environmental factors.

Psychological well-being of the parents and child development, behavior, and quality of life in very low birth weight infants

The parents of premature infants, especially the mothers, are at increased risk for distress. Infants born prematurely are at risk for developmental problems. The aim of this study was to investigate whether the psychological well-being of both parents is associated with child development in very low birth weight (VLBW, ≤1500g) children. The burden of prematurity-related morbidity to the children and to the family was also assessed. A cohort of 201 VLBW infants born during 2001–2006 in the Turku University Hospital, Finland, and their parents were studied (I–IV). One study included a control group (n=166) of full-term infants (IV). The psychological well-being of the parents was evaluated by assessments of depressive symptoms, parenting stress, the sense of coherence and general family functioning. Cognitive, behavioral, and socio-emotional development, and the health-related quality of life (HRQoL) of the children were determined when the children were 2 to 8 years old. The psychological well-being of the parents was associated with the cognitive, behavioral and social development of the VLBW children. The VLBW infants with prematurity-related morbidities had a poorer HRQoL and the general functioning of the family was inferior compared to the control children and their families. 64.5% of the VLBW children survived without morbidities. Most of the VLBW children did not have significant behavior problems (93%), had normal social skills (63%), had no emotional problems (64%), and had no problems in executive functioning (62%). Only 3% of the surviving VLBW infants had significant cognitive delay. In conclusion, the depressive symptoms and stress of the parents can be risk factors for disadvantageous child development, while a strong sense of coherence can be protective. Parents of the premature children with developmental delays might also experience more depressive symptoms and stress than other parents. Prematurity-related morbidities were a burden to the VLBW child as well as to the family.

Correlates and outcomes of severe bullying: internalizing maladjustments of adolescent bullies, victims and bully- victims

The current study examined the association between involvement in bullying and victimization and internalizing difficulties such as self-esteem, social anxiety, depression and body image. Possible gender differences were also examined. The participants, high school students from Southern Ontario (N=533), were drawn from a larger, data set as part ofa study that was completed by the Youth Lifestyle Choices: Community Research Alliance (YLCCURA). The students completed a self-report questionnaire on a number ofmeasures; including, bullying, victimization, self-esteem, social anxiety, depression and body image. The results of this study suggest that those students who self-identified as victims and bully-victims also report higher levels of anxiety and depression than controls and bullies. Severe victims and bullyvictims had a lower body image than severe bullies and controls, whereas severe bullies seem to have a higher body image score than controls. These results are relevant when considering treatments and interventions for students experiencing adjustment difficulties who may also be at risk for bullying victimization. The results also suggest that particular attention needs to be focused on those adolescents who play multi-roles in bullying situations (i.e., bully-victims), since these students may come to the attention ofthe school system for externalizing behaviours, but may also need assistance for internalizing maladjustments.

The Family Game: A Parent Education Intervention to Increase Positive Parent-Child Interactions in Parents with Learning Difficulties

Children of parents with learning difficulties (LD) are at risk for a variety of developmental problems including behavioural and psychiatric disorders. However, there are no empirically supported programs to prevent behavioural and psychiatric problems in these children. The purpose of the study was to test the effectiveness of a parenting intervention designed to teach parents with learning difficulties positive child behaviour management strategies. A multiple baseline across skills design was used with two parents, who were taught three skills: 1) clear instructions, 2) recognition of compliance and 3) correction of noncompliance. Training scores improved on each skill and maintained at a 1-month follow-up. Scores on generalization cards were high and showed maintenance, but improvements in parenting skills in the naturalistic environment were low at posttest and follow-up. Increases were seen in child compliance at posttest and 1-month follow-up. Results of pre-post social validity measures were also generally positive.

Comportements parentaux et autorégulation chez l’enfant : une perspective développementale

Étant donné que le sommeil ainsi que les problèmes intériorisés et extériorisés durant l’enfance sont associés à plusieurs aspects du développement social, affectif et cognitif de l’enfant, il apparait essentiel d’étudier ces deux indicateurs de l’autorégulation chez les enfants ainsi que de comprendre les facteurs qui contribuent à leur émergence. L’objectif général de la thèse était donc de mieux comprendre les facteurs associés au développement de l’autorégulation psychophysiologique, telle que mesurée par la qualité du sommeil de l’enfant, ainsi que l’autorégulation émotionnelle et comportementale, telle qu’indiquée par la présence de symptômes intériorisés et extériorisés chez l’enfant. La thèse est composée de deux articles de nature empirique. L’objectif du premier article de la thèse était d’examiner les liens qui existent entre quatre comportements parentaux (i.e., la sensibilité maternelle, le soutien à l’autonomie maternel, l'orientation mentale de la mère et la qualité des interactions père-enfant) et le sommeil de l’enfant, de façon longitudinale et prospective. Les trois comportements maternels ont été mesurés avec 70 dyades mère-enfant, tandis que la qualité des interactions père-enfant a été évaluée chez 41 de ces familles. À 12 mois, l’orientation mentale maternelle et la sensibilité maternelle ont été évaluées. Le soutien à l'autonomie maternel a été mesuré à 15 mois, tandis que la qualité des interactions père-enfant a été évaluée à 18 mois. Le sommeil des enfants a été mesuré à 3 et 4 ans en utilisant un agenda de sommeil rempli par la mère. Les résultats indiquaient qu’en contrôlant pour le statut socioéconomique familial et le fait d’aller en garderie ou non, la qualité des interactions mère-enfant et père-enfant est liée à la proportion de sommeil ayant lieu la nuit chez les enfants d’âge préscolaire. Le deuxième article visait à étudier les effets d’interaction entre le sommeil de l’enfant et la sensibilité maternelle en ce qui a trait au développement des problèmes intériorisés et extériorisés. À 1 et 4 ans, 55 dyades mère-enfant ont participé à deux visites à domicile. À 1 an, la sensibilité maternelle a été évaluée et les mères ont complété l’agenda du sommeil de l’enfant. À 4 ans, les mères ont rempli le Child Behavior Checklist pour évaluer les symptômes intériorisés et extériorisés chez leur enfant. Les résultats ont montré que la sensibilité maternelle interagit avec la durée du sommeil de l’enfant. Ainsi, les résultats ont indiqué une relation négative entre la sensibilité maternelle et les problèmes intériorisés et extériorisés, mais seulement chez les enfants qui dorment plus la nuit. Les résultats présentés dans les deux articles ont été discutés, ainsi que leurs implications théoriques et cliniques.

La présence de symptômes émotionnels chez l’enfant placé et les liens avec son intégration familiale, sociale et scolaire

Exposés à de multiples facteurs de risque avant et pendant le placement, les enfants placés présentent une prévalence élevée de troubles intériorisés. Ces troubles peuvent entraver leur intégration familiale, sociale et scolaire. L’objectif de ce mémoire est de tracer un portrait des enfants placés présentant des troubles intériorisés afin de mieux les repérer pour ainsi mieux les soutenir, ainsi que les adultes qui en prennent soin. L’échantillon est composé de 62 enfants, âgés de 10 à 12 ans, placés en famille d’accueil régulière et impliqués dans le projet S’Occuper des Enfants (SOCEN). Les données analysées proviennent du Cahier d’évaluation et de suivi (CÉS-C2), outil clinique (avec mesures standardisées) dans lequel l’intervenant, le parent d’accueil et l’enfant inscrivent des informations sur différents aspects du développement de l’enfant. Des variables relatives au placement ainsi que d’autres portant sur l’intégration familiale, sociale et scolaire de l’enfant placé sont mises en relation avec les scores de la sous-échelle des symptômes émotionnels du Strengths and Difficulties Questionnaire à l’aide de corrélations de Pearson et d’ANOVA. Près de 19% des 62 enfants éprouvent des symptômes émotionnels élevés. Les résultats révèlent la forte présence de troubles extériorisés (troubles hyperactifs, troubles de la conduite) chez les enfants placés présentant des symptômes émotionnels élevés. Ces enfants éprouvent aussi plus de problèmes avec les pairs. Ceux qui ont vécu plus de trois placements présentent davantage de symptômes émotionnels élevés.

Children treated in psychoanalytical psychotherapy for learning problems

A clinical psychotherapy needs to turn its gaze to the current demands, and update its practice in empirical studies. The objective of this research is to ascertain the sociodemographic and clinical characteristics of children treated in psychotherapy by learning problems. We conducted a retrospective documentary study with records of 2106 children treated between 1979 and 2007 in two outpatient psychological care of the city of Porto Alegre, southern Brazil. The results showed that demand for Learning Problems is the fourth largest cause of psychotherapeutic care. There was no statistically significant difference regarding gender. Children with learning problems come to psychotherapy more frequently in the early stages of elementary school, around 7 years old. Increased demand for psychotherapy of children with learning problems takes place in May. Perhaps, learning difficulties can be understood simultaneously as a symptom global, in which other aspects, besides the uniqueness of the subject are involved. We conclude that individual and social aspects involved in Learning Problems may be useful in the clinical management of these children by professionals who are dedicated to meeting this particular clientele. One must be aware of ongoing partnership which should be placed between psychologist and pedagogue. Both professionals, education and health, account for components of the child to know