Jorma Piha | University of Turku (original) (raw)

Papers by Jorma Piha

Research paper thumbnail of Persistence of bullying from childhood to adolescence—a longitudinal 8-year follow-up study

Child Abuse & Neglect, 2000

Method: An 8-year longitudinal study included questions about bullying and victimization at age 8... more Method: An 8-year longitudinal study included questions about bullying and victimization at age 8 and 16. Children were evaluated with Rutter scales by parents and teachers and with the Child Depression Inventory filled in by the children at age 8. When the children were at ...

Research paper thumbnail of Short-term child psychiatric inpatient treatment. Place of residence as one-year outcome measure

European Child & Adolescent Psychiatry, 1996

In this study, 100 patients consecutively admitted to four child psychiatric inpatient wards in F... more In this study, 100 patients consecutively admitted to four child psychiatric inpatient wards in Finland were prospectively followed 12 months after discharge from short-term inpatient treatment. It turned out that 50 patients were discharged back to their previous residence and to outpatient treatment, 40 patients were admitted to long-term inpatient treatment and 10 patients were placed in some institution. The child's antisocial behaviour on admission was the strongest determinant for long-term treatment or placement at the 12 month follow-up. Other predictors of long-term treatment or placement in an institution included a high total score in teacher's behaviour ratings, being referred by a psychiatric agency and living in a semi-rural area. No statistically significant relationship was found in the child's age, gender, parents' education level or occupation, family characteristics, total life events, parent's ratings of total behaviour, total life events, parent's ratings of total behaviour, CGAS ratings by a clinician or a wide range of treatment variables.

Research paper thumbnail of Psychosocial factors and adequacy of services for children in children's homes

European Child & Adolescent Psychiatry, 1999

Risk and protective factors of psychosocial development in children in different residential care... more Risk and protective factors of psychosocial development in children in different residential care settings need to be further studied internationally, in order to develop working methods for social and health care services. Standardized methods of the CBCL, TRF, and CGAS, were used to evaluate psychosocial functioning of children in children's homes in Finland. Further, data on sociodemographic situations and traumatic events in their lives were assembled. The percentage of behavioural and emotional problems within clinical or borderline range in the different ratings was 55–80%. Combined traumatization, sexual abuse, school difficulties, male sex, older age (>11 years) and older age at first and on-going placement (>7 years), as well as difficulties in relationships with parents are likely to be associated with more severe behaviour problems and lower general functioning. The results of this study show that children and adolescents in social service residential settings are a highly vulnerable group and that these children have extensive mental health needs.

Research paper thumbnail of An early report on the mother–baby interactive capacity of substance-abusing mothers

Journal of Substance Abuse Treatment, 2001

Objective: Examination of maternal interactive behavior and psychosocial situation of substance-a... more Objective: Examination of maternal interactive behavior and psychosocial situation of substance-abusing mothers in treatment. Method: Twelve mothers with an alcohol or drug abuse problem and 12 control mothers were assessed in random order with the Parent–Child Early Relational Assessment, for the analysis of videotaped mother–infant interactions at 3 and 6 months' postpartum. Depressive symptoms were assessed with Edinburgh Postnatal Depression Scale and aspects of social support with two Social Support Questionnaires. Results: Substance-abusing mothers tended to have more problematic areas in their interactive behavior, a tendency which increased during the study period. As was expected, they were more often depressive, and experienced more social environment difficulties and less social support. Conclusions: Mothers with alcohol and drug abuse problems need intensive professional support in early motherhood, and are seen to be particularly motivated to strive for abstinence and accept help at this stage of life.

Research paper thumbnail of Childhood Predictors of Psychiatric Disorders Among Boys: A Prospective Community-Based Follow-up Study From Age 8 Years to Early Adulthood

Journal of The American Academy of Child and Adolescent Psychiatry, 2005

Research paper thumbnail of Validity of child psychiatric screening methods

European Child & Adolescent Psychiatry, 1998

The Parent Questionnaire (scale A2), the Teacher Questionnaire (scale B2) by Rutter, and the Chil... more The Parent Questionnaire (scale A2), the Teacher Questionnaire (scale B2) by Rutter, and the Children’s Depression Inventory (CDI) were validated using ROC-analysis. The material was collected from an epidemiological study of a normal population of 5664 8–9 year-old children. The screening results were compared with the corresponding parent, teacher, and child (DISC) interviews. In addition to this traditional way of validating the combined interview, results from all three interviews were also used. We found that the Teacher Questionnaire scale B2 was the most valid, and had the best overall power to discriminate psychiatric disturbances. The Teacher Questionnaire (scale B2) may be recommended when screening child psychiatric disturbances. The Parent Questionnaire (scale A2) was also found to be a valid instrument. Our results do not support the use of CDI as a sole screening instrument of psychiatric disturbances in children.

Research paper thumbnail of Children with Symptoms of Depression – What Do the Adults See

Journal of Child Psychology and Psychiatry, 1998

In order to find out whether parents and teachers report depressive symptoms in children with sel... more In order to find out whether parents and teachers report depressive symptoms in children with self-reported depression and which features are connected with sought psychiatric care, a sample of 5682 prepubertal children was assessed with the Children's Depression Inventory (CDI), the Rutter A2 scale (RA) and Rutter B2 scale (RB). In stepwise regression analysis of parent report, depressed mood, unpopularity, social withdrawal, disobedience, inattentiveness, and stealing were associated with high CDI scores. The items of the teacher report associated with high CDI scores included poor school performance, restlessness, somatic complaints, unresponsiveness, being bullied, and absenteeism from school. Although the parents and teachers readily saw and reported depressive symptoms in children, only for a small minority of children with multiple depressive symptoms had psychiatric care been sought or even considered. The symptoms associated with sought psychiatric care for depressed children were somatic (soiling, asthma) and behavioural (disobedient, restless). The results indicate that a large number of children with multiple depressive symptoms are left without necessary psychiatric assessment and help.

Research paper thumbnail of Emotional and behavioural symptoms in 8–9-year-old children in relation to family structure

European Child & Adolescent Psychiatry, 1999

The association between family structure and behavioural and emotional symptoms in prepubertal ch... more The association between family structure and behavioural and emotional symptoms in prepubertal children was studied in an epidemiological survey conducted in Finland. Five thousand eight hundred thirteen children aged 8 and 9 years were screened using the Rutter Parent Questionnaire (RA2) for parents and the Rutter Teacher Questionnaire (RB2) for teachers. Information concerning family type, birth order and sibship size were obtained from the parents. The majority of the children (84%) in the sample lived with both their biological parents, 10% with a single parent, and around 5% with a biological parent and a stepparent. Around 1% of the children lived outside their original home. The prevalence of behavioural and emotional symptoms was lowest in children living with both their biological parents and highest among children living outside their original home according to both parents’ and teachers’ reports. Children living with a parent and a stepparent had problems more often at home, but less often at school than children living with a single parent. Living with a single father was associated with having more externalising, school-related problems, while living with a stepfather was associated with having more internalising, home related problems. Having younger siblings seemed to be associated with fewer problems at school, and being the youngest child with having less problems both at home and at school.

Research paper thumbnail of Design and subjects of a Finnish epidemiological study on psychiatric disorders in childhood

European Child & Adolescent Psychiatry, 1999

In an epidemiological multi-centre study, parents filled in the Rutter Parent Questionnaire (RA2)... more In an epidemiological multi-centre study, parents filled in the Rutter Parent Questionnaire (RA2) and teachers filled in the Rutter Teacher Questionnaire (RB2) for almost 6000 children. The children filled in the Children’s Depression Inventory (CDI). The subjects well represented the entire population of 8–9-year-old children in Finland. The material and design of the study as well as the basic demographic characteristics are presented.

Research paper thumbnail of Three-year follow-up of child psychiatric inpatient treatment

European Child & Adolescent Psychiatry, 1998

Eighty child psychiatric inpatients with behavioral and emotional disorders were evaluated from ... more Eighty child psychiatric inpatients with behavioral and emotional disorders were evaluated from multiple perspectives on admission and at 5-month and 3-year follow-ups. A majority of the patients showed a significant improvement in functioning during the 3-year follow-up. About half of the patients were functioning within clinical range at 3-year follow-up on parental (CBCL) and/or teacher (TRF) ratings. A less favorable outcome was predicted by disruptive behavioral disorder, severity of initial dysfunction, high antisocial and hyperkinetic symptoms, adoptive household and postdischarge institutional placement. Pure anxiety or affective disorder was associated with favorable outcome. Age, sex, place of treatment, and length of hospital treatment were not related to outcome variables.

Research paper thumbnail of Have There Been Changes in Children's Psychiatric Symptoms and Mental Health Service Use? A 10Year Comparison From Finland

Journal of The American Academy of Child and Adolescent Psychiatry, 2004

To study the differences in children&... more To study the differences in children's psychiatric symptoms and child mental health service use at two time points: 1989 and 1999. Two cross-sectional representative samples of 8- to 9-year-old children from southern Finland were compared. The 1989 sample consisted of 985 children, of whom 95% participated, and the 1999 sample consisted of 962 children, of whom 86% participated. Information was gathered from parents and teachers using Rutter's questionnaires and other related determinants of service use and from children using the Child Depression Inventory. The sampling, procedure, and methods were similar at both time points. The overall rate of children's problems assessed by parents and teachers had not increased during the period 1989 to 1999. Boys had fewer psychiatric symptoms in 1999 than in 1989, whereas no clear change had occurred in girls' symptoms, except that, according to parents, girls in 1999 had more hyperactive symptoms. However, children themselves reported more depressive symptoms in the 1999 than in the 1989 sample. In 1989, 2.3% and in 1999, 5.3% of children had used child mental health services. The increase in service use among girls was fourfold. Parental evaluations of child psychopathology and teacher evaluations whether the child was psychologically healthy were the strongest determinants for referral at both time points. Parents preferred to seek help for their children's problems from teachers, school nurses, and school psychologists rather than from specialized child psychiatric services. There has been an increase in mental health service use especially among girls as well as a convergence of symptom levels by gender. It is important to develop child psychiatric services that are as close to the child's living environment as possible to further reduce the threshold for seeking help and to promote early detection and intervention.

Research paper thumbnail of Bullying and Psychiatric Symptoms Among Elementary School-Age Children

Child Abuse & Neglect, 1998

Research paper thumbnail of Child and adolescent mental health service use in Finland

Social Psychiatry and Psychiatric Epidemiology, 2001

Background: The study examines the associations of parent, teacher and self-report evaluations of... more Background: The study examines the associations of parent, teacher and self-report evaluations of child psychopathology, help-seeking variables and family factors with the use of child mental health services. Method: The study comprised an 8-year follow-up of the Epidemiological Child Psychiatry Study in Finland. Children were evaluated at age 8 with Rutter parent and teacher scales and with the Child Depression Inventory, and at age 16, with the Child Behavior Checklist and the Youth Self Report. Information was obtained from about 70 % of the follow-up sample (n=857). Results: About 7 % of the sample had been in contact with child mental health services during the follow-up. The most potent predictors at age 8 of later referral were total problem behaviours and antisocial problems in parental evaluation, teacher's evaluation of the child's need for referral and living in other than a biological two-parent family. At age 16, externalizing and internalizing problems, total competence and family composition were independently associated with service use. Conclusions: Both child psychopathology and family disruption were associated with service use. Only a minority of children at risk of psychiatric disorders had used child mental health services.

Research paper thumbnail of Factors associated with depressive symptoms among 18-year-old boys: a prospective 10-year follow-up study

Journal of Affective Disorders, 2004

Research paper thumbnail of Antenatal depression, substance dependency and social support

Journal of Affective Disorders, 2001

The purpose of this study was to explore the prevalence of depression and factors associated with... more The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women. 391 women who were 14-37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2). 7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression. The caseness was defined with a self-report instrument. Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.

Research paper thumbnail of Psychiatric Symptoms in Preadolescents With Musculoskeletal Pain and Fibromyalgia

Pediatrics, 1997

To study the association of musculoskeletal pain with emotional and behavioral problems, especial... more To study the association of musculoskeletal pain with emotional and behavioral problems, especially depressive symptoms in Finnish preadolescents. A structured pain questionnaire was completed by 1756 third- and fifth-grade schoolchildren for identifying children with widespread pain (WSP), children with neck pain (NP), and pain-free controls for the comparative study. There were 124 children with WSP (mean age, 10.7 years), 108 children with NP (mean age, 11.1 years), and 131 controls (mean age, 10.7 years) who completed the Children's Depression Inventory (CDI) and a sleep questionnaire. A blinded clinical examination was done to detect fibromyalgia. For parental evaluation, the Child Behavior Checklist and a sociodemographic questionnaire were used. For teacher evaluation the Teacher Report Form was used. Children with WSP had significantly higher total emotional and behavioral scores than controls, according to child and parent evaluation. A significant difference in the mean total CDI scores was also found between the WSP and NP groups. Children with fibromyalgia had significantly higher CDI scores than the other children with WSP. Musculoskeletal pain, especially fibromyalgia, and depressive symptoms had high comorbidity. Pain and depressive symptoms should be recognized to prevent a chronic pain problem.

Research paper thumbnail of Psychiatric disturbances among prepubertal children in Southern Finland

Social Psychiatry and Psychiatric Epidemiology, 1998

The prevalence of psychiatric disorders among prepubertal children in Southern Finland was studie... more The prevalence of psychiatric disorders among prepubertal children in Southern Finland was studied in a two-stage epidemiological survey. In the first stage of the study 3397 children aged 8 or 9 were screened with the Rutter A2 scale for parents, Rutter B2 scale for teachers and Children's Depression Inventory (CDI). In the second stage a random sample of the children screened was drawn for more detailed assessment. Altogether 279 children were interviewed with the Finnish version of the Diagnostic Interview Schedule for Children (DISC), and their parents with the Isle of Wight Interview Schedule. In the parental interview the prevalence of psychiatric disturbance among children was 15.1%. The rate was higher for boys (23.7%) than for girls (5.3%). The prevalence of psychiatric disturbance verified with the child interview was 14.9%. The prevalence of psychiatric disturbance in boys based on the child interview was 20.5%. For girls the prevalence of psychiatric disturbance based on the child interview was 8.7%. The spectrum of psychiatric disturbance differed in the two interviews. Attention deficit disorder, depression and conduct disorder were the most common diagnoses in the parent interview, while anxiety disorder and depression were most common according to the child interview. In only 24% of the cases both the parent and child interview gave the same diagnosis.

Research paper thumbnail of Who Is at Greatest Risk of Adverse Long-Term Outcomes? The Finnish From a Boy to a Man Study

Journal of The American Academy of Child and Adolescent Psychiatry, 2007

To study associations between comorbid psychopathology and long-term outcomes in a large birth co... more To study associations between comorbid psychopathology and long-term outcomes in a large birth cohort sample from age 8 to early adulthood.The sample included long-term outcome data on 2,556 Finnish boys born in 1981. The aim was to study the impact of early childhood psychopathology types (externalizing versus internalizing versus both) and informant sources (self-report versus parent/teacher reports) on young adult outcomes, based on data from a military registry of psychiatric diagnosis, a police registry on criminal and drug offenses, and self-reported problems in late adolescence and early adulthood.Children with combined conduct and internalizing problems at age 8 had the worst outcomes and highest risk of subsequent psychiatric disorders, criminal offenses, and self-reported problems at follow-up, with 62% of these boys manifesting psychiatric disorders, committing criminal offenses, or both at follow-up. Although these children included only 4% of the sample, they were responsible for 26% of all criminal offenses at follow-up. In contrast, children with conduct problems without internalizing problems and those with attention problems had much less severe but nonetheless elevated levels of risk of antisocial personality disorder and criminal offenses. Long-term outcomes for these two groups were substantially better than for children with combined conduct and internalizing problems. Children with “pure” emotional problems had an elevated risk only of similar emotional problems at follow-up.The subjective suffering and long-term burden to society is especially high among children with comorbid conduct and internalizing problems in childhood. A major challenge for child and adolescent psychiatric, education, and social services is to develop effective intervention strategies focusing on these children. Additional longitudinal epidemiological studies of this comorbidity group are needed, and, if replicated, such findings will have important implications for future diagnostic classification systems (DSM-V).

Research paper thumbnail of Childhood Bullying Behaviors as a Risk for Suicide Attempts and Completed Suicides: A Population-Based Birth Cohort Study

Journal of The American Academy of Child and Adolescent Psychiatry, 2009

Research paper thumbnail of Childhood Predictors of Male Criminality: A Prospective Population-Based Follow-up Study From Age 8 to Late Adolescence

Journal of The American Academy of Child and Adolescent Psychiatry, 2006

To study childhood predictors for late adolescence criminality. The follow-up sample included 2,7... more To study childhood predictors for late adolescence criminality. The follow-up sample included 2,713 Finnish boys born in 1981. Information about the 8-year-old boy' problem behavior was obtained from parents, teachers, and the children themselves. The follow-up information about criminal offenses was based on the national police register between the years 1998 and 2001 when the subjects were 16 to 20 years old. According to the national police register, 22.2% of boys had at least one criminal offense other than a minor traffic violation during the 4-year study period. Living in nonintact family, low parental education level, parent reports of conduct problems, and teacher reports of hyperkinetic problems when the child was 8 independently predicted a high level (more than five) of offenses. Living in nonintact family at age 8 predicted all types of criminal offenses. Low parental education level and parent or teacher reports of conduct problems independently predicted violence, property, traffic, and drunk driving offenses. Teacher reports of hyperkinetic problems independently predicted all types of criminal offenses except drunk driving. Self-reports of bullying others independently predicted violent offenses. Living in a broken home, low parental education level, conduct problems, and hyperactivity in middle childhood predict criminal offenses in late adolescence. Efforts to prevent later criminality already in childhood are emphasized.

Research paper thumbnail of Persistence of bullying from childhood to adolescence—a longitudinal 8-year follow-up study

Child Abuse & Neglect, 2000

Method: An 8-year longitudinal study included questions about bullying and victimization at age 8... more Method: An 8-year longitudinal study included questions about bullying and victimization at age 8 and 16. Children were evaluated with Rutter scales by parents and teachers and with the Child Depression Inventory filled in by the children at age 8. When the children were at ...

Research paper thumbnail of Short-term child psychiatric inpatient treatment. Place of residence as one-year outcome measure

European Child & Adolescent Psychiatry, 1996

In this study, 100 patients consecutively admitted to four child psychiatric inpatient wards in F... more In this study, 100 patients consecutively admitted to four child psychiatric inpatient wards in Finland were prospectively followed 12 months after discharge from short-term inpatient treatment. It turned out that 50 patients were discharged back to their previous residence and to outpatient treatment, 40 patients were admitted to long-term inpatient treatment and 10 patients were placed in some institution. The child's antisocial behaviour on admission was the strongest determinant for long-term treatment or placement at the 12 month follow-up. Other predictors of long-term treatment or placement in an institution included a high total score in teacher's behaviour ratings, being referred by a psychiatric agency and living in a semi-rural area. No statistically significant relationship was found in the child's age, gender, parents' education level or occupation, family characteristics, total life events, parent's ratings of total behaviour, total life events, parent's ratings of total behaviour, CGAS ratings by a clinician or a wide range of treatment variables.

Research paper thumbnail of Psychosocial factors and adequacy of services for children in children's homes

European Child & Adolescent Psychiatry, 1999

Risk and protective factors of psychosocial development in children in different residential care... more Risk and protective factors of psychosocial development in children in different residential care settings need to be further studied internationally, in order to develop working methods for social and health care services. Standardized methods of the CBCL, TRF, and CGAS, were used to evaluate psychosocial functioning of children in children's homes in Finland. Further, data on sociodemographic situations and traumatic events in their lives were assembled. The percentage of behavioural and emotional problems within clinical or borderline range in the different ratings was 55–80%. Combined traumatization, sexual abuse, school difficulties, male sex, older age (>11 years) and older age at first and on-going placement (>7 years), as well as difficulties in relationships with parents are likely to be associated with more severe behaviour problems and lower general functioning. The results of this study show that children and adolescents in social service residential settings are a highly vulnerable group and that these children have extensive mental health needs.

Research paper thumbnail of An early report on the mother–baby interactive capacity of substance-abusing mothers

Journal of Substance Abuse Treatment, 2001

Objective: Examination of maternal interactive behavior and psychosocial situation of substance-a... more Objective: Examination of maternal interactive behavior and psychosocial situation of substance-abusing mothers in treatment. Method: Twelve mothers with an alcohol or drug abuse problem and 12 control mothers were assessed in random order with the Parent–Child Early Relational Assessment, for the analysis of videotaped mother–infant interactions at 3 and 6 months' postpartum. Depressive symptoms were assessed with Edinburgh Postnatal Depression Scale and aspects of social support with two Social Support Questionnaires. Results: Substance-abusing mothers tended to have more problematic areas in their interactive behavior, a tendency which increased during the study period. As was expected, they were more often depressive, and experienced more social environment difficulties and less social support. Conclusions: Mothers with alcohol and drug abuse problems need intensive professional support in early motherhood, and are seen to be particularly motivated to strive for abstinence and accept help at this stage of life.

Research paper thumbnail of Childhood Predictors of Psychiatric Disorders Among Boys: A Prospective Community-Based Follow-up Study From Age 8 Years to Early Adulthood

Journal of The American Academy of Child and Adolescent Psychiatry, 2005

Research paper thumbnail of Validity of child psychiatric screening methods

European Child & Adolescent Psychiatry, 1998

The Parent Questionnaire (scale A2), the Teacher Questionnaire (scale B2) by Rutter, and the Chil... more The Parent Questionnaire (scale A2), the Teacher Questionnaire (scale B2) by Rutter, and the Children’s Depression Inventory (CDI) were validated using ROC-analysis. The material was collected from an epidemiological study of a normal population of 5664 8–9 year-old children. The screening results were compared with the corresponding parent, teacher, and child (DISC) interviews. In addition to this traditional way of validating the combined interview, results from all three interviews were also used. We found that the Teacher Questionnaire scale B2 was the most valid, and had the best overall power to discriminate psychiatric disturbances. The Teacher Questionnaire (scale B2) may be recommended when screening child psychiatric disturbances. The Parent Questionnaire (scale A2) was also found to be a valid instrument. Our results do not support the use of CDI as a sole screening instrument of psychiatric disturbances in children.

Research paper thumbnail of Children with Symptoms of Depression – What Do the Adults See

Journal of Child Psychology and Psychiatry, 1998

In order to find out whether parents and teachers report depressive symptoms in children with sel... more In order to find out whether parents and teachers report depressive symptoms in children with self-reported depression and which features are connected with sought psychiatric care, a sample of 5682 prepubertal children was assessed with the Children's Depression Inventory (CDI), the Rutter A2 scale (RA) and Rutter B2 scale (RB). In stepwise regression analysis of parent report, depressed mood, unpopularity, social withdrawal, disobedience, inattentiveness, and stealing were associated with high CDI scores. The items of the teacher report associated with high CDI scores included poor school performance, restlessness, somatic complaints, unresponsiveness, being bullied, and absenteeism from school. Although the parents and teachers readily saw and reported depressive symptoms in children, only for a small minority of children with multiple depressive symptoms had psychiatric care been sought or even considered. The symptoms associated with sought psychiatric care for depressed children were somatic (soiling, asthma) and behavioural (disobedient, restless). The results indicate that a large number of children with multiple depressive symptoms are left without necessary psychiatric assessment and help.

Research paper thumbnail of Emotional and behavioural symptoms in 8–9-year-old children in relation to family structure

European Child & Adolescent Psychiatry, 1999

The association between family structure and behavioural and emotional symptoms in prepubertal ch... more The association between family structure and behavioural and emotional symptoms in prepubertal children was studied in an epidemiological survey conducted in Finland. Five thousand eight hundred thirteen children aged 8 and 9 years were screened using the Rutter Parent Questionnaire (RA2) for parents and the Rutter Teacher Questionnaire (RB2) for teachers. Information concerning family type, birth order and sibship size were obtained from the parents. The majority of the children (84%) in the sample lived with both their biological parents, 10% with a single parent, and around 5% with a biological parent and a stepparent. Around 1% of the children lived outside their original home. The prevalence of behavioural and emotional symptoms was lowest in children living with both their biological parents and highest among children living outside their original home according to both parents’ and teachers’ reports. Children living with a parent and a stepparent had problems more often at home, but less often at school than children living with a single parent. Living with a single father was associated with having more externalising, school-related problems, while living with a stepfather was associated with having more internalising, home related problems. Having younger siblings seemed to be associated with fewer problems at school, and being the youngest child with having less problems both at home and at school.

Research paper thumbnail of Design and subjects of a Finnish epidemiological study on psychiatric disorders in childhood

European Child & Adolescent Psychiatry, 1999

In an epidemiological multi-centre study, parents filled in the Rutter Parent Questionnaire (RA2)... more In an epidemiological multi-centre study, parents filled in the Rutter Parent Questionnaire (RA2) and teachers filled in the Rutter Teacher Questionnaire (RB2) for almost 6000 children. The children filled in the Children’s Depression Inventory (CDI). The subjects well represented the entire population of 8–9-year-old children in Finland. The material and design of the study as well as the basic demographic characteristics are presented.

Research paper thumbnail of Three-year follow-up of child psychiatric inpatient treatment

European Child & Adolescent Psychiatry, 1998

Eighty child psychiatric inpatients with behavioral and emotional disorders were evaluated from ... more Eighty child psychiatric inpatients with behavioral and emotional disorders were evaluated from multiple perspectives on admission and at 5-month and 3-year follow-ups. A majority of the patients showed a significant improvement in functioning during the 3-year follow-up. About half of the patients were functioning within clinical range at 3-year follow-up on parental (CBCL) and/or teacher (TRF) ratings. A less favorable outcome was predicted by disruptive behavioral disorder, severity of initial dysfunction, high antisocial and hyperkinetic symptoms, adoptive household and postdischarge institutional placement. Pure anxiety or affective disorder was associated with favorable outcome. Age, sex, place of treatment, and length of hospital treatment were not related to outcome variables.

Research paper thumbnail of Have There Been Changes in Children's Psychiatric Symptoms and Mental Health Service Use? A 10Year Comparison From Finland

Journal of The American Academy of Child and Adolescent Psychiatry, 2004

To study the differences in children&... more To study the differences in children's psychiatric symptoms and child mental health service use at two time points: 1989 and 1999. Two cross-sectional representative samples of 8- to 9-year-old children from southern Finland were compared. The 1989 sample consisted of 985 children, of whom 95% participated, and the 1999 sample consisted of 962 children, of whom 86% participated. Information was gathered from parents and teachers using Rutter's questionnaires and other related determinants of service use and from children using the Child Depression Inventory. The sampling, procedure, and methods were similar at both time points. The overall rate of children's problems assessed by parents and teachers had not increased during the period 1989 to 1999. Boys had fewer psychiatric symptoms in 1999 than in 1989, whereas no clear change had occurred in girls' symptoms, except that, according to parents, girls in 1999 had more hyperactive symptoms. However, children themselves reported more depressive symptoms in the 1999 than in the 1989 sample. In 1989, 2.3% and in 1999, 5.3% of children had used child mental health services. The increase in service use among girls was fourfold. Parental evaluations of child psychopathology and teacher evaluations whether the child was psychologically healthy were the strongest determinants for referral at both time points. Parents preferred to seek help for their children's problems from teachers, school nurses, and school psychologists rather than from specialized child psychiatric services. There has been an increase in mental health service use especially among girls as well as a convergence of symptom levels by gender. It is important to develop child psychiatric services that are as close to the child's living environment as possible to further reduce the threshold for seeking help and to promote early detection and intervention.

Research paper thumbnail of Bullying and Psychiatric Symptoms Among Elementary School-Age Children

Child Abuse & Neglect, 1998

Research paper thumbnail of Child and adolescent mental health service use in Finland

Social Psychiatry and Psychiatric Epidemiology, 2001

Background: The study examines the associations of parent, teacher and self-report evaluations of... more Background: The study examines the associations of parent, teacher and self-report evaluations of child psychopathology, help-seeking variables and family factors with the use of child mental health services. Method: The study comprised an 8-year follow-up of the Epidemiological Child Psychiatry Study in Finland. Children were evaluated at age 8 with Rutter parent and teacher scales and with the Child Depression Inventory, and at age 16, with the Child Behavior Checklist and the Youth Self Report. Information was obtained from about 70 % of the follow-up sample (n=857). Results: About 7 % of the sample had been in contact with child mental health services during the follow-up. The most potent predictors at age 8 of later referral were total problem behaviours and antisocial problems in parental evaluation, teacher's evaluation of the child's need for referral and living in other than a biological two-parent family. At age 16, externalizing and internalizing problems, total competence and family composition were independently associated with service use. Conclusions: Both child psychopathology and family disruption were associated with service use. Only a minority of children at risk of psychiatric disorders had used child mental health services.

Research paper thumbnail of Factors associated with depressive symptoms among 18-year-old boys: a prospective 10-year follow-up study

Journal of Affective Disorders, 2004

Research paper thumbnail of Antenatal depression, substance dependency and social support

Journal of Affective Disorders, 2001

The purpose of this study was to explore the prevalence of depression and factors associated with... more The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women. 391 women who were 14-37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2). 7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression. The caseness was defined with a self-report instrument. Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.

Research paper thumbnail of Psychiatric Symptoms in Preadolescents With Musculoskeletal Pain and Fibromyalgia

Pediatrics, 1997

To study the association of musculoskeletal pain with emotional and behavioral problems, especial... more To study the association of musculoskeletal pain with emotional and behavioral problems, especially depressive symptoms in Finnish preadolescents. A structured pain questionnaire was completed by 1756 third- and fifth-grade schoolchildren for identifying children with widespread pain (WSP), children with neck pain (NP), and pain-free controls for the comparative study. There were 124 children with WSP (mean age, 10.7 years), 108 children with NP (mean age, 11.1 years), and 131 controls (mean age, 10.7 years) who completed the Children's Depression Inventory (CDI) and a sleep questionnaire. A blinded clinical examination was done to detect fibromyalgia. For parental evaluation, the Child Behavior Checklist and a sociodemographic questionnaire were used. For teacher evaluation the Teacher Report Form was used. Children with WSP had significantly higher total emotional and behavioral scores than controls, according to child and parent evaluation. A significant difference in the mean total CDI scores was also found between the WSP and NP groups. Children with fibromyalgia had significantly higher CDI scores than the other children with WSP. Musculoskeletal pain, especially fibromyalgia, and depressive symptoms had high comorbidity. Pain and depressive symptoms should be recognized to prevent a chronic pain problem.

Research paper thumbnail of Psychiatric disturbances among prepubertal children in Southern Finland

Social Psychiatry and Psychiatric Epidemiology, 1998

The prevalence of psychiatric disorders among prepubertal children in Southern Finland was studie... more The prevalence of psychiatric disorders among prepubertal children in Southern Finland was studied in a two-stage epidemiological survey. In the first stage of the study 3397 children aged 8 or 9 were screened with the Rutter A2 scale for parents, Rutter B2 scale for teachers and Children's Depression Inventory (CDI). In the second stage a random sample of the children screened was drawn for more detailed assessment. Altogether 279 children were interviewed with the Finnish version of the Diagnostic Interview Schedule for Children (DISC), and their parents with the Isle of Wight Interview Schedule. In the parental interview the prevalence of psychiatric disturbance among children was 15.1%. The rate was higher for boys (23.7%) than for girls (5.3%). The prevalence of psychiatric disturbance verified with the child interview was 14.9%. The prevalence of psychiatric disturbance in boys based on the child interview was 20.5%. For girls the prevalence of psychiatric disturbance based on the child interview was 8.7%. The spectrum of psychiatric disturbance differed in the two interviews. Attention deficit disorder, depression and conduct disorder were the most common diagnoses in the parent interview, while anxiety disorder and depression were most common according to the child interview. In only 24% of the cases both the parent and child interview gave the same diagnosis.

Research paper thumbnail of Who Is at Greatest Risk of Adverse Long-Term Outcomes? The Finnish From a Boy to a Man Study

Journal of The American Academy of Child and Adolescent Psychiatry, 2007

To study associations between comorbid psychopathology and long-term outcomes in a large birth co... more To study associations between comorbid psychopathology and long-term outcomes in a large birth cohort sample from age 8 to early adulthood.The sample included long-term outcome data on 2,556 Finnish boys born in 1981. The aim was to study the impact of early childhood psychopathology types (externalizing versus internalizing versus both) and informant sources (self-report versus parent/teacher reports) on young adult outcomes, based on data from a military registry of psychiatric diagnosis, a police registry on criminal and drug offenses, and self-reported problems in late adolescence and early adulthood.Children with combined conduct and internalizing problems at age 8 had the worst outcomes and highest risk of subsequent psychiatric disorders, criminal offenses, and self-reported problems at follow-up, with 62% of these boys manifesting psychiatric disorders, committing criminal offenses, or both at follow-up. Although these children included only 4% of the sample, they were responsible for 26% of all criminal offenses at follow-up. In contrast, children with conduct problems without internalizing problems and those with attention problems had much less severe but nonetheless elevated levels of risk of antisocial personality disorder and criminal offenses. Long-term outcomes for these two groups were substantially better than for children with combined conduct and internalizing problems. Children with “pure” emotional problems had an elevated risk only of similar emotional problems at follow-up.The subjective suffering and long-term burden to society is especially high among children with comorbid conduct and internalizing problems in childhood. A major challenge for child and adolescent psychiatric, education, and social services is to develop effective intervention strategies focusing on these children. Additional longitudinal epidemiological studies of this comorbidity group are needed, and, if replicated, such findings will have important implications for future diagnostic classification systems (DSM-V).

Research paper thumbnail of Childhood Bullying Behaviors as a Risk for Suicide Attempts and Completed Suicides: A Population-Based Birth Cohort Study

Journal of The American Academy of Child and Adolescent Psychiatry, 2009

Research paper thumbnail of Childhood Predictors of Male Criminality: A Prospective Population-Based Follow-up Study From Age 8 to Late Adolescence

Journal of The American Academy of Child and Adolescent Psychiatry, 2006

To study childhood predictors for late adolescence criminality. The follow-up sample included 2,7... more To study childhood predictors for late adolescence criminality. The follow-up sample included 2,713 Finnish boys born in 1981. Information about the 8-year-old boy' problem behavior was obtained from parents, teachers, and the children themselves. The follow-up information about criminal offenses was based on the national police register between the years 1998 and 2001 when the subjects were 16 to 20 years old. According to the national police register, 22.2% of boys had at least one criminal offense other than a minor traffic violation during the 4-year study period. Living in nonintact family, low parental education level, parent reports of conduct problems, and teacher reports of hyperkinetic problems when the child was 8 independently predicted a high level (more than five) of offenses. Living in nonintact family at age 8 predicted all types of criminal offenses. Low parental education level and parent or teacher reports of conduct problems independently predicted violence, property, traffic, and drunk driving offenses. Teacher reports of hyperkinetic problems independently predicted all types of criminal offenses except drunk driving. Self-reports of bullying others independently predicted violent offenses. Living in a broken home, low parental education level, conduct problems, and hyperactivity in middle childhood predict criminal offenses in late adolescence. Efforts to prevent later criminality already in childhood are emphasized.