| 1. |
- Birkeland, Anna-Lena, 1955-
(författare)
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Psychosocial aspects of living with congenital heart disease : child, family, and professional perspectives
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The vast majority of infants born with congenital heart disease (CHD) reach adulthood because of the developments in cardiology in recent decades. This thesis aims to describe the psychosocial situation of child/adolescent cardiac patients and their families, investigate the situation faced by parents and siblings initially and over time, investigate the approaches paediatric cardiologists use in encountering the family, and describe the teamwork occurring in paediatric cardiology teams (PCTs) in Sweden.Theoretical framework: The theoretical framework was based on a quality of life model applied to children, a stress-coping model, and a psychosocial approach including support, profession, and teamwork.Methods: The research combines quantitative data collection/analysis and qualitative research interviews/content analysis.Results: Complexity: The three grades of medical complexity differed regarding the number and severity of psychosocial symptoms, the children with the most complex CHD having the most severe symptoms. The most frequent symptoms in the whole patient group regarding various spheres were: healthcare and treatment-related needs in the external sphere, family symptoms in the interpersonal sphere, and mental/psychosomatic symptoms in the personal sphere.Coping: Being informed of a child’s/sibling’s heart disease has emotional consequences, so information, communication, and support are essential. Breaking the news of a child’s disease can be described as a turning point still significant after ten years. The professionalism of the doctor’s approach in breaking the news is crucial.Profession: Among paediatric cardiologists, how to break bad news to a family is an important concern, evident in findings regarding the significance of trust and confidence and the use of various emotional positions. Paediatric cardiologists commonly wish to be skilled at handling this situation, and attaining the needed skills calls for reflection, education, and sharing experience.Team: PCTs in Sweden aim and try to work in a structured way. In PCTs, there is a need for leadership, resource coordination, coaching, and a forum for joint reflection. Dependence on the physician on the team was identified in all PCTs. The challenge of managing increasing complexity at both the family and system levels requires interprofessional teams.Conclusions: These studies illustrate the psychosocial complexity and the need of psychosocial support. Emotional consequences, communication, information and support are essential both for the children, parents/families and for the professionals. To manage this complexity organizational alteration action plans are required. There is a need for a forum to stimulate dialogue and common reflection in the local PCT and at the regional and national centres.
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| 2. |
- Desta, Menelik, 1955-
(författare)
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Epidemiology of child psychiatric disorders in Addis Ababa, Ethiopia
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Although mental disorders are common among children all over the world, information on the extent and types of child psychiatric disorders in Ethiopia is extremely limited. A study was conducted in an urban setting of Ethiopia to look at the prevalence of child psychiatric disorders and their correlates. A two-phase survey was performed. In the first phase, parents of 5000 children in Addis Ababa, the capital city of Ethiopia, were interviewed using the Reporting Questionnaire for Children (RQC). In the second phase, parents of all screen-positive children (n=864) and parents of 1537 screen-negative children were interviewed using the revised parent version of the Diagnostic Interview for Children and Adolescents (DICA-R), a semi-structured diagnostic instrument that is based on the third revised edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III-R). This thesis discusses the results of that study in comparison with other child mental health studies in Ethiopia and elsewhere. At the recommended cut-off score of 1, the sensitivity, specificity, predictive values and likelihood ratios of the RQC to DICA-R diagnoses were acceptable. The RQC had high accuracy with a misclassification rate of 17%. The weighted prevalence for any DSM-III-R diagnosis was 17%. The most prevalent condition was enuresis (12.1%) followed by simple phobia (5.5%). The prevalence rates of all other identified conditions were below 1%. Children's age, severe economic problems, and single parenthood were found to be risk factors for any DSM-III-R diagnosis in children. Male sex, younger age, and lower achieved educational grade of the child were all independently associated with childhood enuresis. The odds of having enuresis were significantly higher for children in families with extreme poverty and in children from single-parent homes. The risk of having enuresis was significantly higher in children who had anxiety disorders (AD) and disruptive behaviour disorders (DBD). Sex was significantly associated with disruptive behaviour disorders while grade level, age, family size, ethnicity, poverty, and single parenthood were not. Anxiety disorders were significantly associated with sex, ethnicity, and extreme poverty but not with the other socio-demographic variables. The absence of mood disorders and somatoform disorders, of which symptoms are often encountered in both children and adults at clinical settings and the low prevalence rates of most identified conditions, were probably related to the lack of awareness or alternative explanations at the community level regarding the understanding of behaviour changes. Campaigns of public mental health education with the aim of providing scientific information to society are highly recommended. While Ethiopia works towards mainstreaming mental health into its health care system, training health care workers in applying simple screening tools like the RQC is recommended.
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| 3. |
- Fekadu Wolde-Giorgis, Daniel, 1965-
(författare)
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Child labour in Addis Ketema, Ethiopia : a study in mental health
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Child labour is a very common global problem. There are an estimated over 250 million in the world, and about 7.5 million child labourers in Ethiopia. Most of the studies available to date focus on the social, political, and economical issues, but very little on mental health or psychosocial problems of child labourers. There is no study describing the epidemiology of psychiatric disorders among this group of children. Aims: 1. to assess the level of awareness and attitude of an urban community on child labour. 2. to describe the patterns of child labour and the experiences of child labourers in the informal sector with emphasis to child domestic labour. 3. to determine the risk factors contributing to child abuse and psychiatric disorders in child labourers. Method: An initial qualitative survey, using key informants in a Rapid Assessment Procedure, was conducted in a central urban area of Addis Ababa, to determine the knowledge, attitude, and intervention priorities of the people on child labour. A cross-sectional quantitative study informed by this initial survey was conducted in a sampled population of 5-15 year old child labourers and non-economically active controls. Information about possible risk factors, socio-demography and child abuse were gathered using a questionnaire different from that used for mental health assessment. An Amharic translation of the Diagnostic Interview for Children and Adolescents (DICA) was used to collect data for symptoms of mental disorders and diagnosis was made according to the American Psychiatric Association (APA) Diagnostic and Statistical Manual, 3rd edition (DSM-III-R) criteria. Data analysis was done using Statistical Package for Social Sciences (SPSS) software. Results: Domestic labour, working in the streets, and in private enterprises were the three main types of child labour identified. These types of child labour were identified by 82% (n=158) key informants, who thought child labour was a social problem, mainly resulting from poverty, and associated with abuse. In the quantitative study (5-15 year old sample) 528 child labourers and 472 non-labourers were included in the study. Of the child labourers, 34% were engaged in domestic labour, 57% working in the streets, and 9% in private enterprises. Over half of the child labourers worked for more than 9 hours daily. The prevalence of child abuse was 43.9% and 17.2% among child labourers and controls, respectively (OR=3.7, 95% CI: 2.74, 5.09; p<0.001). Emotional abuse was the commonly encountered abuse compared to other types (OR=3.06, 95% CI: 2.23-4.20; p< 0.001). Child domestics and street labourers were the most vulnerable group. The prevalence of any DSM-III-R psychiatric disorder was 20.1% and 12.5% among child labourers and controls, respectively and the difference was statistically significant (OR=1.89, 95% CI: 1.34-2.67, p<0.01). Controlling for all socio-demographic factors, child labour status was the only significant factor in determining DSM-III-R diagnosis. Discussion: In a comparable group of child labourers and controls, child labourers were found to be a high-risk group for different types of abuse and psychiatric disorders. Although parental unemployment and low maternal education were associated with child labour, the only factor that was associated with psychiatric morbidity was being a child labourer. It seems that poverty is not the only reason for child labour; hence its mere alleviation alone is unlikely to dramatically improve the risk for child labour and mental health of the children. There are many motivating reasons to be a child labourer, and likewise various positive and negative maintaining factors. Therefore, not all child labourers are prepared to stop their paid job altogether in order to become a full time student. Recommendation: Education of all children and parents is a keystone to prevent child labour and the associated consequences. In enforcing legislations on child labour, the government, non-governmental organisation (NGO), and the public should view child labour as a menace in children’s development, with risk of psychiatric disorders. Policy design should accommodate the interests of children. It is recommended to do a cohort and a larger size study, in order to further examine the association of various risk factors, and psychiatric disorders in a comparative and similar vulnerable group of children.
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| 4. |
- Goldin, Stephen, 1948-
(författare)
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Living in the present with the past : mental health of Bosnian refugee children in Sweden
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The negative impact of war on child mental health has been repeatedly documented. Still, the majority of children exposed to ethnic and political violence show no signs of clinical disorder. In Western countries of exile, these findings have prompted a variety of attempts to evaluate refugee children, in the hope of identifying and offering support to those children “at risk”. This study critically examines one such attempt. The aims are fourfold: 1. to describe the range and pattern of child trauma-stress exposure and mental health reactions as captured on clinician semi-structured interview; 2. to critically compare clinician assessment with independent parent, child and teacher reports; 3. to identify factors of potential risk or protective import for child mental health; 4. to draw clinical implications: from whom and by what means can children at risk be reasonably identified? The target of our study was the entire population of Bosnian-Serbian-Croatian speaking child refugee families assigned to Umeå and surrounding municipalities during 1994-95. Fifty families, containing 90 children aged one month to 20 years, were included in the study. Assessment occurred in two phases. First, a semi-structured interview was conducted that inquired broadly as to the child’s family background, trauma-stress exposure, emotional-behavioral problems, patterns of family functioning, and future hopes. Second, standardized self-report questionnaires were administered, separately to parent and child, to provide alternative appraisal of the child’s war exposure, mental health symptoms, coping strategies, and social network. Teacher evaluation of child cognitive-social functioning as well as emotional-behavioral problems was also obtained. Clinician semi-structured interview revealed the child’s pre-war period as preponderantly good, and provided richly detailed narratives of child exposure during war and resettlement that clustered into a limited number of type-stories. Independent parent assessment captured the same broad strokes of child war exposure; but both approaches – fixed questionnaire and semi-structured interview – showed specific areas of blindness. Teenage self-report offered a disparate but equally rich account of war exposure, while that of primary school child was significantly less detailed. Nearly half of the study children (48%) were identified on clinician interview with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%), followed by posttraumatic reactions (23%) and anxiety-regressiveness (15%). Independent symptom appraisal by parent and primary school child was largely concordant with that of clinician, while teenagers made similar assessment as to who was in distress, but defined the nature of that distress differently. Teacher report stood apart, identifying fewer inward emotional problems and asserting the cognitive-social competence of the vast majority of study children. Trauma-stress exposure during both war and resettlement presented as an unequivocal risk to mental health, but accounted for only part of outcome variance. Additional factors of strong import related broadly to “living in the present”. Parent impairment of daily routines, child dissatisfaction with school and an ongoing quarrelsome relationship presented as risk factors. Protection was associated with parent maintenance of a warm family climate and of concrete physical-emotional caring, child social ties to physically present others, including teacher; and above all, a family sense of hope for the future. Results support the general robustness of our semi-structured approach. Exploring the child’s present well-being in narrative relation to past and future, our assessment captured and gave meaning to the complexity of child exposure and behavior. At the same time, independent parent and child appraisals provided an additional richness to the retelling and evaluation of child experience. Particularly the apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment.
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| 5. |
- Karling, Mats, 1944-
(författare)
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Child behaviour and pain after hospitalization, surgery and anaesthesia
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hospitalization, surgery and anaesthesia are for some children associated with anxiety and could be a frightful experience which may result in later problematic behaviour. Pain is associated with the fears of hospitalization. The first aim was to investigate how pain in children is treated in Swedish hospitals as well as to assess the results of this treatment. Behaviour after hospitalization has been measured by the Post Hospital Behaviour Questionnaire (PHBQ). A second aim was to translate this instrument into Swedish and to validate it. The third aim was to analyze which factors (sociodemographic back¬ground; earlier experience; events at the hospital) that might be associated with changes in behaviour. Methods: A questionnaire regarding acute pain, its treatment methods and results of treatments as well as contributing factors to inadequate results, was sent to all departments in hospitals that might treat children. One form was answered by phy¬sicians and another form by nurses. In the second part of the study, a cohort of 340 children ages 2-13 were followed from two weeks before hospitalization until two weeks after. Data regarding socio¬demography and earlier health care experience were collected. The Child Behav¬iour Checklist was issued before and after hospitalization, the PHBQ was issued after. During hospitalization staff and parents assessed anxiety, pain and nausea mainly by VAS and Likert scales, (parents assessed own and child emotions). Children, older than 4-5 years of age, assessed their own pain using a faces scale. Results: Despite treatment, moderate to severe pain occurred postoperatively in 23% of patients and in 31% of patients with pain of other origin. Postoperative pain seemed to be a greater problem in units where children were treated together with adults and in departments where fewer children were treated. Pain could often or always be treated more efficiently according to 45% of physi¬cians and nurses. Of all departments, pain assessments were performed regularly in 43%, but pain measurement was less frequent. Opioids were never or infrequently used by 15 %. A five factor model fitted data better than the original 6 factor model when confir¬mative factor analyse was performed. Cronbach’s alpha was adequate for factors and excellent for the total score (0.92). Risk factors for increased problematic be¬haviour included the following: age less than 5 years of age, living in a one adult family, anxiety at anaesthesia induction, nausea at hospital and pain at home. Liv¬ing in a rural area and midazolam in premedication seem to be protective. Conclusions: Acute pain in children is still a problem. Inadequate pain treatment is mainly associated with organisational factors (missing prescriptions; a low rate of pain assessments). The PHBQ in Swedish translation is a reliable instrument and its relation to CBCL warrants its further use in research and quality control espe¬cially in younger children. Hospital-induced stress in older children needs further investigation. One third of the children who have been hospitalized and exposed to anaesthesia will have in¬creased problematic behaviour when returning home. Pro¬active interventions are suggested to prevent this by improving pain treatment at home.
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| 6. |
- Nilsson, Karin, 1950-
(författare)
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Recovery from adolescent onset anorexia nervosa : a longitudinal study
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anorexia Nervosa is a psychiatric illness with peak onset in ages 14-17. Most cases recover within a few years, but the illness can have a fatal outcome or long duration. Multifactor causes of anorexia nervosa include genetics, personality, family, and socio-cultural factors. This study measures mortality, recovery from anorexia nervosa, and psychosocial outcome of patients with adolescent onset anorexia nervosa that were treated in Child and Adolescent Psychiatry in northern Sweden from 1980 to 1985. In addition, this study assesses the predictive value of background variables and studies perfectionism in relation to recovery. Finally, this study looks at how patients understand the causes of their anorexia nervosa and how they view their recovery process. Follow ups were made 8 and 16 years after initial assessment at CAP. Quantitative and qualitative methods were used. These included a semistructured interview, DSM diagnostics of eating disorders (including GAF), and the self-assessment questionnaires EDI and SCL-90. The interview also contained questions about causes and recovery. Recovery increased from 68% to 85% from first to second follow-up and the mortality rate was 1%. Somatic problems and paediatric inpatient care during the first treatment period could predict long-term outcome of eating disorders. Most former patients had a satisfying family and work situation. At both follow-ups, individuals with long-term recovery had a lower level of perfectionism than those that recovered later. On individual levels, eating disorder symptoms and psychiatric symptoms decreased during recovery, whereas the levels of perfectionism stayed the same. Causes were attributed to self, family, and socio-cultural stressors outside of the family. The most common self-reported causes were high own demands and perfectionism. All recovered subjects could remember and describe a special turning point when the recovery started and 62% saw themselves as an active agent in the recovery process. Supportive friends, treatment, activities, family of origin, boyfriend, husband, and children were also helpful in the recovery process. Compared to other outcome studies, the results were good. In spite of the good outcome, some individuals had a long duration of illness and were not yet fully recovered after 16 years of follow-up. Predictors of non-recovery were related to initial somatic problems. Levels of perfectionism were associated to recovery and patients with initial high levels of perfectionism may need more complex treatment strategies. Results from the study also implied that one should stimulate the patients’ social contacts and their sense of self-efficacy in their recovery- process.
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| 7. |
- Nishikawa, Saori, 1978-
(författare)
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Japanese adolescents' self-concept and well-being in comparison with other countries
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In a rapidly changing and increasingly interconnected world, the issue of mental health and well-being among adolescents is one of the important research topics. However, there have been few studies amongst Japanese adolescents that have been published in international journals. Objectives: (I) to make a comparison in selfconcept between healthy adolescents in Japan and Sweden, (II) to address the influence of perceived parental rearing on self-concept and mental health problems among Japanese adolescents, (III) to investigate contributions of attachment and self-concept to mental health problems reported by Japanese adolescents, (IV) to address a comparison of mental health problems and self reported competence in adolescents from Greece, Japan, Russia, and Sweden. Methods: The following self-report instruments were used: Self- Description Questionnaire II (Marsh, 1992), Actual-Ideal Questionnaire (Nishikawa, 2003), Self-Description Questionnaire IIShort (Marsh, Ellis, Parada, Richards, & Heubeck, 2005), Youth Self- Report (Achenbach, 1991), Attachment Questionnaire- for Children (Sharpe et al., 1998), and Egna Minnen Beträffande Uppfostran (my memories of child upbringing) for Children (Muris, Meesters, & van Brakel, 2003). The participants for Paper I were adolescents aged 14 and 15 from Japan (n=144) and Sweden (n=96). One hundred ninety three Japanese students between the ages of 15-19 participated in Paper II and 228 students for Paper III. The participants for Paper IV were 812 healthy adolescents between 15 and 17 years of age from Greece (n=152), Japan (n=219), Russia (n=159), and Sweden (n=282). Results: Paper I showed that Japanese students reported less positive self-concept compared to the Swedish counterparts. The results were discussed in terms of different response style and modesty in Japanese culture. Paper II showed that dysfunctional parental rearing and insecure peer attachment were associated with negative self-concept and more mental health problems. A unique influence on mental health problems from parent-adolescent relationships depending on the gender of parents and adolescents was also found. Paper III showed a mediating role of self-concept in influencing the relationships between attachment style and Internalizing Problems. Paper IV indicated rather small differences across countries in the syndrome scales. Japanese and Swedish adolescents tended to score lower than Russian and Greek counterparts. Some cultural specific syndromes were found. Conclusion: These results reported in this thesis present a general view of Japanese adolescents’ self-concept and the influence of interpersonal relationships in mental health problems assessed by Western self-report instruments. When being compared with other countries, cultural background and response style must be taken into account.
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| 8. |
- Petersen, Solveig, 1955-
(författare)
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Recurrent pain and health related quality of life in young schoolchildren
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objectives of this thesis were 1) to describe the occurrence and co-occurrence of recurrent pain (headache, stomach-ache, and backache) in young school children; 2) to describe Health Related Quality of Life (HRQoL) in these children, from the perspective of the child, 3) to examine the psychometric properties of the PedsQL, a pediatric HRQoL instrument. Three data collections were performed, two in Umeå, Sweden, and one in a nearby smaller municipality, Lycksele. In Umeå, the first survey included schoolchildren from grades 0-6 and three years later all schoolchildren attending grade three and six were approached. In Lycksele all school children attending grades three through six and grade nine were invited to participate. Pain and quality of life were measured by questionnaires. The main findings of the thesis were that 2/3 of the children experienced pain from the head, stomach or back recurrently (at least monthly) and 1/3 experienced weekly pain. Weekly headache was reported by 23% of the children, 19 % reported weekly stomach-ache and 7% weekly backache. Half of the children with recurrent pain conditions reported pain from several body sites, and, in children with weekly pain, 2/3 reported multi-site pain. HRQoL in children with recurrent pain problems was markedly impaired, especially in children with multi-site pain and in children with weekly pain. Finally, The Swedish PedsQL self-report forms showed acceptable psychometric properties. In conclusion, in young schoolchildren, headache, stomach-ache and backache are common conditions associated with a clearly reduced HRQoL. The results show an urgent need for early preventive and curative programs targeting HRQoL domains such as physical, emotional, social and school areas. The results also indicate that recurrent pain should be regarded a potential general pain disorder rather than merely a local disorder. The PedsQL was found to be a reliable and valid measure of HRQoL in young Swedish school-aged children.
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| 9. |
- Zashikhina, Anna, 1980-
(författare)
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Juvenile chronic physical illness in Northern Russia : Studies on mental health, health-related quality of life, and family functioning
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Chronic physical illness (CPI) is a prolonged, rarely cured condition, which often causes impairment of activities of a child’s or adolescent’s daily living. This thesis encompasses three cohorts of patients with CPI – diagnosed with diabetes, asthma or epilepsy. Psychological disturbances and difficulties experienced by young patients with CPI are common, and changes in the family environment are inevitable. Hence, from a health care perspective, three cohorts of CPI can give a frame of reference to guide our understanding on the psychological health of adolescents with CPI, and the disease impact on their life; to determine target groups for psychological interventions, and to identify important directions for health care development.Objectives The overall aim of the study was to assess the psychological well-being of adolescents with CPI in Northern Russia, as well as to identify factors of potential risk or protective significance for adolescents’ well-being.Methods The questionnaires covering different aspects of psychological well-being as behavior-emotional problems, depressive symptoms, self-esteem, and health-related quality of life (HRQoL) as well as family functioning were answered by the adolescents with CPI and their mothers, including the Child Behavior Check-List (CBCL) and Youth Self-Report (YSR); Beck Depression Inventory (BDI); The Rosenberg Self-Esteem Scale; I think I am; Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48); Diabetes Quality of Life Questionnaire for Youths (DQOLY); Pediatric Asthma Quality of Life Questionnaire (PAQLQ); Self-report Family Inventory (SFI); and Socio-Economic Status (SES) questions. Disease related clinical information was withdrawn from the pediatric outpatient clinic. The sample consisted of 148 adolescents with CPI identified from Arkhangelsk pediatric outpatient clinic records and their mothers. Comparative data were obtained from a group of 301 schoolchildren and their mothers.Results Results in Paper I showed certain differences in mental health of adolescents with CPI compared to healthy counterparts indorsed by mother’s reports alone, while self-reports by adolescents with CPI didn’t show any discrepancy in the level of behavior/emotional problems and depression compared to healthy peers. Most pronounced symptoms were found in adolescents with asthma and epilepsy associated with disease severity and gender. In the results of Paper II there were no significant differences found in self/mother reported family functioning of the total group with CPI versus controls. The perception of family functioning differed between the CPI groups and was associated to certain disease-related and non-disease factors. Paper III showed that adolescents with diabetes and asthma maintain positive self-esteem similar to or even higher than that of their healthy counterparts. Adolescents with epilepsy reported lower self-esteem compared to other CPI groups or controls. A diversity of factors contributed to self-esteem variation within the CPI groups. Paper IV provides evidence that adolescents with CPI maintained relatively moderate to high levels of HRQoL. The domains affecting HRQoL were related to both disease-specific (severity) and non-disease factors (gender and SES).Conclusions In the scope of the present thesis we assessed and described psychological well-being and family functioning of adolescents with chronic illnesses. Our results demonstrate generally low levels of behavior-emotional problems, depressive symptoms, and relatively high self-esteem, positive health-related quality of life, and successful family functioning in adolescent with CPI in Northern Russia. However, we conclude that there is a risk of mental health problems, particularly of internalizing nature, in adolescents with asthma and epilepsy. The significant risk factors associated with psychological well-being mediated by family functioning in CPI groups were single-parent household, child age, disease severity, child gender, family SES, and changes in the family life. High family competence and successful family functioning are indisputable protective factors for psychological well-being in adolescents with CPI.
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