Sexual abuse and associations with psychosocial aspects of health. A population-based study with Swedish adolescents.

BACKGROUND: Few population-based Nordic studies with adolescents investigate the associations between sexual abuse (SA) and psychosocial health. AIM: Associations between adolescents' self-reported experiences of SA different severity and aspects of psychosocial health such as emotional and behavioral problems, sense of coherence and self-esteem were investigated. METHODS: A school-based study with 1107 Swedish high school seniors was conducted. The students completed the Strengths and Difficulties Questionnaire (SDQ), the Sense of Coherence Scale (SOC), I think I am and a self-report survey that included questions about SA, socio-demographic variables and family variables. RESULTS: SA was related to more emotional and behavioral problems, weaker SOC and lower self-esteem when compared with non-abuse. There was also a dose-response effect insofar as more severe abuse was related to poorer psychosocial health. When adjusted for socio-demographic and family-related variables, the associations between penetrating SA and most of the health variables weakened or disappeared. SOC was associated with penetrating SA even after adjustment. CONCLUSIONS: This population-based study suggests that SA should not be regarded as an isolated factor in relation to psychosocial health as the associations at a group level may be smaller than expected. Among a number of covariates, family variables such as parental bonding showed to be especially important. Sense of Coherence may be of special interest in further research and clinical treatment.

A long-term follow-up study of adolescents with conduct disorder: Can outcome be predicted from self-concept and intelligence?

BACKGROUND: This study examines Swedish young adults (age 21) with a history of conduct disorder (CD) in adolescence. Research has established CD as a condition for a range of adverse outcomes. Intelligence, aggression, parent-child conflict, parent-child relation and peer-rejection are known factors influencing the outcome. AIM: The aim of this longitudinal study is to find how self-confidence and intelligence in an inpatient group diagnosed with CD are related to health in young adulthood. METHODS: The subjects were diagnosed with CD in their adolescence at the inpatient child and adolescent psychiatric unit. Using structured questionnaires as independent variables, this study uses multiple regression analysis to predict health outcomes. RESULTS: The results showed that self-concept and verbal intelligence could significantly predict health outcomes. However, in the multivariate analysis, only self-concept variables significantly predicted the outcome. The predicted outcome was small, but substantial in most models (R(2)=0.12-0.25). CONCLUSION: This means that clinicians need to be humble in forecasting individual adult health among adolescents with severe CD. According to this study, it is difficult to separate positive and negative outcomes. We suggest that this structural data has better prediction potential than medical casebook data. If this is the general case, this psychometric data paves the way for more structural ways of assessing child and adolescence psychiatric problems.

Temperament and character associated with depressive symptoms in women: analysis of two genetically informative samples.

Although previous research has explored associations between personality and depressive symptoms, a limited number of studies have assessed the extent to which genetic and environmental influences explain the association. This study investigated how temperament and character were associated with depressive symptoms in 131 pairs of twin and sibling women in early adulthood, as well as 326 pairs of twin women in middle adulthood. Results indicated that genetic influences accounted for a moderate to substantial percentage of the association between these personality features and depressive symptoms, emphasizing the role of genetic influences. Nonshared environmental influences made important contributions to the association between character and depressive symptoms, particularly in the sample of middle-aged twin women. These findings suggest that unique social experiences and relationships with a partner in adulthood may play an important role in these associations between character and depressive symptoms.

The role of temperament and social support in depressive symptoms: a twin study of mid-aged women.

BACKGROUND: Although research has found that temperament and social support are associated with depression, these relationships have not been explored in conjunction with one another as they relate to depression using a genetically informative design. This study investigated how the association among the three constructs is mediated. METHODS: The sample in this study consisted of 326 pairs of adult monozygotic and dizygotic twins drawn from the Swedish Twin Registry. Twins were mothers of adolescent from married or partnered relationships. The genetic and environmental contributions to the association were evaluated by self-reported measures of temperament, social support, and depressive symptoms. RESULTS: Multivariate genetic model fitting revealed that a moderate portion of genetic influences were common among the three central constructs of harm avoidance, perceived social support, and depressive symptoms. LIMITATIONS: The results may not be generalizable to depressive disorders in clinical settings. The measures were self-reported from a cross-sectional study. CONCLUSIONS: The findings suggest that the heritable component may contribute to genetic influences on an individual's ability to secure social support and thus to genetic risk for depressive symptomatology in women.

The transportability of multisystemic therapy to Sweden: short-term results from a randomized trial of conduct-disordered youths.

This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Treatment of ADHD with amphetamine: short-term effects on family interaction.

OBJECTIVE: This research seeks to study the impact on family function after 3 months of treatment with amphetamine. METHOD: A total of 43 children, 6 to 11 years of age, with ADHD were treated with amphetamine for 3 months. Family function was studied before and after treatment by parent self-rating and independent observer ratings of videotaped parent-child interactions. RESULTS: The families with a child with ADHD were found to be more dysfunctional than control families. Families with children with severe ADHD behavior showed evidence of more family dysfunction compared to families with children with less severe ADHD behavior. After 3 months of treatment with amphetamine, the children's behavior and the mother's well-being and some aspects of parent-reported and observer-rated family functioning improved. CONCLUSION: This study gives support to the notion that some aspects of family dysfunction may be related to the child's ADHD behavior.

A follow-up study of adolescents with conduct disorder: can long-term outcome be predicted from psychiatric assessment data?

This study examines Swedish young adults (mean age 21) with a history of conduct disorder (CD) as adolescents. Using medical records, this study explores the relationship between adolescent inpatients and their outcomes in adulthood. Two outcome variables were used: an indication of non-successful outcome variable (seven undesirable outcomes) and sense of coherence. Using multiple regression analyses, this study showed that extracted data from the medical case record could significantly explain small variance depending on output variable. The small variance could be related to the homogeneous clinical sample, the follow-up time, the outcome variables and the absence of a biological perspective. This study suggest, clinicians should be very careful when predicting outcome in young adulthood, if they should predict outcome at all. The positive conclusion in this matter is that as far as we know any teenager with CD could have a positive outcome in young adulthood.

Blueprints in Sweden. Symptom load in Swedish adolescents in studies of Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC).

The purpose of the present study was to compare symptom load in youth groups treated with three Swedish Blueprint programmes - Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC) - to see if symptom load matches the intensity of the treatment model as expected. These youth groups were also compared with in- and outpatients from child and adolescent psychiatry, and a normal comparison group. In addition, we compared the symptom load of their mothers. Symptom load was measured by the Achenbach System of Empirically Based Assessment (ASEBA) in the adolescents, and by the Symptom Checklist 90 in their mothers. The results showed that youth in the MST and MTFC studies had a higher symptom load than in the FFT study, and the same pattern of results was found in their mothers. It is concluded that there seems to be a reasonable correspondence between the offered resources and the symptom load among youth and parents; treatment methods with higher intensity have been offered to youth with higher symptom load. The correlation between internalized and externalized symptoms was high in all study groups. The MST and MTFC groups had an equally high total symptom load as the psychiatric inpatient sample.

Group therapy for women sexually abused as children: mental health before and after group therapy.

Forty-five female outpatients sexually abused in childhood were offered a 2-year phase-divided group therapy. Before and after treatment and at 12 months follow-up, they answered questionnaires designed to elicit responses concerning psychological symptoms (Symptom Checklist; SCL-90) and sense of coherence (SOC). Symptoms for posttraumatic stress disorder (PTSD) were assessed before and after treatment. Inpatient days and sick listing days were assessed during 2 years before and 2 years after treatment. The psychological and PTSD symptoms were significantly reduced after treatment, and the SOC was increased as well. Inpatient days were decreased, and sick listing days increased but not significantly. Compared to a similar short-term focused therapy group and a waiting-list group there were no significant differences between the groups. Trauma-focused group therapy for women who were sexually abused in childhood seems to have promising effects on mental health, both concerning long-term and short-term approaches.

Genetic effects on women's positive mental health: do marital relationships and social support matter?

Interpersonal relationships are important factors in mental health. A genetically sensitive design was used to examine associations among marital quality, adequacy of social support, and 2 aspects of positive mental health in a sample of 652 Swedish twin women and their families. There were 3 main findings. First, the covariance between relationships and positive mental health was partially accounted for by common genetic variance. Second, nonshared environmental influences played a substantial role in the covariance among the 3 constructs, with evidence for husbands being a source of this influence. Finally, different patterns of associations were found between relationships and 2 aspects of mental health, well-being and global self-worth, which shows how seemingly similar constructs can be differentially associated with relationships. Together, these findings emphasize the importance of genetically informed studies in family research and the role of the environment and interpersonal relationships in promoting and improving mental health.

Accounting for depressive symptoms in women: a twin study of associations with interpersonal relationships.

BACKGROUND: This study examined how interpersonal relationships, specifically marital quality and adequacy of social support, are associated with depressive symptoms among women. METHODS: A sample of 326 female monozygotic and dizygotic twin pairs and their spouses was drawn from the Swedish Twin Registry. Associations among the three variables were evaluated by comparing similarities among monozygotic and dizygotic female twin pairs. RESULTS: Interpersonal relationships contributed between 18% and 31% of the variance for depressive symptoms in women. Associations among the three variables were accounted for by genetic influences when women's reports were used. Non-shared environmental influences were important for the association between marital quality and depressive symptoms when a combination of husband and wife reports of marital quality were used. LIMITATIONS: The data is cross-sectional and the generalizability of these findings to depressive symptoms in men or to individuals with major depression is not clear. CONCLUSIONS: These findings indicate important associations among marital quality, social support and depressive symptoms in women, which should be taken into consideration for prevention and intervention strategies targeting depression.

Genetic and environmental influences on mothering of adolescents: a comparison of two samples.

This study examined 2 samples of adolescents and mothers using a child-based design (Nonshared Environment in Adolescent Development [NEAD] project, N = 395 families) and a parent-based design (Twin Moms [TM] project, N = 236 twin family pairs) to compare genetic and environmental influences on mothering. For both samples, the same measures of positivity, negativity, control, and monitoring were used. The use of matched child-based and parent-based samples enabled passive and nonpassive genotype-environment (GE) correlations to be approximated, providing information about process. Passive GE correlations were suggested for mother's positivity and monitoring. For mother's negativity and control, primarily nonpassive GE correlations were suggested. In several cases, both types of GE correlation were indicated. Finally, observer ratings of negativity and monitoring were influenced only by environmental factors.

Genetic and environmental influences on marital relationships.

As most adults will marry at least once during their lifetime, studying marital quality and its predictors is of great importance. The current study addresses (a) the extent of agreement between husbands and wives on their marital quality, (b) genetic and environmental sources of individual differences on spouse reports of marital quality, and (c) the extent to which genetic and environmental influences account for overlap of spouse reports on marital quality. Adult Swedish twin women and their partners participated in this study. Genotype-environment (GE) correlations were found for marital quality, suggesting that wives' genetically influenced characteristics set a tone for the marriage. Wives' genetically influenced characteristics also accounted for overlap of spouse reports of marital quality. Finally, nonshared environmental influences were the primary contributor to both individual reports and the overlap of spouse reports, an interesting deviation from findings of behavior genetic studies of other types of relationships.

International epidemiology of child and adolescent psychopathology ii: integration and applications of dimensional findings from 44 societies.

OBJECTIVE: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. METHOD: Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. RESULTS: CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. CONCLUSIONS: Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.

Understanding the role of personality in explaining associations between marital quality and parenting.

Analyses assessed the degrees to which personality accounts for associations between marital quality and parenting and mediates genetic contributions to these relationships. Participants included 318 male and 544 female same-sex twin pairs from the Twin and Offspring Study in Sweden. All twins completed self-report measures of marital quality and personality (anxiousness, aggression, sociability). Composite measures of parent negativity and warmth were derived from the twins' and their adolescent children's ratings of the twins' disciplinary styles and the emotional tone of the parent-child relationship. Observational ratings of marital quality and parenting were also obtained for a subset of twins. Personality characteristics explained 33% to 42% of the covariance between reported marital quality and parenting and 26% to 28% of the covariance between observed marital quality and parenting. For both sets of analyses, personality accounted for more than half of the genetic contributions to covariance between marital quality and parenting. Results indicate that personality significantly contributes to associations between marital quality and parenting and that personality is an important path through which genetic factors contribute to family relationships.

Individual resiliency factors from a genetic perspective: results from a twin study.

This article is part of the Twin Mother's Study, a study that examines influences on maternal adjustment. A number of studies have investigated the importance of genetic factors for mental health, but few of these examine how genes and the environment influence resiliency/salutogenic factors. This article investigates the relative importance of genetic and environmental influences on resiliency/salutogenic factors. This study includes 326 twin pairs (150 monozygotic and 176 dizygotic) who are mothers, who are living with their spouse, and who are part of the Swedish twin register. Using self-report structured questionnaires, we assessed salutogenic factors, depression, and quality of life; however, we analyzed the questionnaires completed by the mothers. Statistical analyses were conducted using structural equation modeling. We conclude that nonshared environmental components were of principal importance in individual resiliency/salutogenic factors in a genetically informative design, but we also noted that genetic influences were important. The shared environment had mainly no effect.

Evaluation of the Incredible Years Series - an open study of its effects when first introduced in Sweden.

Behaviour management problems (BMP) are common among children (4-12%) and the prevalence seems to be rising. Persistent antisocial behaviour often leads to poor long-term psychosocial adjustment. Structured parent-training programmes have proven to be the most effective way of treating BMP in young children. The Incredible Years Series (IYS), which is a manual-based programme, was introduced in Sweden in 2001. The aim of the present study was to evaluate the effectiveness of IYS in diverse clinical settings in Sweden. Parents of 113 children (3-9 years), recruited through the IYS-trained group leaders' ordinary services, participated in the study. The parents answered various questionnaires regarding their children's symptoms and their own psychological well-being before and after participating in the parent-training groups. The results are very encouraging; significant reduction of BMP in the children was found on all relevant measures. A significant increase in the self-rated well-being of the mothers was also found. The IYS seems to work in Sweden, even when used by group leaders who are in training. The importance of using a well-documented manualized method when implementing new models is accentuated.

A long-term follow-up of conduct disorder adolescents into adulthood.

This study focuses on young male and female adults (n=290) who were diagnosed with conduct disorder (CD) during adolescence at the inpatient child and adolescent psychiatric unit in Lund, Sweden. Their adulthood is described using seven outcome variables: in custody, crime, illicit drug use, mental health, teenage parenthood, transference income and educational attainment. Together, the seven outcome variables represent a wide perspective of individual life and known risks for both genders. The variables are compared, scaled and described in an outcome that identifies successful outcome. Although this was a severe clinical inpatient group of adolescents, a relatively large number-about a third of the males and close to half of the females-exhibit a successful outcome by their early twenties. This study highlighted the merits use gender-sensitive outcome variables. The take-home message from a societal perspective is that many improvements are needed, a message that has been voiced in several Swedish commissions.

The development of a systemic school-based intervention: Marte Meo and coordination meetings.

Antisocial behavior is often persistent, and in addition to causing suffering to children and their families, it also poses considerable costs for society. Children who display externalizing behavior in their early years run a high risk of having severe problems later in life. There is a need for treatment methods that may be used in various settings because these children constitute a group that is hard to reach with conventional treatment methods. In addition, the dropout rate from ordinary treatment is often high. In the present study, a systemic school-based model for early detection and intervention among 4-12-year-old children who displayed externalizing behavior problems was developed and examined in a nonrandomized study in the county of Skaraborg in Sweden. The intervention was collaborative and included a combination of the Marte Meo model and coordination meetings based on systemic theory and practice. Treatment effects in the group who had received the intervention were compared with a group who had received treatment as usual in their ordinary school setting. Assessments were carried out before, and 2 years after, the intervention. For the intervention group (N = 33), there was a significant decrease in the children's reported symptoms in school and in the home. No decrease in externalizing behavior was found in the comparison group (N = 16). There were no dropouts in the intervention group after the intervention had begun. The results are promising; the study demonstrates that it is possible to work effectively with many children who display externalizing behavior problems in a nonclinical setting.

Outcomes in couple therapy: reduced psychiatric symptoms and improved sense of coherence.

In Sweden, only a few empirical studies of couple therapy have been performed. This is the hitherto most comprehensive assessment of clinical treatment. Effectiveness of treatment is reported and compared with non-clinical ratings. Initially the couples displayed marital distress, many psychiatric symptoms, dyadic interactions characterized by high criticism and a low sense of coherence. In Sweden, couple therapy is primarily aimed to reduce marital distress and does not focus on individual disorders. It should be seen as innovative that overall psychic symptoms (Global Symptom Index, GSI) as well as depressive symptoms were reduced (more than one standard deviation) for both women and men to the extent of 50-55%. Normal values were attained by 73-78%. Of those who initially identified a low sense of coherence, 22% of the women and 37% of the men improved (more than one standard deviation). Normal values were attained by 68-70%. The treatment was relatively short, which meant that, with relatively limited treatment, it was also possible to attain relatively significant improvements in all dimensions of psychiatric symptoms.