Correction to: Maternal personality disorder symptoms in primary health care: associations with mother-toddler interactions at one-year follow-up.

Following publication of the original article.

Maternal personality disorder symptoms in primary health care: associations with mother-toddler interactions at one-year follow-up.

BACKGROUND: Research is scarce on how mothers' symptoms of personality disorders are linked to the mother-toddler relationship. In this study we have explored the extent to which these symptoms are associated with mutual mother-toddler interactions assessed 1 year after the initial assessment. METHODS: Mothers and their 0-24-month-old children (n = 112) were recruited by nurses at well-baby clinics due to either self-reported or observed mother-toddler interaction problems. At inclusion (T1), mothers filled out the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q), which measures symptoms of ten personality disorders. A year later (T2), mother-toddler interactions were video-recorded and coded using a standardised observation measure, the Emotional Availability Scales. RESULTS: Only maternal schizotypal personality disorder symptoms predicted both the mothers' and the toddlers' interactional styles. Mothers with schizotypal personality symptoms appeared less sensitive, less structuring and more intrusive in their interactions with their toddlers, while mothers' borderline personality disorder symptoms were associated with increased hostility. Furthermore, toddlers who had mothers with schizotypal personality symptoms were less responsive towards their mothers. CONCLUSION: Measured dimensionally by self-report, maternal schizotypal personality symptoms were observed to predict the interaction styles of both mothers and their toddlers in the dyad, while borderline personality disorder symptoms predicted mothers' interactional behaviour only. TRIAL REGISTRATION: Current Controlled Trials ISRCTN99793905 , retrospectively registered. Registered on (04/08/2014).

Developmental course of anxiety and depression from adolescence to young adulthood in a prospective Norwegian clinical cohort.

Anxiety and depression are often co-occurring disorders, reflecting both homotypic and heterotypic continuity as possible developmental pathways. The present study aimed to examine homotypic and heterotypic continuities of anxiety and depression across 3 years in adolescence and young adulthood. Participants included patients presenting to psychiatric care with diagnoses of anxiety and/or depressive disorders aged 13-18 at T1 (N = 717, 44% initial participation rate) and aged 16-21 at T2 (N = 549, 80% follow-up participation rate). McNemar's mid-p test and ordinal proportional odds logistic regression analyses were used to assess changes in prevalence within and across diagnostic categories, respectively. More adolescents had an anxiety disorder (+ 11%), whereas fewer had a depressive disorder (- 11%), at T2 compared to T1. Of adolescents with anxiety and/or depression at T1, only 25% recovered or were non-symptomatic 3 years after referral to a psychiatric clinic. Homotypic continuity was observed for anxiety disorders in general (OR = 2.33), for phobic anxiety disorders (OR = 7.45), and for depressive disorders (OR = 2.15). For heterotypic continuity, depression predicted later anxiety (OR = 1.92), more specifically social anxiety (OR = 2.14) and phobic anxiety disorders (OR = 1.83). In addition, social anxiety predicted later generalized anxiety disorder (OR = 3.11). Heterotypic continuity was thus more common than homotypic continuity. For adolescents presenting with anxiety or depression, treatment should, therefore, target broad internalizing symptom clusters, rather than individual diagnoses. This may contribute to prevent future mental illness, particularly anxiety, in clinical samples.

Quality of life among adolescents living in residential youth care: do domain-specific self-esteem and psychopathology contribute?

PURPOSE: Many adolescents living in residential youth care (RYC) institutions perceive their quality of life (QoL) to be low. Enhancing QoL is thus important, but little is known about the potential contributors to their QoL. Early interpersonal trauma and subsequent removal from home and repeated relocations to new placements are expected to affect mental health and self-esteem. We therefore investigated if domain-specific self-esteem contributed to QoL among adolescents living in RYC institutions over and beyond their levels of psychopathology. METHODS: All youth in Norwegian RYC institutions between the ages 12-23 years were invited to participate. Of a total of 98 RYC institutions, 86 participated, and 400 of 601 eligible youths were examined. The participants' primary contact completed the Child Behavior Checklist to assess psychopathology. The adolescents completed a revised version of the Self-Perception Profile for Adolescents and the questionnaire for measuring health-related quality of life in children and adolescents (KINDL-R). RESULTS: After adjusting for psychopathology, age, and gender, self-esteem domains uniquely explained 42% of the variance in Qol, where social acceptance (ß = 0.57) and physical appearance (ß = 0.25) domains significantly predicted concurrent QoL. CONCLUSIONS: The self-esteem domains, social acceptance and physical appearance, add substantially to the explained variance in QoL among adolescents living in RYC institutions, over and beyond the levels of psychopathology. These self-esteem domains may be targets of intervention to improve QoL, in addition to treating their psychopathology.

Associations between parental chronic pain and self-esteem, social competence, and family cohesion in adolescent girls and boys--family linkage data from the HUNT study.

BACKGROUND: Parental chronic pain has been associated with adverse outcomes in offspring. However, knowledge on individual and family resilience factors in adolescent offspring of chronic pain sufferers is scarce. This study thus aimed to investigate the associations between parental chronic pain and self-esteem, social competence, and family cohesion levels reported by adolescent girls and boys. METHODS: Based on cross-sectional surveys from the Nord Trøndelag Health Study (the HUNT 3 study), the study used independent self-reports from adolescents aged 13 to 18 years (n = 3227) and their parents and conducted separate linear regression analyses for girls and boys. RESULTS: Concurrent maternal and paternal chronic pain was associated with reduced self-esteem, social competence, and family cohesion in girls. Moreover, maternal chronic pain was associated with higher social competence in boys and reduced self-esteem in girls. The majority of the observed associations were significantly different between girls and boys. Paternal chronic pain was not found to be associated with child outcomes. CONCLUSIONS: The findings indicate that the presence of both maternal and paternal chronic pain could be a potential risk factor for lower levels of individual and family resilience factors reported by girls. Further research on the relationship between parental pain and sex-specific offspring characteristics, including positive resilience factors, is warranted. The study demonstrates the importance of targeting the entire family in chronic pain care.

Familial aggregation of anxiety and depression in the community: the role of adolescents' self-esteem and physical activity level (the HUNT Study).

BACKGROUND: Symptoms of anxiety and depression are significantly associated in parents and children, but few studies have examined associations between recurrent parental problems and offspring symptoms, and fathers have rarely been included in these studies. Additionally, few have investigated factors that may protect against familial aggregation of anxiety and depression. The aims of the present study are to examine the associations between recurrent parental anxiety/depression over a ten-year time span and offspring anxiety/depression in adolescence and to test whether two factors proposed to be inversely related to anxiety and depression, namely, adolescent self-esteem and physical activity, may moderate and mediate the transmission of anxiety/depression. METHODS: This study used data from two waves of a Norwegian community study (the HUNT study) consisting of 5,732 adolescents, ages 13-18, (mean age = 15.8, 50.3% girls) who had one (N = 1,761 mothers; N = 742 fathers) or both parents (N = 3,229) participating in the second wave. In the first wave, 78% of the parents also participated. The adolescents completed self-reported questionnaires on self-esteem, physical activity, and symptoms of anxiety/depression, whereas parents reported on their own anxiety/depressive symptoms. The data were analysed with structural equation modeling. RESULTS: The presence of parental anxiety/depression when offspring were of a preschool age predicted offspring anxiety/depression when they reached adolescence, but these associations were entirely mediated by current parental symptoms. Self-esteem partly mediated the associations between anxiety/depression in parents and offspring. No sex differences were found. Physical activity moderated the direct associations between anxiety/depression in mothers and offspring, whereas no moderating effect was evident with regard to paternal anxiety/depression. CONCLUSIONS: These findings suggest that children of parents with anxiety/depression problems are at a sustained risk for mental health problems due to the apparent 10-year stability of both maternal and paternal anxiety/depression. Thus, preventing familial aggregation of these problems as early as possible seems vital. The associations between parental and offspring anxiety/depression were partially mediated by offspring self-esteem and were moderated by physical activity. Hence, prevention and treatment efforts could be aimed at increasing self-esteem and encouraging physical activity in vulnerable children of parents with anxiety/depression.

Self-reported social anxiety symptoms and correlates in a clinical (CAP) and a community (Young-HUNT) adolescent sample.

PURPOSE: The frequencies of social anxiety symptoms in a mental health clinical and a community sample of adolescents are compared. Also, we explore if adolescents can be classified in subgroups based on social anxiety symptoms. Associations between social anxiety symptoms and coexisting problems and sociodemographic characteristics are examined. METHODS: Adolescent participants, aged 13-18, in two large Norwegian studies, consisting of a clinical (n = 694, 42.1% participation rate, 55% girls, mean age = 15.6) and a community (n = 7,694, 73.1% participation rate, 51% girls, mean age = 15.8) sample completed identical self-report questionnaires measuring social anxiety and related variables. RESULTS: Median sum scores (interquartile range) of social anxiety symptoms were higher among girls than boys and in the clinical [girls = 16 (12-22); boys = 12 (9-16)] compared to the community sample [girls = 12 (9-15); boys = 10 (7-12)] (p < 0.001). Latent profile analysis revealed two classes of adolescents based on social anxiety profiles. Adolescents scoring high on social anxiety symptoms, which ranged from 16% (boys in community sample) to 40% (girls in clinical sample), had significantly more coexisting problems than those scoring low. Social anxiety symptoms were associated with academic school problems, bullying, eating problems, acne, and general anxiety and depression in both samples. CONCLUSION: Social anxiety symptoms were commonly reported by adolescents, in both clinical and community settings. These symptoms were associated with a broad spectrum of coexisting problems, which can be used to detect adolescents struggling with social anxiety. Adolescent, family, peer, school, and community interventions targeting these associated problems may contribute to prevent and alleviate social anxiety symptoms.

Psychiatric problems and quality of life in a clinical sample of adolescents: The role of peer relations.

BACKGROUND: The quality of peer relations is linked to mental health in childhood and adolescence, but few studies have investigated its clinical relevance. In particular, the potential mediating role of peer functioning in the associations between different dimensions of symptoms and quality of life (QoL) has not been sufficiently examined. OBJECTIVE: In a clinical sample of adolescents, we examined peer relations in light of psychiatric diagnoses, as well as QoL and symptoms of mental health problems, with particular focus on symptoms of anxiety, depression, and ADHD. We also examined the potential mediating role of peer problems in the relationship between such symptoms and QoL. METHODS: The sample consisted of 603 adolescents (ages 13-18) referred to clinical assessment. Psychiatric diagnoses according to the criteria of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, were collected from participants' clinical charts. Symptoms of disorders, QoL, and quality of peer relations were measured by self-report questionnaires. RESULTS: Adolescents diagnosed with anxiety/depressive disorder reported more peer problems and lower QoL than adolescents with attention deficit/hyperactivity disorder. These findings were supported with symptom ratings. A path model with bootstrapping was used to assess the potential mediating role of peer problems in the association between symptoms and QoL, showing that peer problems partly mediated the relationship between emotional symptoms and QoL, but not the relationship between ADHD-symptoms and QoL. CONCLUSION: Improvement of peer relations may be a fruitful path for enhancing QoL among adolescents with symptoms of anxiety and depression.

Parental chronic pain and internalizing symptoms in offspring: the role of adolescents' social competence - the HUNT study.

BACKGROUND: A growing body of research suggests that the children of parents with chronic pain are at risk for internalizing symptoms. The mechanisms of such associations have not been as thoroughly examined. The aim of the present study was to investigate whether adolescents' social competence mediates the association between parental chronic pain and offspring internalizing symptoms as well as whether these associations are moderated by adolescent gender. METHODS: The current study was based on cross-sectional data from the Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in 2006-2008. The present sample comprised adolescents who had both parents participating (n=9,681). Structural equation modeling was used for the data analysis. RESULTS: Our results indicated that the association between concurrent maternal and paternal chronic pain and offspring's symptoms of anxiety and depression was partly mediated by low social competence for girls (b(SE)=0.060 [0.030], P=0.043) but not for boys (b(SE)=-0.059 [0.040], P=0.146). This suggests that these associations are moderated by offspring gender. CONCLUSION: The study extends the existing literature on the possible pathways between parental chronic pain and internalizing symptoms in the offspring. Identifying protective factors in the pathways between parental chronic pain and mental distress in children could guide measures that promote the wellbeing of the child and family of chronic pain sufferers.

The role of self-esteem in the development of psychiatric problems: a three-year prospective study in a clinical sample of adolescents.

BACKGROUND: Self-esteem is fundamentally linked to mental health, but its' role in trajectories of psychiatric problems is unclear. In particular, few studies have addressed the role of self-esteem in the development of attention problems. Hence, we examined the role of global self-esteem in the development of symptoms of anxiety/depression and attention problems, simultaneously, in a clinical sample of adolescents while accounting for gender, therapy, and medication. METHODS: Longitudinal data were obtained from a sample of 201 adolescents-aged 13-18-referred to the Department of Child and Adolescent Psychiatry in Trondheim, Norway. In the baseline study, self-esteem, and symptoms of anxiety/depression and attention problems were measured by means of self-report. Participants were reassessed 3 years later, with a participation rate of 77% in the clinical sample. RESULTS: Analyses showed that high self-esteem at baseline predicted fewer symptoms of both anxiety/depression and attention problems 3 years later after controlling for prior symptom levels, gender, therapy (or not), and medication. CONCLUSIONS: Results highlight the relevance of global self-esteem in the clinical practice, not only with regard to emotional problems, but also to attention problems. Implications for clinicians, parents, and others are discussed.