First-in-human study of a pharmacological duodenal exclusion therapy shows reduced postprandial glucose and insulin and increased bile acid and gut hormone concentrations.

AIMS: To address the need for noninvasive alternatives to metabolic surgery or duodenal exclusion devices for the management of type 2 diabetes (T2D) and obesity by developing an orally administered therapeutic polymer, GLY-200, designed to bind to and enhance the barrier function of mucus in the gastrointestinal tract to establish duodenal exclusion noninvasively. MATERIALS AND METHODS: A Phase 1, randomized, double-blind, placebo-controlled, single- (SAD) and multiple-ascending-dose (MAD) healthy volunteer study was conducted. In the SAD arm, four cohorts received a single dose of 0.5 g up to 6.0 g GLY-200 or placebo, while in the MAD arm, four cohorts received 5 days of twice-daily or three-times-daily dosing (total daily dose 2.0 g up to 6.0 g GLY-200 or placebo). Assessments included safety and tolerability (primary) and exploratory pharmacodynamics, including serum glucose, insulin, bile acids and gut hormones. RESULTS: No safety signals were observed; tolerability signals were limited to mild to moderate dose-dependent gastrointestinal events. In the MAD arm (Day 5), reductions in glucose and insulin and increases in bile acids, glucagon-like peptide-1, peptide YY and glicentin, were observed following a nonstandardized meal in subjects receiving twice-daily dosing of 2.0 g GLY-200 (N = 9) versus those receiving placebo (N = 8). CONCLUSIONS: GLY-200 is safe and generally well tolerated at doses of ≤2.0 g twice daily. Pharmacodynamic results mimic the biomarker signature observed after Roux-en-Y gastric bypass and duodenal exclusion devices, indicating a pharmacological effect in the proximal small intestine. This study represents the first clinical demonstration that duodenal exclusion can be achieved with an oral drug and supports further development of GLY-200 for the treatment of obesity and/or T2D.

Service Use as a Predictor of Change in Mental Health Problems Among Children: A Prospective Cohort Study.

OBJECTIVE: Psychosocial interventions for children's mental health problems typically differ in several characteristics, such as therapist training, content, motivation for treatment, and extent of comorbid conditions among patients, depending on whether the interventions take place in clinical research studies or in real-life settings. Accordingly, the effects found in research studies may not be generalizable to typical service provision. The authors sought to examine the potential associations between receiving usual care and later psychiatric symptoms, impairment, and potential improvements in social skills. METHODS: Participants (N=996) drawn from the 2003-2004 birth cohorts in Trondheim, Norway, included children who received usual care and those who did not receive any services (as a control group). The children were assessed with biennial clinical interviews from ages 4 to 14 years. Random intercept, cross-lagged panel models were combined with propensity scoring to adjust for measured time-varying and all unmeasured time-invariant confounders. RESULTS: Usual care was not associated with alterations in social skills or impairment due to mental health problems. Similarly, usual care provided to 7- to 12-year-olds did not predict changes in the number of symptoms of psychiatric disorders. However, usual care received at ages 0-4 and 5-6 predicted a slight increase in the number of psychiatric symptoms 2 years later. No significant associations between usual care and improved outcomes were detected. CONCLUSIONS: These observational findings reveal the need to implement existing evidence-based approaches in usual care and to develop evidence-based approaches to the complex cases often seen in specialty and community care systems.

Deaf and hard-of-hearing children and adolescents' mental health, Quality of Life and communication.

Mental health problems and lower Quality of Life (QoL) are more common in deaf and hard-of-hearing - (D)HH - children than in typically hearing (TH) children. Communication has been repeatedly linked to both mental health and QoL. The aims of this study were to compare mental health and QoL between signing deaf and hard-of-hearing (DHH), hard-of-hearing (HH) and TH children and to study associations between mental health/QoL and severity of hearing loss and communication. 106 children and adolescents (mean age 11;8; SD = 3.42), 59 of them DHH and 47 HH, and their parents reported child mental health and QoL outcomes. Parents also provided information about their children's communication, hearing loss and education while their children's cognitive ability was assessed. Although (D)HH and their parents rated their mental health similar to their TH peers, about twice as many (D)HH children rated themselves in the clinical range. However, (D)HH children rated their QoL as similar to their TH peers, while their parents rated it significantly lower. Associations between communicative competence, parent-reported mental health and QoL were found, whereas severity of hearing loss based on parent-report had no significant association with either mental health or QoL. These results are in line with other studies and emphasise the need to follow up on (D)HH children's mental health, QoL and communication.

Change Over 11-13 Year Periods in Quality of Life, Emotional Problems and Negative Stressful Life Events Among 13-17 Year Old Students.

Studies investigating changes in the general population over time concerning adolescent self-reported Quality of life (QoL) are sparse. The aim of this study is to investigate stability and change over more than a decade in self-reported QoL, emotional problems, and negative stressful life-events among students. Three large cross-sectional samples (N = 1032, 4744 and 3826) of 13-17-year-old adolescents attending public school in the Norwegian County of Trøndelag provide data, one from 2017 to 2019 and two from 11 and 13 years earlier. We analyzed linear and binary linear regression adjusted for age. We found few indications of large changes in overall QoL. The exception was a 50% increase in reported emotional problems in both girls and boys. Girls also reported an increase of sexually uncomfortable/abusive acts from peers from 3.7 to 7.0%. The observed changes must be addressed through public health interventions targeting school as an important arena.

Psychometric properties of the caregiver-teacher report form in a sample of Norwegian preschool children.

PURPOSE: The caregiver-teacher report form (C-TRF) is included in the Achenbach system of empirically based assessment (ASEBA) and widely used to measure child psychopathology. In Norway, the C-TRF is frequently used by the Educational and Psychological Counselling Service or for referrals to special health services, however, its psychometric properties in the Norwegian context have not yet been explored. The aim of this study was to investigate the internal consistency of the C-TRF and its factorial validity in a Norwegian preschool context. METHOD: This study is based on baseline data from the project Children in Central Norway, where a total of 169 preschool teachers reported on the C-TRF for 1430 children aged 1-6 years. RESULTS: The findings indicate promising psychometric properties for the C-TRF in terms of internal consistency and factorial validity, however, the somatic complaints scale seems problematic because of its poor psychometric properties. CONCLUSION: Users of the C-TRF can be confident in the instrument's applicability in a Norwegian context, however, careful considerations when applying the somatic complaints scale in clinical decision making is warranted.

Reactive attachment disorder and disinhibited social engagement disorder in adolescence: co-occurring psychopathology and psychosocial problems.

Insufficient care is associated with most psychiatric disorders and psychosocial problems, and is part of the etiology of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). To minimize the risk of misdiagnosis, and aid treatment and care, clinicians need to know to which degree RAD and DSED co-occur with other psychopathology and psychosocial problems, a topic little researched in adolescence. In a national study of all adolescents (N = 381; 67% consent; 12-20 years old; 58% girls) in Norwegian residential youth care, the Child and Adolescent Psychiatric Assessment interview yielded information about psychiatric diagnoses and psychosocial problems categorized as present/absent, and the Child Behavior Check List questionnaire was applied for dimensional measures of psychopathology. Most adolescents with a RAD or DSED diagnosis had several cooccurring psychiatric disorders and psychosocial problems. Prevalence rates of both emotional and behavioral disorders were high in adolescent RAD and DSED, as were rates of suicidality, self-harm, victimization from bullying, contact with police, risky sexual behavior and alcohol or drug misuse. Although categorical measures of co-occurring disorders and psychosocial problems revealed few and weak associations with RAD and DSED, dimensional measures uncovered associations between both emotional and behavioral problems and RAD/DSED symptom loads, as well as DSED diagnosis. Given the high degree of comorbidity, adolescents with RAD or DSED-or symptoms thereof-should be assessed for co-occurring psychopathology and related psychosocial problems. Treatment plans should be adjusted accordingly.

Psychometric properties of the Brief Problem Monitor (BPM) in children with internalizing symptoms: examining baseline data from a national randomized controlled intervention study.

BACKGROUND: Prevention is essential to reduce the development of symptomology among children and adolescents into disorders, thereby improving public health and reducing costs. Therefore, easily administered screening and early assessment methods with good reliability and validity are necessary to effectively identify children's functioning and how these develop. The Brief Problem Monitor (BPM) is an instrument designed for this purpose. This study examined the psychometric properties of the Norwegian version of the BPM parent (BPM-P) and teacher (BPM-T) versions, including internal reliability and construct validity at assessing children with internalizing problems. METHODS: Baseline data were collected from a national randomized controlled intervention study. Children aged 8-12 years with self-reported symptoms of anxiety and/or depression with one standard deviation above a chosen population's mean were included in this study. Teachers (n = 750) and parents (n = 596) rated children using the BPM-T and BPM-P, respectively. Internal consistency was measured using Cronbach's alpha, and multi-informant agreement between the BPM-P and BPM-T was measured using Spearman's correlations. Construct validity was assessed via confirmatory factor analysis. RESULTS: Internal consistency was good throughout all domains for both the BPM-P and BPM-T, with a Cronbach's alpha ranging from .763 to .878. Multi-informant agreement between the parents and the teacher was moderate on the externalizing, attention, and total scales and low on the internalizing scale. The model fit for the three-factor structure of the BPM was excellent for the BPM-P and good for the BPM-T. CONCLUSIONS: Internal consistency was good, and the original three-factor solution of the BPM-P and BPM-T was confirmed based on our sample of school children at-risk for emotional problems. These promising results indicate that the BPM may be a valid short assessment tool for measuring attentional, behavioral, and internalizing problems in children. Trial registration in Clinical Trials: NCT02340637; June 12, 2014.

Nanoengineered Shear-Thinning Hydrogel Barrier for Preventing Postoperative Abdominal Adhesions.

More than 90% of surgical patients develop postoperative adhesions, and the incidence of hospital re-admissions can be as high as 20%. Current adhesion barriers present limited efficacy due to difficulties in application and incompatibility with minimally invasive interventions. To solve this clinical limitation, we developed an injectable and sprayable shear-thinning hydrogel barrier (STHB) composed of silicate nanoplatelets and poly(ethylene oxide). We optimized this technology to recover mechanical integrity after stress, enabling its delivery though injectable and sprayable methods. We also demonstrated limited cell adhesion and cytotoxicity to STHB compositions in vitro. The STHB was then tested in a rodent model of peritoneal injury to determine its efficacy preventing the formation of postoperative adhesions. After two weeks, the peritoneal adhesion index was used as a scoring method to determine the formation of postoperative adhesions, and STHB formulations presented superior efficacy compared to a commercially available adhesion barrier. Histological and immunohistochemical examination showed reduced adhesion formation and minimal immune infiltration in STHB formulations. Our technology demonstrated increased efficacy, ease of use in complex anatomies, and compatibility with different delivery methods, providing a robust universal platform to prevent postoperative adhesions in a wide range of surgical interventions.

Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder.

BACKGROUND: Low self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown. OBJECTIVE: Investigate global and domain-specific self-esteem in adolescents with RAD or DSED. PARTICIPANTS AND SETTING: All adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12-20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12-20). METHODS: Self-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents. RESULTS: Compared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = -0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = -0.42, p = .005), SA (MD = -0.40, p = .015), AC (MD = -0.22, p = .038), PA (MD = -0.33, p = .048), and SW (MD = -0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = -0.42, p = .012) and SW (MD = -0.32, p = .037). More RAD symptoms were associated with lower SA (B = -0.051, p = .013), AC (B = -0.048, p = .028), RA (B = -0.053, p = .007), and CF (B = -0.052, p = .005). More DSED symptoms were associated with lower SC (B = -0.125, p = .038). CONCLUSION: Both global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly.

Psychometric properties of the Inventory of Life Quality in children and adolescents in Norwegian Sign Language.

BACKGROUND: Several studies have assessed the Quality of Life (QoL) in Deaf and hard-of-hearing (DHH) children and adolescents. The findings from these studies, however, vary from DHH children reporting lower QoL than their typically hearing (TH) peers to similar QoL and even higher QoL. These differences have been attributed to contextual and individual factors such as degree of access to communication, the participants' age as well as measurement error. Using written instead of sign language measures has been shown to underestimate mental health symptoms in DHH children and adolescents. It is expected that translating generic QoL measures into sign language will help gain more accurate reports from DHH children and adolescents, thus eliminating one of the sources for the observed differences in research conclusions. Hence, the aim of the current study is to translate the Inventory of Life Quality in Children and Adolescents into Norwegian Sign Language (ILC-NSL) and to evaluate the psychometric properties of the self-report of the ILC-NSL and the written Norwegian version (ILC-NOR) for DHH children and adolescents. The parent report was included for comparison. Associations between child self-report and parent-report are also provided. METHODS: Fifty-six DHH children completed the ILC-NSL and ILC-NOR in randomized order while their parents completed the parent-report of the ILC-NOR and a questionnaire on hearing- and language-related information. Internal consistency was examined using Dillon-Goldstein's rho and Cronbach's alpha, ILC-NSL and ILC-NOR were compared using intraclass correlation coefficients. Construct validity was examined by partial least squares structural equation modeling (PLS-SEM). RESULTS: Regarding reliability, the internal consistency was established as acceptable to good, whereas the comparison of the ILC-NSL with the ILC-NOR demonstrated closer correspondence for the adolescent version of the ILC than for the child version. The construct validity, as evaluated by PLS-SEM, resulted in an acceptable fit for the proposed one-factor model for both language versions for adolescents as well as the complete sample. CONCLUSION: The reliability and validity of the ILC-NSL seem promising, especially for the adolescent version, even though the validation was based on a small sample of DHH children and adolescents.

SuperGAG biopolymers for treatment of excessive bladder permeability.

Few therapeutic options exist for treatment of IC/BPS. A novel high MW GAG biopolymer ("SuperGAG") was synthesized by controlled oligomerization of CS, purified by TFF and characterized by SEC-MALLS and 1H-NMR spectroscopy. The modified GAG biopolymer was tested in an OVX female rat model in which bladder permeability was induced by a 10-minute intravesicular treatment with dilute (1 mg/ml) protamine sulfate and measured by classical Ussing Chamber TEER measurements following treatment with SuperGAG, chondroitin sulfate, or saline. The effect on abrogating the abdominal pain response was assessed using von Frey filaments. The SuperGAG biopolymer was then investigated in a second, genetically modified mouse model (URO-MCP1) that increasingly is accepted as a model for IC/BPS. Permeability was induced with a brief exposure to a sub-noxious dose of LPS and was quantified using contrast-enhanced MRI (CE-MRI). The SuperGAG biopolymer restored impermeability to normal levels in the OVX rat model as measured by TEER in the Ussing chamber and reduced the abdominal pain response arising from induced permeability. Evaluation in the URO-MCP1 mouse model also showed restoration of bladder impermeability and showed the utility of CE-MRI imaging for evaluating the efficacy of agents to restore bladder impermeability. We conclude novel high MW SuperGAG biopolymers are effective in restoring urothelial impermeability and reducing pain produced by loss of the GAG layer on the urothelium. SuperGAG biopolymers could offer a novel and effective new therapy for IC/BPS, particularly if combined with MRI to assess the efficacy of the therapy.

Predictors of community versus specialty mental health service use: a prospective cohort study.

Child and adolescent mental health specialized services (CAMHS) are supposed to serve those who are most seriously disturbed and impaired. However, little is known about how children receiving treatment at different levels of care differ. The present study seeks to determine whether having a psychiatric disorder and resulting impairment measured in early childhood increases the odds of receiving help in CAMHS versus from community services during middle childhood or whether other factors (e.g., parenting stress, family functioning) also influence service utilization. A screen-stratified sample (n = 995 of the 2003-2004 birth cohorts) in Trondheim, Norway was assessed biennially from age 4-12 with semi-structured diagnostic interviews and recording of service use, family functioning, parental perceived need, and parenting stress. Behavioral disorders more strongly predicted CAMHS than community service use, whereas impairment predicted community service use. However, impairment increased the odds of receiving services in CAMHS if the parents perceived a need for help. Parental perceived need for help also increased the odds of CAMHS use independent of diagnosis and impairment. Having an emotional disorder, attention deficit/hyperactivity disorder (ADHD), parenting stress, previous service use, or family functioning did not predict service use at either level. Whereas children with behavioral disorders received help from CAMHS, children with emotional disorders did not receive services at either level. ADHD did not predict service use, indicating that young children with ADHD without comorbid disorders are not sufficiently detected. Efforts to detect, refer and treat emotional disorders and ADHD at the appropriate level should be increased.

Measuring childhood maltreatment: Psychometric properties of the Norwegian version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale.

PURPOSE: Adverse childhood experiences in sensitive periods of the developing brain render the individual at a life-long risk for a broad spectrum of aberrant health outcomes. However, there is a lack of scales for the comprehensive assessment of adverse childhood experiences providing information of various types and the age of occurrence. Based on the complete, experimental version of the Maltreatment and abuse chronology of exposure (MACE-X) scale, the present study aimed to develop and psychometrically test a Norwegian version of MACE. METHODS: The 75-item MACE-X was translated from German to Norwegian and administered as a self-report measure to 90 outpatients and 145 employees at a Division of specialized mental health care in South-Eastern Norway. The outpatients also completed the Childhood trauma questionnaire (CTQ) and the Symptom checklist 90 (SCL-90) to investigate convergent and predictive validity. To investigate test-retest reliability, outpatients completed MACE once more two weeks later. RESULTS: Rasch analysis and Anderson likelihood ratio tests on the combined outpatient and employee data resulted in a 55 item version of the Norwegian MACE. In the outpatient group, test-retest reliability of the MACE-55 was excellent for total scores (ICC ≥ 0.94) and good to excellent for 10 subscale scores (ICC ≥ 0.82). Convergent validity with the CTQ was moderate to high for both total scores (0.63 ≥ r ≥ 0.86) and subscale scores (0.56 ≥ r ≥ 0.82). As compared to CTQ total scores, a MACE total score that combined severity and duration of exposure was numerically more strongly associated with overall psychiatric symptoms and each of nine symptom domains on the SCL-90. CONCLUSIONS: The newly developed Norwegian MACE comprehensively assesses past exposure to adverse childhood experiences with high psychometric properties. This scale is a useful tool for research questions addressing sensitive periods for childhood adversities and associated health phenotypes.

Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence.

Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12-20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6-11%), and the prevalence of DSED was 8% (95% CI 5-11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups.

Validation of the Strengths and Difficulties Self-Report in Norwegian Sign Language.

The majority of studies on mental health in deaf and hard-of-hearing (DHH) children report a higher level of mental health problems. Inconsistencies in reports of prevalence of mental health problems have been found to be related to a number of factors such as language skills, cognitive ability, heterogeneous samples as well as validity problems caused by using written measures designed for typically hearing children. This study evaluates the psychometric properties of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) in Norwegian Sign Language (NSL; SDQ-NSL) and in written Norwegian (SDQ-NOR). Forty-nine DHH children completed the SDQ-NSL as well as the SDQ-NOR in randomized order and their parents completed the parent version of the SDQ-NOR and a questionnaire on hearing and language-related information. Internal consistency was examined using Dillon-Goldstein's rho, test-retest reliability using intraclass correlations, construct validity by confirmatory factor analysis (CFA), and partial least squares structural equation modeling. Internal consistency and test-retest reliability were established as acceptable to good. CFA resulted in a best fit for the proposed five-factor model for both versions, although not all fit indices reached acceptable levels. The reliability and validity of the SDQ-NSL seem promising even though the validation was based on a small sample size.

The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up.

PURPOSE: To investigate, in adolescents referred for psychiatric services, the associations of initial self-esteem and family functioning with level and change of quality of life (QoL) over a 3-year period, over and above the effect of their emotional problems. METHODS: Of 1648 eligible 13-18 years old patients attending the child and adolescent psychiatric clinic (CAP) at least once, 717 (54.8% females) were enrolled at baseline (a response rate of 43.5%). Self- and parent reports on the McMaster Family Assessment Device were obtained. Adolescents reported self-esteem on the Rosenberg Scale, and emotional problems on the Symptom Check List-5. Adolescents completed the Inventory of Life Quality in Children and Adolescents (ILC). After 3 years, 570 adolescents again completed the ILC, and for 418 adolescents parent information was available. The longitudinal analysis sample of 418 adolescents was representative of the baseline sample for age, gender, emotional problems, and QoL. We used modified growth-model analysis, adjusted for SES, age, gender and time of contact with CAP, where residual variances for ILC at baseline and follow-up were fixed to 0. RESULTS: A poorer family functioning at baseline, reported by parents, was significantly associated with worsening QoL during the 3 years follow-up period (p = 0.001). CONCLUSIONS: Parents have important knowledge about their families that may reflect long-term influences on QoL development in adolescent psychiatric patients. Health care providers and policy makers should optimize treatment outcomes by addressing family functioning in adolescents with emotional problems.

What Predicts a Good Adolescent to Adult Transition in ADHD? The Role of Self-Reported Resilience.

OBJECTIVE: ADHD is a disorder associated with impairment and comorbid psychiatric problems in young adulthood; therefore, factors that may imply a more favorable outcome among adolescents with ADHD are of interest. METHOD: This study used a longitudinal design to assess whether adolescent personal resilience characteristics during adolescence protected against psychosocial impairment, depression, and anxiety 3 years later. Self-reported protective factors were used as baseline measures in the assessment of 190 clinically referred adolescents with ADHD. A semi-structured diagnostic interview was performed at the follow-up. RESULTS: In a group of youth with ADHD, personal resilience characteristics were associated with better psychosocial functioning in young adulthood, and less depression and anxiety. CONCLUSION: Although further research is needed, these results indicate that personal resilience characteristics may be protective factors in the transitional period from adolescence to early adulthood.

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.

Childhood maltreatment, psychopathology and well-being: The mediator role of global self-esteem, attachment difficulties and substance use.

Childhood maltreatment is known to be associated with a broad variety of psychopathology and deteriorated well-being in adolescent populations. In the present nationwide study, we aimed to explore global self-esteem, attachment difficulties and substance use as possible mediators of these associations in a high-risk adolescent population. We included 400 adolescents (aged 12-20 years) living in residential youth care in Norway (response rate 67%). The participants completed a semistructured psychiatric interview (Child and Adolescent Psychiatric Assessment (CAPA)), a study-specific questionnaire, a revised version of the Self-Perception Profile for Adolescents (SPPA) and the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). Information was also provided by the adolescent's primary contact at the institution. Two models were tested using structural equation modelling; one assessed the association between childhood maltreatment and psychopathology, and one assessed the association between childhood maltreatment and well-being. Childhood maltreatment, psychopathology, well-being, global self-esteem and attachment difficulties were treated as latent variables, and substance use was added as an observed variable. The results of this study showed that global self-esteem was a mediator of paths in both models, whereas attachment difficulties and substance use were not. Preventing decline in health and well-being in high-risk adolescents is a main goal, and this study suggests that improving self-esteem, in addition to providing psychiatric health services, could be an important tool for achieving this goal.