Childhood externalizing, internalizing and comorbid problems: distinguishing young adults who think about suicide from those who attempt suicide.

BACKGROUND: While childhood externalizing, internalizing and comorbid problems have been associated with suicidal risk, little is known about their specific associations with suicidal ideation and attempts. We examined associations between childhood externalizing, internalizing and comorbid problems and suicidal ideation (without attempts) and attempts by early adulthood, in males and females. METHOD: Participants were from the Quebec Longitudinal Study of Kindergarten Children, a population-based study of kindergarteners in Quebec from 1986 to 1988 and followed-up until 2005. We captured the co-development of teacher-rated externalizing and internalizing problems at age 6-12 using multitrajectories. Using the Diagnostic Interview Schedule administered at age 15 and 22, we identified individuals (1) who never experienced suicidal ideation/attempts, (2) experienced suicidal ideation but never attempted suicide and (3) attempted suicide. RESULTS: The identified profiles were no/low problems (45%), externalizing (29%), internalizing (11%) and comorbid problems (13%). After adjusting for socioeconomic and familial characteristics, children with externalizing (OR 2.00, CI 1.39-2.88), internalizing (OR 2.34, CI 1.51-3.64) and comorbid (OR 3.29, CI 2.05-5.29) problems were at higher risk of attempting suicide (v. non-suicidal) by age 22 than those with low/no problems. Females with comorbid problems were at higher risk of attempting suicide than females with one problem. Childhood problems were not associated with suicidal ideation. Externalizing (OR 2.01, CI 1.29-3.12) and comorbid problems (OR 2.28, CI 1.29-4.03) distinguished individuals who attempted suicide from those who thought about suicide without attempting. CONCLUSION: Childhood externalizing problems alone or combined with internalizing problems were associated with suicide attempts, but not ideation (without attempts), suggesting that these problems confer a specific risk for suicide attempts.

An examination of the relationship between conduct problems and depressive symptoms comorbidity and temperament among elementary school children.

Although the comorbidity between conduct problems (CP) and depressive symptoms (DS) is associated with a host of negative outcomes, the factors, such as temperament, that might explain this comorbidity in school-aged boys and girls are poorly understood. This study compared elementary school children presenting co-occurring CP and DS to children with DS only, CP only, and those with low-level symptoms on temperament dimensions, and explored the moderating role of child sex in the associations. Participants are 487 children (M = 8.38 years, SD = 0.92, 52.2% girls) divided into four groups (CP + DS, DS only, CP only, control). Findings suggest that boys with CP and DS presented a lower level of fear than boys with DS and boys from the control group. They also presented higher levels of activity than boys with DS. Girls with CP and DS presented lower levels of fear than girls with DS, lower levels of approach and activity than girls with CP, and higher levels of shyness than girls from the control group. These findings suggest that temperament may discriminate children with comorbid CP and DS from those presenting only CP or DS.

Self and parent-reported sleep problems of adolescents with childhood conduct problems and comorbid psychological problems.

INTRODUCTION: Childhood conduct problems (CP) are characterized by maladaptive externalizing behaviors and are linked with poor sleep. CP are highly comorbid with other psychological problems, including attention deficit/hyperactivity disorder and depression, which are also associated with disturbed sleep. The present study examined if childhood CP and comorbid depressive and/or attentional-hyperactivity problems were prospectively associated with parent and self-reported sleep difficulties in adolescence. METHODS: Participants (N = 744; 53% boys) from an ongoing longitudinal study in Québec, Canada were assessed for CP and comorbidities when they were between 6 and 9 years old. Participants were classified as without CP, CP only, CP and depressive symptoms, CP and attention-hyperactivity problems, or CP, depressive symptoms, and attention-hyperactivity problems. Regressions were conducted to examine the associations between comorbidity groups, parent, and self-reported sleep problems 7 years later (Median age = 15.33 years), controlling for sex, age, family income, primary caregiver education and medication. RESULTS: Adolescents in all CP groups had higher self and parent-reported sleep problems compared to adolescents without histories of CP. Adolescents with histories of CP, depressive symptoms and attention-hyperactivity problems had more sleep problems than all other groups according to self-reports, but not parent-reports. CONCLUSION: Childhood CP was prospectively linked to sleep problems in adolescence, and comorbid conditions exacerbated these problems, according to youth but not parents.

Predicting Depression and Anxiety from Oppositional Defiant Disorder Symptoms in Elementary School-Age Girls and Boys with Conduct Problems.

This study investigated the relationship between the three DSM-5 categories of oppositional defiant disorder (ODD) symptoms (irritable mood, defiant behavior, vindictive behavior) and anxiety/depression in girls and boys with conduct problems (CP) while controlling for comorbid child psychopathology at baseline. Data were drawn from an ongoing longitudinal study of 6- to 9-year-old French-Canadian children (N = 276; 40.8 % girls) receiving special educational services for CP at school and followed for 2 years. Using linear regression analysis, the results showed that irritable mood symptoms predicted a higher level of depression and anxiety in girls and boys 2 years later, whereas the behavioral symptoms of ODD (e.g., defiant, vindictive symptoms) were linked to lower depression scores. The contribution of ODD symptoms to these predictions, while statistically significant, remained modest. The usefulness of ODD irritable symptoms as a marker for identifying girls and boys with CP who are more vulnerable to developing internalizing problems is discussed.

[Implementation Evaluation of the Pare-Chocs Program in High School]. / Évaluation de la qualité de l'implantation du programme Pare-Chocs à l'école secondaire.

Despite the important increase in the prevalence of depression during adolescence, a low proportion of adolescent presenting elevated depressive symptoms receive school-based mental health services. Moreover, programs implemented in school settings often suffer of a less rigorous implementation, thus limiting their potential effectiveness. The identification of factors influencing implementation fidelity is essential to improve the quality of services. Guided by a theory-driven evaluation model, we assessed the quality of implementation of the Pare-Chocs program and the factors that affected this quality with the elements of action model of Chen (2005). Participants were 15 professionals that implemented Pare-Chocs with six groups of adolescents exhibiting high depressive symptoms. A mixed-method approach was used to collect quantitative data on implementation fidelity in the six groups and qualitative data on action model components. Our results suggest that adherence, dose and participant responsiveness were high. Time constraints and lack of previous education linked to program theory limited the fidelity of implementation, but training, supervision and program guide enhanced it. These findings confirm that prevention programs disseminated in school settings could be implemented with a high level of fidelity, although some challenge must be considered in treatment planning to contribute to higher program effects. Moreover, fidelity should be systematically evaluated in this setting.

Longitudinal associations between conduct problems and depressive symptoms among girls and boys with early conduct problems.

Youth with conduct problems (CP) may experience high rates of depressive symptoms (DS). However, little is known about the direction of the longitudinal associations between CP and DS in this specific population. Although girls with CP appear at greater risk than boys for presenting comorbid depression, empirical research on gender differences in these associations is even sparser. The current study used autoregressive latent trajectory models to compare four perspectives with hypotheses regarding the longitudinal associations between CP and DS, while taking into account the evolution of both problems. We also examined gender differences in the longitudinal associations. A total of 345 children (40.6 % female) presenting with a high level of CP in early elementary school (mean age at study inception = 8.52; SD = .94) were evaluated annually over a four-year period (5 measurement time points). The results revealed that CP and DS were quite stable over time. Moreover, CP and DS showed strong covariation at each measurement time point, but only one significant positive cross-lagged association between the two processes, indicating that higher levels of DS at time 3 were associated with higher levels of CP 1 year later. No differences were observed in the longitudinal associations between CP and DS in boys and girls. Given the comorbidity and stability of CP and DS, these findings suggest that DS should be systematically evaluated among children with early clinically significant CP, and treatment plans should include interventions aimed at both CP and DS among children who present with both types of problems.

Effects of an interdisciplinary education program on hypertension: A pilot study.

BACKGROUND: The goal of this pilot study was to examine the effects of a structured interdisciplinary education program on blood pressure, knowledge, anthropometric measures, medication compliance, behavioural risk factors and quality of life. METHOD: In this quasi-experimental study, participants were assigned to an intervention (n = 21) or a regular care group (n = 19). The intervention group attended four weekly sessions related to hypertension. Anthropometric measures and blood pressure were recorded at baseline, one, three and six months for all participants. Both groups completed questionnaires on knowledge, health-related behaviours and quality of life at these same intervals. RESULTS: The reduction in systolic blood pressure was greater in the intervention group than in the regular care group (p = 0.05). However, there were no between group differences with regard to the other variables studied. CONCLUSION: Participation in a structured interdisciplinary education program was associated with a reduction of systolic blood pressure, thus contributing to a risk reduction for cardiovascular disease.

Longitudinal relationships between conduct problems, depressive symptoms, and school dropout.

School dropout can be an ongoing process of academic failure and disengagement starting as early as elementary school. Given the multitude of factors involved and the importance of early identification of vulnerabilities, this study examined whether (a) initial levels of conduct problems and depressive symptoms predicted school dropout, (b) the rate of change in conduct problems and depressive symptoms predicted dropout, (c) the interaction between trajectories of conduct problems and depressive symptoms affected the likelihood of dropout, and (d) whether there were sex differences in these associations. Using a dataset of 364 children ages 6-9 (T1) years who had displayed conduct problems, mean trajectories of conduct problems and depressive symptoms over 6 years were drawn using parallel process latent growth curve modeling. Results showed that both the initial levels of and rate of change in conduct problems predicted dropout, whereas trajectories of depressive symptoms did not. The interaction between trajectories of conduct problems and depressive symptoms was non-significant and sex differences were not observed. These results suggest that, for boys and girls presenting early conduct problems, although a higher initial levels of conduct problems increases the risk of school dropout, a larger decrease in these problems over time may reduce this likelihood. Recognizing and treating conduct problems consistently may be crucial in reducing the risk of dropout in children with early-onset issues.

Developmental Trajectory of Conduct Problems Among Boys and Girls Receiving Psychoeducational Services at Elementary Schools.

Elementary public schools remain the most common venues for addressing children's severe conduct problems. Nevertheless, very few longitudinal studies have examined association between receiving psychoeducational services for conduct problems in school and subsequent conduct problem severity. This study explored if psychoeducational service reception contributed to reduce conduct problems in a sample of 434 elementary school-aged boys and girls presenting a high level of conduct problems. The study used a repeated measures design at 12-month intervals, for 4 years. Information regarding the severity of children's conduct problems and services was provided by parents and teachers. Latent Growth Modeling was used to identify a mean trajectory of conduct problems. Results revealed that psychoeducational services were associated with a decrease in conduct problems over time, but this association was only observed in boys. There was no association between service reception at study inception and the trajectory of conduct problems among girls. These results suggests that psychoeducational services are well suited to the difficulties of boys with conduct problems; however, they may call for a review of the services offered to girls in schools, both in terms of the detection of conduct problems in young girls, and in terms of their treatment options.

Association of Childhood Externalizing, Internalizing, and Comorbid Symptoms With Long-term Economic and Social Outcomes.

Importance: Little is known about the long-term economic and social outcomes for children with longitudinally assessed comorbid externalizing and internalizing symptoms, especially compared with children with externalizing symptoms or internalizing symptoms only. Objective: To examine the association between childhood trajectories of externalizing, internalizing, and comorbid symptoms and long-term economic and social outcomes. Design, Setting, and Participants: A 32-year prospective cohort study linked with administrative data was conducted in school-aged participants aged 6 to 12 years in the Québec Longitudinal Study of Kindergarten Children (N = 3017) followed up from 1985 to 2017. Data analysis was conducted between August 1, 2021, and March 31, 2022. Exposures: Teacher-rated behavioral symptoms were used to categorize children from age 6 to 12 years into developmental profiles using group-based trajectory modeling. Main Outcomes and Measures: Multivariable regression models were used to test the association between childhood symptom profile group and adult employment earnings, welfare receipt, intimate partnership status, and having children living in the household. Participant sex, IQ, and socioeconomic background were adjusted for. Results: Of 3017 participants in this sample, 1594 (52.8%) were male and 1423 (47.2%) were female. Per confidentiality rules established by Statistics Canada, income variables were rounded to base 100 and count variables were rounded to base 10; the mean (SD) age was 37 (0.29) years at follow-up. Four symptom profiles were identified: no/low (n = 1369 [45.4%]), high externalizing (882 [29.2%]), high internalizing (354 [11.7%]), and comorbid (412 [13.7%]) symptoms. Compared with the no/low symptom profile, participants in the high externalizing-only profile earned $5904 (95% CI, -$7988 to -$3821) less per year and had 2.0 (95% CI, 1.58-2.53) times higher incidence of welfare receipt, while participants in the high internalizing group earned $8473 (95% CI, -$11 228 to -$5717) less per year, had a 2.07 (95% CI, 1.51-2.83) higher incidence of welfare receipt, and had a lower incidence of intimate partnership (incident rate ratio [IRR], 0.89; 95% CI, 0.80-0.99). Participants in the comorbid profile fared especially poorly: they earned $15 031 (95% CI, -$18 030 to -$12 031) less per year, had a 3.79 (95% CI, 2.75-5.23) times higher incidence of annual welfare receipt, and were less likely to have an intimate partner (IRR, 0.71; 95% CI, 0.63-0.79) and children living in the household (IRR, 0.86; 95% CI, 0.80-0.92). Estimated lost earnings over a 40-year working career were $140 515 for the high externalizing, $201 657 for the high internalizing, and $357 737 for the comorbid profiles. Conclusions and Relevance: In this cohort study, children exhibiting sustained childhood high externalizing, high internalizing, or comorbid symptoms were at increased risk of poor economic and social outcomes into middle age. These findings suggest that children exhibiting comorbid problems were especially vulnerable and that early detection and support are indicated.

Canadian clinical capacity for fetal alcohol spectrum disorder assessment, diagnosis, disclosure and support to children and adolescents: a cross-sectional study.

OBJECTIVE: Canadian fetal alcohol spectrum disorder (FASD) guidelines encourage an age-specific interdisciplinary diagnostic approach. However, there is currently no standard-of-care regarding FASD diagnosis disclosure and few studies document Canadian FASD clinical capacity. Our objectives were to describe clinical capacity (defined as skills and resources) for FASD assessment, diagnosis, disclosure and support in Canada. DESIGN, SETTING AND PARTICIPANTS: Data were drawn from the CanDiD study, a cross-sectional investigation of Canadian FASD clinical capacity. Forty-one clinics participated in the study. Data were collected in 2021 on the number and types of health professionals included in the assessment and diagnostic teams, the presence (or absence) of a minor patient when the FASD diagnosis is disclosed to parents/guardians, who is responsible for the diagnosis disclosure, the use of explanatory tools, and the types of support/counselling services available. The proportion of clinics that follow the Canadian interdisciplinary diagnostic guidelines by age group is described among participating clinics. RESULTS: Overall, 21, 13 and 7 specialised FASD clinics were in Western/Northern, Central and Atlantic Canada, respectively. The number of referrals per year surpassed the number of diagnostic assessments completed in all regions. Approximately, 60% of clinics who diagnosed FASD in infants and preschool children (n=4/7 and 15/25, respectively) followed the interdisciplinary guidelines compared with 80% (n=32/40) in clinics who diagnosed school-aged children/adolescents. Diagnostic reporting practices were heterogeneous, but most used an explanatory tool with children/adolescents (67%), offered support/counselling (90-95%) and used case-by-case approach (80%) when deciding who would disclose the diagnosis to the child/adolescent and when. CONCLUSIONS: Limited diagnostic capacity and lack of FASD resources across Canada highlights a critical need for continued FASD support. This study identifies gaps in assessment, diagnosis and reporting practices for FASD in children/adolescents across Canada.

The longitudinal association between externalizing and internalizing problems: An exploration of the dual failure model.

The Dual Failure Model suggests that peer victimization (social failure) and academic difficulties (academic failure) mediate the association between externalizing and later internalizing problems. The present study sought to better understand why children with externalizing problems develop later internalizing problems by testing the Dual Failure Model using a sample of 744 children (aged 6 to 10 at Time 1 [T1]), of whom 434 (44.7% girls) presented with high levels of conduct problems at study inception. Both parent and teacher ratings of externalizing and internalizing problems support the social failure pathway, but not the academic failure pathway. Children with externalizing behaviors at T1 who developed internalizing problems 2 years later did so via their experiences of peer victimization. These results apply for both boys and girls and do not vary according to child age at T1 or the level of conduct problems at study inception. These findings underscore the importance of early screening and intervention for externalizing behavioral problems in order to reduce subsequent peer victimization and internalizing problems. Findings regarding the consequences of internalizing are also discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Avoidance of the vaginal incision site for mesh placement in vaginal wall prolapse surgery: A prospective study.

OBJECTIVE: To evaluate efficacy of a minimal surface area, vaginally-installed polypropylene tape (VPT), avoiding insertion on the incision line to treat an anterior, posterior or anteroposterior vaginal wall prolapse. STUDY DESIGN: Patients with an anterior, posterior or anteroposterior vaginal wall prolapse waiting for surgical treatment were included in the study. Primary outcome was the incidence of prolapse recurrence reported with combined outcome measures and was reported with Kaplan-Meier cumulative incidence. Secondary outcomes were operative complications, adverse events, urinary, colorectal and sexual functions as well as quality of life. Participation in the study involved up to 8 visits over 5 years. At each visit, patients used a self-reported questionnaire to report symptoms related to pain, urinary, colorectal, sexual functions, and quality of life. A physical examination was also performed. Paired t-tests were used to investigate change in POP-Q and quality of life measurements since baseline. RESULTS: 71 patients underwent the procedure and were followed-up for an average (standard deviation) of 32.5 (18.7) months. Only 2 (2.8%) women experienced a recurrence of their pelvic organ prolapse. Only one case of erosion and no case of persistent pain have been recorded up to 5 years post-surgery. Quality of life was improved and then sustained throughout the follow-up period (p<0.01). CONCLUSION: This VPT surgical procedure is safe and has a high level of efficacy to treat anterior, posterior or anteroposterior vaginal wall prolapse. It is also associated with improvements in quality of life of patients which are sustained for many years.