Concurrent adversities and suicide attempts among Sami and non-Sami adolescents: the Norwegian Arctic Adolescent Study (NAAHS).

BACKGROUND: Little is known about connections between adolescent suicide attempts (SA) and concurrent adversities. AIMS: In a cross-sectional study, the authors wanted to investigate prevalences, additive effects of adversities, family and peer relations, gender, divorce and poverty, and ethnic differences between Sami and non-Sami youth. METHODS: In an adolescent community population encompassing 4881 adolescents of 15-16 years of age, youth with and without self-reports of attempted suicide the last year were compared on 12 concurrent adversities, on scales assessing family and peer functioning, and on sociodemographic variables. RESULTS: The prevalence of attempted suicide the last year was 5.3%, and more girls (8.8%) than boys (1.8%). All 12 concurrent adversities were strongly related to SA. The suicide attempters reported two and a half times as many adversities as non-attempters. A strong multiple additive relationship was found. Multivariately, among boys, the strongest risk factors were suicide among friends (OR = 9.4), and suicide in the family or in the neighbourhood (OR = 4.8). Among girls, sexual abuse (OR = 5.2) and parent mental problems (OR = 4.6) were strongest related to SA. Suicide attempters reported more divorce and poverty, more conflicts with parents, and less family support and involvement. Totally, Sami youth reported more SA and more concurrent adversities than non-Sami peers. CONCLUSION: Adolescent suicide attempters are heavily burdened with concurrent adversities. Clinicians should be aware of gender differences in risk factors, and should ask about abuse and suicide or attempts among relatives and peers. A family perspective in clinical work is needed.

Concurrent adversities among adolescents with conduct problems: the NAAHS study.

PURPOSE: Several studies have confirmed that maltreatment and abuse in childhood are related to conduct problems. Less is known about such relationships with concurrent adversities in adolescence and, also, when compared with other severe adversities and possible multiple additive effects. METHODS: The study encompassed a community population of 4881 adolescents 15-16 years of age 50.1 % boys and 49.9 % girls. Youth with and without conduct problem scores within the deviant range on the Strength and Difficulties Questionnaire (SDQ) was compared on 12 concurrent adversities. RESULTS: Based on self-reports, 4.4 % of the adolescents had conduct problem scores within the deviant range and more girls (5.1 %) than boys (3.7 %). In the deviant conduct problem group, 65.1 % had experienced two or more concurrent adversities compared with 26.3 % of youths in the non-deviant group (OR 5.23, 95 % CI 3.91-7.01). Likewise, the deviant conduct problem group was from 1.71 to 8.43 times more at the risk of experiencing the different adversities. Parental mental health problems and experiences of violence were multivariately strongest associated with conduct problem scores within the deviant range on the SDQ. A strong multiple additive relationship with adversities was found. CONCLUSIONS: Two-thirds of youth with SDQ conduct problem scores within the deviant range reported two or more concurrent adversities. Clinicians should seek information about kinds and amount of possible traumatic adversities in youth with conduct problems and offer evidence based treatment.

Prevalences and correlates of sleep problems among adolescents in specialty mental health services and in the community: what differs?

AIMS: Knowledge of sleep problems and their relationships among adolescent psychiatric patients is limited. This study investigated whether adolescents in specialty mental health care differ in rate and correlates of sleep problems from adolescents in a community sample; 2465 adolescents from a community sample were compared with a representative clinical sample of 129 adolescent patients. METHODS: Comparisons were made on frequent sleep problems according to scores on the Youth Self-Report, the Mood and Feelings Questionnaire, and instruments assessing coping styles, stresses and family functioning. RESULTS: Sleep problems were more frequent in the clinical sample than the community sample (31.3% vs. 5%). Sleeping little and being overtired were the most common sleep problems. Sleep problems were multivariately associated with internalizing problems in both samples. Poor family functioning and distractive coping were multivariately associated with sleep problems among adolescent patients, whereas depressive symptoms were multivariately associated in community adolescents. CONCLUSIONS: Prevalences of sleep problems were high among adolescent patients. However, sleep problems may be in danger of being unnoticed in clinical practice. Clinicians should ask about such problems and be aware of possible connections with family functioning, depression and suicidality. Therapeutic interventions directed towards sleep problems should be considered.

Diagnosed and self-reported childhood abuse in national and regional samples of child and adolescent psychiatric patients: prevalences and correlates.

We investigated if rates of ICD-10 axis 5 abuse diagnoses in the total child psychiatric population in Norway were different from self-reported abuse at 12-18?years of age, and we investigated their respective correlates. Study 1: The official registers of the total child psychiatric population in Norway in the years 2000 and 2001 were analysed for rates and correlates of axis 5 diagnoses of sexual and physical abuse. Study 2: Self-reports of abuse and neglect in a representative clinical sample of 129 adolescents referred during the same period were analysed for rates and correlates Prevalence of diagnosed sexual abuse inside and outside the family was low (1.6% and 1.9%, respectively) in the total Norwegian clinical population, and physical abuse diagnoses were even lower (0.4%). Self-reports of abuse and neglect were much higher (60.2%). One-fourth (25.5%) of the adolescents reported more than one kind of abuse. Self-reports of abuse were associated with referral for depression, symptoms of depression and suicidal risk. Patients reporting physical abuse were more often intoxicated by alcohol, used solvents and cannabis, and scored higher on the Youth Self-Report externalizing syndrome. There is a large discrepancy between rates of ICD-10 axis 5 diagnoses of sexual and physical abuse and self-reports of such abuse. Childhood abuse needs more attention in clinical practice within child and adolescent psychiatry. Physical abuse needs to be addressed in particular.

Adolescents referred to specialty mental health care from local services and adolescents who remain in local treatment: what differs?

BACKGROUND: The study investigates whether adolescents referred to specialty mental health services from local services differ from adolescents who only have received help for psychiatric problems locally. If so, which factors associate strongest with referral? METHOD: Adolescents (n = 76) from an adolescent population sample (N = 2,538) who had received help during the last year for mental problems from local services were compared to a clinical sample of adolescents (N = 129) referred to specialty mental health services from such local services. Comparisons were made according to scores on the Youth Self-Report (YSR); depressive symptoms; family functioning; attachment to parents; self-concept; coping styles; response styles; dysfunctional attitudes; negative life events; daily hassles; socio-demographics. RESULTS: As compared to adolescents receiving help locally, adolescents in specialty mental health care scored higher on YSR internalising syndrome; YSR attention problems; YSR thought problems; suicidality; psychosocial stressors; knowing someone who had attempted suicide; parental divorce; substance use; recent moves; living in lodgings; lost a pal or boy/girlfriend; and lower on attachment to parents. Multivariate logistic regression analysis identified four factors associated with receiving specialty mental health care: low family functioning; moved previous year; knowing someone who had attempted suicide; own suicidality. CONCLUSIONS: Family functioning as reported by the adolescents, and not mental health problems except for suicidality, was found to be the strongest associated with referral to specialty mental health services. Contrary to findings from many other studies, referral was associated with internalising problems, not externalising ones.

Pain in Adolescent Psychiatric Patients.

BACKGROUND: Little is known about the extent of pain among adolescent psychiatric patients, and the relationships with psychosocial factors and psychiatric symptoms. METHOD: A representative sample of 129 adolescent patients were assessed with measures including the Youth Self-Report, the Mood and Feelings Questionnaire, and instruments assessing self-perceptions, coping styles, stresses, sociodemographic factors, and childhood abuse. RESULTS: More than half of the adolescents (54%) reported to be bothered currently by frequent pain. Frequent pain correlated with depression, self-harm, suicide attempt, and with ruminative and emotion oriented coping. Adolescents suffering from frequent pain had more often experienced childhood abuse/neglect. A stepwise multiple regression analysis revealed that depression, alcohol intoxication and childhood neglect were the strongest concurrent predictors of frequent pain. CONCLUSIONS: Clinicians should ask child and adolescent psychiatric patients about pain, and be aware of possible connections with abuse/neglect, depression and suicidality.

Changes in referrals to child and adolescent psychiatric services in Norway 1992--2001.

BACKGROUND: The study analyzes changes in types of problems referred to child and adolescent psychiatry in Norway from 1992 to 2001, and investigates if referral practices and media attention account for these changes. METHOD: All referrals to child and adolescent psychiatry in Norway in the period 1992--2001 were analyzed, as well as frequencies of articles in media on psychiatric problems. RESULTS: The shares of referrals for sadness/depression increased from 0.5 % to 15.4 %. Referrals for hyperactivity/attention problems increased from 1.2 % to 13.6 %. The increases could be statistically attributed to decreased use of other referral categories, and/or alternatively to media attention on these and related topics. Convergence between diagnosis and corresponding referral problem increased in the period. CONCLUSIONS: Referrals for sadness/depression and hyperactivity/attention problems increased sharply in Norway during the 1990s. This increase may be attributed to a different understanding of and a sharper look at these problems by referral agencies and by increased media attention.