"Nobody asked us if we needed help": Swedish parents experiences of enuresis.

OBJECTIVE: To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals. SUBJECTS AND METHODS: The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation. RESULTS: The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers. CONCLUSION: Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families.

Genetic probes of three theories of maternal adjustment: I. Recent evidence and a model.

Studies focusing on genetic and social influences on maternal adjustment will illumine mother's marriage, parenting, and the development of psychopathology in her children. Recent behavioral genetic research suggests mechanisms by which genetic and social influences determine psychological development and adjustment. First, heritable, personal attributes may influence individuals' relationships with their family members. These genetically influenced family patterns may amplify the effects of adverse, heritable personal attributes on adjustment. Second, influences unique to siblings may be the most important environmental determinants of adjustment. We derive three hypotheses on maternal adjustment from integrating these findings from genetic studies with other contemporary research on maternal adjustment. First, mother's marriage mediates the influence of her heritable, personal attributes on her adjustment. Second, mother's recall of how she was parented is partially genetically influenced, and both her relationships with her spouse and her child mediate the impact of these genetically influenced representations on her current adjustment. Third, characteristics of mother's spouse are important influences on difference between her adjustment and that of her sister's. These sibling-specific influences are unrelated to mother's heritable attributes. The current article develops this model, and [figure: see text] the companion article describes the Twin Mom Study that was designed to test it as well, as its first findings. Data from this study can illumine the role of family process in the expression of genetic influence and lead to specific family interventions designed to offset adverse genetic influences.

Genetic probes of three theories of maternal adjustment: II. Genetic and environmental influences.

This is the first report of the Twin Mom Study, an investigation of three hypotheses concerning influences on maternal adjustment. These hypotheses concern the role of the marital and parent-child relationships in mediating genetic influences on maternal adjustment and on the importance of the mothers' marital partners as a specifiable source of influences on their adjustment not shared with their sisters. The study's sample of 150 monozygotic (MZ) twins and 176 dizygotic (DZ) twins was drawn randomly from the Swedish Twin Registry and is, with some small exceptions, likely to be representative of women in the Swedish population. The sample included the marital partners of these twins and their adolescent children. Self-report and coded videotapes were a source of information about family process. Results reported in this first report focus on comparability of American and Swedish samples on scales measuring psychiatric symptoms, and on an analysis of genetic and environmental influences on nine measures of mothers' adjustment. Results suggest comparability between the US and Sweden. Genetic influences were found for all measures of adjustment, particularly in the psychological manifestations of anxiety and for smoking. The pattern of findings also underscored the importance of influences unique to each sibling within the twin pair, thus focusing attention on the potential role of marital partners in maternal adjustment. Results also suggested that experiences shared by the twin sisters, experiences unrelated to their genetic similarity, may influence their fearfulness and alcohol consumption. Our model did not include these influences and thus must be amended.

Associations between cerebral blood-flow measured by single photon emission computed tomography (SPECT), electro-encephalogram (EEG), behaviour symptoms, cognition and neurological soft signs in children with attention-deficit hyperactivity disorder (ADHD).

Twenty-eight children with attention-deficit hyperactivity disorder (ADHD) were examined with SPECT (single photon emission computed tomography). Seven of the children had abnormal distribution of the regional cerebral blood-flow (rCBF) on visual evaluation and 10 had abnormal EEG findings. The only clinical finding that differentiated the group with normal from abnormal rCBF was behaviour symptom load. A factor analysis of the rCBF in different regions of interest yielded one factor with low rCBF in the temporal and cerebellar regions and high rCBF in the subcortical and thalamic regions, which was significantly associated with the degree of motor impairment and results on a cognitive test (WISC). Another factor consisting of high rCBF in frontal and parietal regions had a significant negative correlation with the degree of behaviour symptoms. There was a negative correlation between the rCBF in the right frontal regions and the degree of behaviour symptoms. The number of minor physical anomalies (MPA) was negatively correlated to the rCBF in the frontal lobes bilaterally. These results suggest that there may be at least two functional disturbances in ADHD, one specific neurodevelopmentally determined disturbance of the frontal lobes, especially of the right hemisphere, related to behaviour deviance, and another disturbance of the integration of the temporal lobes, the cerebellum and subcortical structures, related to motor planning and aspects of cognition.

Mental health in international adoptees as teenagers and young adults. An epidemiological study.

Sweden has now around 38,000 individuals who have been adopted from other countries. Most often they are transracially adopted and have a different appearance from their new parents--"visible" adoptions. This study was made to explore the mental health of a teenager/young adult group that arrived with their families in the southernmost county of Sweden between 1970 and 1977. They were placed through the largest Swedish adoption agency at that time. One hundred and forty-seven families and their 211 adopted children, who were 13 years of age or older at the time of the investigation, were interviewed in their homes. CBCL, SCL-90, a self-esteem questionnaire, and two family relations inventories were also completed. Compared to nonadopted Swedish young persons of the same ages, who had been investigated with the same inventories in earlier epidemiological studies, the adoptees had as good mental health. The adoptees also reported good self-esteem. The pre-adoption conditions were more important than the age of arrival in itself for the risk of later maladaptation. Family relations, various aspects of identity, and peer relations explained much of the variance of mental health and self-esteem. Those who were most engaged in questions about their identity and felt mostly non-Swedish had more behaviour problems. The association, however, between the factor "Identity" and the mental health variables approached zero for the older subjects (18-27 years of age). The majority (about 90%) of the adoptees felt mostly Swedish. Seventy per cent didn't feel any connection to their country of origin.

Intelligence and behaviour in children born after in-vitro fertilization treatment.

This study is the first to examine a large group of children born after in-vitro fertilization (IVF) who were old enough at the time of the investigation to make it possible to draw conclusions about the outcome. The aim of the study was to assess the cognitive, behavioural and social development of the children. The study comprised 99 IVF children, 33-85 months of age, from the University Hospitals of Lund and Malmö, Sweden. The children's development was assessed with the Griffiths' scales of mental development. The children's behaviour was delineated through semi-structured interviews with their mothers, covering 50 different behaviours. The mothers also filled in Achenbach's Child Behaviour Checklist (CBCL). All children were examined by a paediatric neurologist. The results were compared to Swedish population groups. Of the children born, 66% were singletons, 22% were twins, 12% were triplets and 28% were born prematurely in gestational weeks 32-36. The cognitive development of the IVF children was excellent, and their behaviour was normal when compared with two Swedish population groups. Our conclusion was that the development, behaviour and social adaptation of the children was very satisfactory.

Sense of coherence--a concept influencing health and quality of life in a Swedish psychiatric at-risk group.

We explored the predictive value of individual dispositions hypothesized to be related to coping with stress and to health. The independent variables were Antonovsky's sense of coherence (SOC) and its components--comprehensibility, manageability and meaningfulness. Other independent variables included intelligence, validity (energy level), solidity (flexibility level) and stability (sociability level), locus of control, mastery and ways of coping. The outcome (dependent) variables were measured both by self-rating questionnaires (the Symptom Check List and Quality of Life), by the Health Sickness Rating Scale, and by independent raters using information obtained by in-depth interviews. A group of 148 middle-aged subjects, considered to be at risk for psychiatric disturbances, were drawn from a longitudinal population study in Sweden, the Lundby Study, and investigated in 1988/89. The results indicate that all the independent variables contributed to the variance of the health measures. Stepwise regression indicated that the SOC was by far the best correlate of health and mental well-being.

Coping with life span crises in a group at risk of mental and behavioral disorders: from the Lundby study.

The subjects belong to a prospective, longitudinal population study on mental health, the Lundby study, performed in 1947, 1957 and 1972. In 1988-1989, 148 individuals, then 42-56 years of age, raised in families with at least 3 risk factors for mental or behavioral disorders, were interviewed about their life span coping style. Twenty-two coping mechanisms were rated; optimism, substitution, wishful thinking, problem-solving, planning, self-reliance, humor, acceptance, resignation, social support, comparison with others, religion, catharsis, self-criticism, value reinforcement, alcohol and drug consumption, professional help, endurance, information-seeking, isolating activity, magic and minimizing. Together they contributed statistically significantly to mental health (explained variance 24%) and quality of life (explained variance 28%). Problem-solving, social support and optimism were frequently used and were statistically associated with positive mental health and lower frequencies of some mental disorders. Sense of coherence, a personal disposition factor, was also statistically associated (explained variance 22%) with the combined coping mechanisms.

Intelligence and temperament as protective factors for mental health. A cross-sectional and prospective epidemiological study.

The Sjöbring system of personality dimensions measuring intellectual capacity, activity, impulsivity and sociability was used to study possible "salutogenic" (i.e. causes of health) effects. The study comprised 590 subjects investigated in 1947, 1957, 1972 and 1988-1989 in the Lundby project, an epidemiological study in Sweden. Psychiatric diagnoses were made in 1947, 1957 and 1972. Mental health was estimated in 1988-1989 using the concept "love well, work well, play well and expect well". The Sjöbring dimensions were clinically assessed in 1972. Both in the concurrent study in 1972 and in the prospective study in 1988-1989 "super capacity" (high intellectual function), "super validity" (high activity level) and "super solidity" (low impulsivity) were statistically associated with lower frequencies of certain psychiatric diagnoses and a higher frequency of positive mental health. These variables are proposed to increase coping capacity, and therefore increase stress resilience.

Salutogenic childhood factors reported by middle-aged individuals. Follow-up of the children from the Lundby study grown up in families experiencing three or more childhood psychiatric risk factors.

This study is salutogenic (= causes of health), focusing on factors which corresponded to good mental health in subjects who had been exposed to at least three child psychiatric risk factors when growing up. The material was drawn from a prospective, longitudinal population study on mental health, the Lundby Study, which was performed in three waves in 1947, 1957 and 1972. In 1988/89, 148 individuals then 42-56 years of age, were re-visited and interviewed about their life span experiences. Factors previously found to increase stress resilience in children and adolescents were identified. The personal dispositions during childhood found to be associated with adult positive mental health were childhood positive self-esteem, successful coping, internal locus of control and intellectual capacity. Childhood family factors, such as trusting relations with a parent and shared values, were also important. Antonovsky's sense of coherence model can be used to explain the mechanisms by which the different variables can lead to health through increasing an individual's capacity for comprehensibility, manageability and meaningfulness, the three concepts of sense of coherence.

[Good mental health among adopted children from foreign countries]. / God psykisk hälsa hos utländska adoptivbarn.

All 181 families living in one county in southern Sweden who during the period, 1970-77, adopted children via Adoptionscentrum, the largest adoption agency in Sweden, were invited to take part in a study of mental health and identity development; 152 families (84 percent) accepted, a total of 211 adopted youngsters over 12 years of age thus being included in the study. According to the results of interviews with the parents and self-rating instruments administered to the youngsters, their mental health was good. The results were compared with those of an age-matched group of non-adoptive children who had taken part in an epidemiological study using the same investigative methods. The relevance of family factors and age at adoption is discussed.

Thrombocyte monoamine oxidase activity and behavior deviances in adolescence.

The frequencies of patients with low thrombocyte monoamine oxidase (MAO) activity (defined as having an activity lower than 1 SD below the mean of a respective control group) were studied in 100 consecutive cases admitted to a clinic for child and youth psychiatry. 41 boys and 26 girls (group I) had behavior disorders, attention deficit disorders and/or alcohol and hashish abuse according to DSM III R. 16 boys and 17 girls had other diagnoses (group II). None of the 2 male patient groups differed significantly from the controls. A significantly higher percentage of the girls in group I had low activity of platelet MAO than in the control group (p = 0.015), while the girls in group II did not differ from the controls. Acting out, antisocial behavior and abuse is less accepted in women than in men. Therefore, the girls in the present study might be either more psychiatrically disturbed or have more deviant personalities than the boys, which might explain why our hypothesis about a lower thrombocyte MAO activity in the adolescents with externalizing symptoms (group I) was verified only in the girls.

Childhood vulnerability and adult invincibility.

This study is salutogenic, focusing on the people who cope successfully with the handicapping background of a high-risk childhood. Of those aged 0-15 in 1947 in a total population survey of 2 Swedish parishes, 221 persons with 3 or more childhood psychiatric risk factors were identified. Personal interviews were conducted with 148 of them in 1988-1989. Four measures were used: the Sense of Coherence Scale, the Symptom Distress Checklist, the Quality of Life Scale, and a qualitative overall measure of health status using all interview material. Data analysis focuses on stressing the considerable proportion who managed to overcome their handicapped backgrounds. The sense of coherence is proposed as a powerful explanatory variable in such success.

Epidemiology of mental disorders in young adults of a newly urbanized area in Khartoum, Sudan.

Two hundred and four subjects, 22-35 years old, were selected from a suburban part of Khartoum. They were assessed using the Self-Rating Questionnaire, the Eysenck Personality Inventory, and a Sudanese rating scale of anxiety and depression. Socio-economic information was collected. A psychiatric interview and a medical examination were carried out. It was found that 40.3% had at least one psychiatric symptom, and 16.6% received clinical diagnoses according to DSM-III. The most common diagnoses were depressive illness (neurotic and endogenous) (8.4%) and generalised anxiety (3.4%). Alcohol abuse was very rare (0.4%). There was no sex difference.

A longitudinal study of mental health problems in a suburban population in Sudan.

A psychiatric study of 197 children living in villages outside Khartoum was made in 1964-1965. In 1983, 104 randomly chosen subjects were investigated again. All were interviewed by a psychiatrist and somatically examined. The overall psychiatric impairment was 14% (males, 18%; females, 8%) according to the psychiatric interview; the Self-rating Questionnaire gave a higher figure (28%). The rate of somatic illness was similar: 14% according to the medical doctor, 22% according to the self-rating of the subjects. Childhood data predicted 17% of the variance in adult mental health. Somatic state of health in childhood and traditional type of work by the father were the most important variables. Data from the life situation of the individual explained 67% of the variance in adult mental health.